Violence against women rises in Ebola-hit nations: ministers

UNITED NATIONS (Thomson Reuters Foundation) - The Ebola epidemic in West Africa exacerbated violence against women and rolled back access to reproductive healthcare in the region, ministers from Guinea and Liberia said on Wednesday.

In Guinea, data indicates a 4.5 percent increase in cases of gender-based violence since before the epidemic including twice as many rapes, Sanaba Kaba, the country's minister of social action, women and children, said on a panel at the United Nations 59th Commission on the Status of Women.

Liberia also saw more cases of gender-based violence as a result of the outbreak, said Julia Duncan Cassell, minister of gender and development in that country.

She said some men were not respecting the recovery protocol that Ebola survivors should observe and were infecting their spouses and female partners through unprotected sex.

Sierra Leone also has seen an increase in violence against women, said panel moderator Awa Ndiaye Seck, Liberian country representative for UN Women, the agency responsible for gender equality and women's empowerment.

The death toll from West Africa's Ebola outbreak has passed 10,000, according to the latest tally released by the World Health Organization.

Guinea has suffered a setback in its fight against Ebola with a rash of new cases, while Liberia released its last patient earlier this month.

The deadly virus has put a considerable strain on reproductive health services, which are still recovering, and chipping away at health gains made before the epidemic, the ministers said.

Kaba of Guinea said that during the outbreak there was a significant drop in the number of women seeking prenatal consultations and a 7 percent to 10 percent decrease in those seeking delivery of their babies - all of which are provided free of charge in Guinea.

As Ebola raged in the region, people turned away from health clinics that they saw as places of possible infection.

At times, pregnant women who were courageous enough to go to a clinic would find that healthcare workers had fled for fear of infection, experts said.

Deliveries usually involve a large amount of bodily fluids, through which the deadly virus spreads.

WOMEN BEAR BRUNT OF EBOLA

Women have been more affected by the deadly virus than men, with an infection rate of 56 percent compared to 44 percent for men, said Ndiaye Seck of UN Women.

This is largely due to the fact that many of the health workers providing care for Ebola victims are female, and women are also most likely to look after sick relatives at home, according to the United Nation's Children Fund (UNICEF).

Women accounted for 40 percent of the total Ebola death toll in Liberia, Guinea and Sierra Leone, the three most directly affected nations, said Duncan Cassell of Liberia.

Another devastating effect of the epidemic was the economic disruption it caused, the ministers said.

The economic impact of the disease on women, who are the majority of smallholder farmers, was greatest in rural areas. There was a dramatic drop in food production due to death and sickness among farmworkers or their fear of leaving home to tend fields.

(Reporting by Maria Caspani, Editing by Lisa Anderson)

Struggling Liberia creates 'plague villages' in Ebola epicenter

#GNN Health - To try to control the Ebola epidemic spreading through West Africa, Liberia has quarantined remote villages at the epicenter of the virus, evoking the "plague villages" of medieval Europe that were shut off from the outside world.

With few food and medical supplies getting in, many abandoned villagers face a stark choice: stay where they are and risk death or skip quarantine, spreading the infection further in a country ill-equipped to cope.

In Boya, in northern Liberia's Lofa County, Joseph Gbembo, who caught Ebola and survived, says he is struggling to raise 10 children under five years old and support five widows after nine members of his family were killed by the virus.

Fearful of catching Ebola themselves, the 30-year-old's neighbors refuse to speak with him and blame him for bringing the virus to the village.

"I am lonely," he said. "Nobody will talk to me and people run away from me." He says he has received no food or health care for the children and no help from government officials.

Aid workers say that if support does not arrive soon, locals in villages like Boya, where the undergrowth is already spreading among the houses, will simply disappear down jungle footpaths.

"If sufficient medication, food and water are not in place, the community will force their way out to fetch food and this could lead to further spread of the virus," said Tarnue Karbbar, a worker for charity Plan International based in Lofa County.

Ebola has killed at least 1,145 people in four African nations, but in the week through to August 13, Lofa county recorded more new cases than anywhere else - 124 new cases of Ebola and 60 deaths.

The World Health Organization and Liberian officials have warned that, with little access by healthcare workers to the remote areas hidden deep in rugged jungle zones, the actual toll may be far higher.

WHITE SHIELD
In the ramshackle coastal capital Monrovia, which still bears the scars of the brutal 14-year civil war that ended in 2003, officials say controlling the situation in Lofa is crucial to overcoming the country's biggest crisis since the conflict.

With her country under threat, President Ellen Johnson Sirleaf has imposed emergency measures including the community quarantine and a "cordon sanitaire" -- a system of medical roadblocks to prevent the infection reaching cities, widely used against the Black Death in Medieval times.

Troops have been deployed under operation "White Shield" to stop people from abandoning homes and infecting others in a country where the majority of cases remain at large, either because clinics are full or because they are scared of hospitals regarded as 'death traps'.

A crowd attacked a makeshift Ebola quarantine center in Monrovia on Saturday, throwing stones and looting equipment and food, and, according to one health worker, removing patients from the building.

"There has to be concern that people in quarantined areas are left to fend for themselves," said Mike Noyes, head of humanitarian response at ActionAid UK. "Who is going to be the police officer who goes to these places? There's a risk that these places become plague villages."

