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The Ebola epidemic, a major threat to Africa

The Ebola epidemic which started in Western Africa last March has become a major threat for the entire continent. Scientists predict that 100,000 people could be infected. The economy, and the freedom of movement of millions of people are also at stake.

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Since its first outbreak, in 1976, in the Equator province of the Democratic Republic of Congo (DRC), the Ebola haemorrhagic fever has never been as murderous as in West-Africa this year. Researchers traced the current outbreak to a two years old child in the Guéckédou prefecture of South-Eastern Guinea-Conakry near the borders with Liberia and Sierra Leone, who died on the 6 December 2013. According to the World Health Organisation (WHO), by the 7 September, 4,366 cases and 2,218 deaths were reported. The most affected country was Liberia (1,186 deaths) followed by Sierra Leone (586) and Guinea-Conakry (324). By then, 21 cases and 8 deaths were also reported in Nigeria and one case and no casualty was reported in Senegal.
A separate outbreak in DRC, had accordingly infected 53 people and caused 31 deaths by early September. The causes of this terrible disease whose symptoms are sore throat, muscle pain, headaches, diarrhea and bleeding both within the body externally, are believed to be the same in both the West-African and the Congolese outbreaks. The virus is transmitted through contact with blood or bodily fluids of an infected animal. Fruit bats and primates are believed to be the carriers, but also porcupines and forest antelopes. Funerary rituals including washing, touching and kissing the dead body also contribute to spread the disease. With no vaccine or specific treatment available so far, Ebola has a 60 % mortality rate. But in Western Africa, the toll is much higher than during previous epidemics. The reason is that this time, the epidemic that could be isolated in remote areas of Gabon and DRC has spread to much more populated and more dense areas.

An international public health emergency

Last August, the WHO declared the epidemic to be an international public health emergency. By mid-August 2014, Doctors Without Borders reported the situation in Liberia’s capital Monrovia as “catastrophic” In all affected countries, the epidemic has also caused a collapse of health services. By then, the outbreak has resulted in more than 120 healthcare worker deaths partly due to the lack of equipment and insufficient training of the medical staff.

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Another reason for the spread of the disease is that since some patients were infected in health centres, in some areas, people do not trust anymore the health system. In early September, the Swiss epidemiologist Christian Althaus from the Bern University warned in an article published by the Science magazine that if the epidemic continues that way in Liberia, the number of cases could rise beyond 100,000 in December. Simultaneously, the WHO came up with a lower but still very high forecast of 20,000 possible cases.
On the 8 September, a University of Oxford research team estimated in article published by Life magazine that up to 20 African countries risk to be contaminated by the epidemic taking into account criteria such as the population of bats, vegetation and temperature which characterize the environment in the areas where the epidemics took place since 1976. Beside affected West-African countries and other countries which experimented previous, (DRC, Congo-Brazzaville, Gabon, Uganda, Côte d’Ivoire and Southern Sudan), the epidemics is accordingly also possible in 12 additional countries with similar conditions. The list includes Angola, Burundi, Cameroon, the Central African Republic, Ethiopia, Ghana, Madagascar, Malawi, Mozambique, Rwanda, Tanzania and Togo. According to the Oxford University team, at least 22 million people are living in areas where the transmission is possible.

The economies of affected countries

Beside the human cost, the epidemic has also hit the economies of affected countries where it has not only disrupted the health system but also the trade and the freedom of movement of citizens and the humanitarian personnel. Several countries closed indeed their borders and several airlines have decided to suspend their flights to West-African destinations after their pilots refused to land there. The list includes Emirates, Air France and British Airways, whereas the last remaining companies, namely Brussels Airlines and Royal Air Maroc which operate flights to Freetown or Monrovia to raise their tariffs outrageously. Other restrictive measures were taken by China which prohibited African athletes to participate to the Youth Olympic games, by Saudi Arabia which stopped issuing visas for Guinean, Sierra Leonese and Liberian muslims who wish to participate to the hajj pilgrimage in October and by the Universal Postal Union which cancelled a conference scheduled for October in Abidjan
By end of August, Botswana closed its border with Zambia to 100 trucks transporting copper from the DRC.

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Sierra Leone will likely miss its target of exporting diamonds worth US $ 200 million, because of the disorganization caused by the Ebola outbreak, including the repatriation by some mining companies of their expatriate staff. On the last 8 August, Arcelor Mittal announced it had put on hold the development of an iron mine in Liberia. Firestone which owns the largest rubber plantation in the world registered a production loss after the quarantine on the 20 August of the Dolo Town where most of its employees are living. Movement restrictions in Liberia, Guinea and Sierra Leone have also disorganized the food markets and production, causing prices hikes owed to panic purchases of staples reports the Food Agricultural Organization (FAO) which warned in early September against the intensification of food insecurity in the forthcoming months. In Monrovia for instance, the cassava price rose by 150 percent at the beginning of August. The Sierra Leone government is anticipating a 4 percent fall of the GDP growth rate, down from 11.3 percent to 7 percent. “Revenues are down, foreign exchange levels are down, markets are not functioning, airlines are not coming in, projects are being cancelled, business people have left – that is very, very damaging,”, deplored the chairman of the African Development Bank, Donald Kaberuka.

From bad to worse

The response to the crisis has not been strong enough, complained the European Commissioner for Humanitarian Affairs, Kristalina Georgieva at a hearing on the crisis at the EU parliament in Brussels, on the 3 September. “The situation is going from bad to worse, despite the brave efforts of humanitarian organisations and despite early and substantial assistance provided by the international community”, she said. The EU allocated first EUR 11.9 million to the epidemic response, supporting the WHO, Doctors without Borders and the Red Cross. It deployed humanitarian experts, and mobile laboratories on the ground to for the detection of the virus and training health workers.

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On the 5 september 2014, the European Commission announced EUR 140m of funding for the countries affected by the Ebola virus including EUR 38 million to help the governments bolster their health services, through reinforcing treatment centres or support for health workers, both during the crisis and in the recovery phase. The package included EUR 97.5 million of budget support to Liberia and Sierra Leone, to reinforce governments’ capacity to deliver public services and macro-economic stability.
Like the WHO and humanitarian NGOs, the EU Commission considers that measures aimed at isolating affected countries will only exacerbate the situation. Indeed, says the Commission, air transport is essential to maintain connections between the affected countries and the outside world to tackle the epidemic effectively, notably for the free circulation of health workers or for medical evacuation. Suspension of flights, absence of traffic rights granted for air ambulances for example, are all hampering efforts to solve the situation. Limited access to some areas in the affected countries also complicates the registration and isolation of patients, accordingly.
In August, the International Monetary Fund was considering to expand its financial support to the three most affected countries while President Barrack Obama announced on the 16 September a deepening of U.S. involvement in combating the Ebola crisis, including the deployment of 3,000 troops to coordinate international aid, build 17 treatment centres each with 100 beds and train 500 health-care workers per week. Meanwhile, Malaysia announced that it will send 20 million medical rubber gloves to Africa. On the medical front, scientists expect that an experimental vaccine found by the US National Institute of Allergy and Infectious Diseases that was tested in September could provide a valid immune response and help stop the epidemic. But time is running short…

François Misser

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