Aid workers say the virus reminds them of the forces roaming Liberia during the civil war, making it a byword for brutality.

"It was like the war. It was so desolate," said Adolphus Scott, a worker for U.N. child agency UNICEF describing Zango Town in the jungles of northern Liberia, where most of the 2,000 residents had either died of Ebola or fled.

Elderly people sat in the doorways of their homes, gazing at a dirt street empty but for a few roaming goats and skinny chickens, he said. "Ebola is like a guerrilla army marauding the country."

HEALTHY AT RISK
The Ebola virus, never previously detected in poverty-racked West Africa, is carried by jungle mammals like fruit bats. It is thought to have been transmitted to the human population via bush meat as early as December in remote southeastern Guinea.

Initial symptoms like fever and muscular pains are difficult to distinguish from other tropical illnesses such as malaria, meaning the outbreak was not detected til March. By the late stages of the disease, victims are at their most contagious, bleeding from eyes and ears, with the virus pouring out of them.

Countries like Uganda in east Africa have tackled previous rural outbreaks through online reporting systems and rigorous surveillance, said Uganda's Director of Community and Clinical Services Dr. Anthony Mbonye. But in the West of the continent, weak healthcare systems were unprepared.

Liberia, one of the world's least developed nations, has poor Internet and telecommunications, and only around 50 doctors for a population of over 4 million. Traditional funerals, where family members bathe and dress highly contagious corpses, have expedited Ebola's spread to 9 of the country's 15 counties.

In recognition of the region's inability to cope, the World Health Organization this week declared Ebola an international health emergency - only the third time in its 66-year history it has taken this step.

Neighbors Guinea and Sierra Leone have placed checkpoints in Gueckedou and Kenema, creating a cross-border quarantine zone of roughly 20,000 square km, about the size of Wales, called the "unified sector".

Within this massive area, Information Minister Lewis Brown described more intense quarantine measures in Lofa county, ring fencing areas where up to 70 percent of people are infected.

"Access to these hot spots is now cut off except for medical workers," he said in an interview this week.

Reaching the sick in isolated villages there is critical because the county's main Foya health center is full. The site was run by U.S. charity Samaritan's Purse until it pulled out after two of its health workers contracted the virus in Monrovia.

Medical charity MSF, which has now stepped in, says 137 patients are packed into the 40-bed site.

Health workers hope to train locals to create isolation units in schools and churches within their own communities.

"Quarantines expose healthy people to risk - which is why the effectiveness of states is so important in supporting preventive measures that will minimize this," said Robert Dingwall, specialist in health policy responses to infectious diseases at Nottingham Trent University.

Such measures include prevention education, crematorium facilities and protective equipment, he said.

ISOLATED
But Liberia's response team is struggling to keep up.

The main health care center in Lofa is "overwhelmed" by new patients, a health ministry report said. A total of 13 health care workers have already died from Ebola in the county while its surveillance office lacks computers to manage cases.

Liberia's Brown also acknowledged the risk: "We can establish as many checkpoints as we want but if we cannot get the food and the medical supplies in to affected communities, they will leave."

Even if the resources arrive, help might be chased away.

Unlike in other areas of the country, where Ebola awareness campaigns are helping to draw people out of hiding, in this isolated border region, far from the otherwise ubiquitous 'Ebola is Real' government billboards, denial is still strong.

According to a local rumor, merchants dressed as health workers are taking people away in order to sell human organs, provoking violent reactions from locals, Karbarr said.

In late July, an ambulance was stoned in the Kolahun district as it tried to take a body for burial. In the same area, a group of hand pump technicians were told to leave or have their vehicle torched. The police arrested a man this week for Ebola denial.

SUPPLY DISRUPTIONS
Brown said that people in unaffected counties in Liberia's east have so far welcomed the quarantine, but sentiment could swing if supplies start to run short.

The Italian roots of the word quarantine - meaning 40 days - refers to the isolation period for ships arriving into Venice from plague regions. But Liberia's operation could go on for three months or more, creating the need for a long-term plan.

As well as increasing the feelings of isolation and criminalisation felt by those in quarantine, the duration of the quarantine risks creating national supply disruptions. Already the price of oil and rice has doubled, residents say.

While those in Lofa are located within the country's sweet potatoes and palm fruit-growing food belt, the unaffected eastern counties cannot feed themselves.

The World Food Programme intends to distribute food to more than 1 million people living in the cross-border quarantine zone, but there are not yet plans for the unaffected counties.

"My worry is how the southeast will get food. You could have trade with Ivory coast but they might not want to for fear of the virus," said UNICEF'S Scott, referring to the landlocked River Gee and Maryland counties.

The early signs suggest this is happening already.

Aboubacar Barry, who sells rice and sugar in the Ivorian town of Danane, says his business is a fifth of what it was before the de facto closure of the Liberian border.

Yacouba Sylla, the driver of a motorbike taxi in the border area, also complained of a slump in his business.

"Ebola hasn't arrived here, but it is going to kill us anyway before it gets here, as we will die of hunger," he said.

(GNN)(Reuters)(Additional reporting by Ange Aboa in Ivory Coast, Alphonso Toweh in Washington, Daniel Flynn in Dakar, Elias Biryabarema in Kampala; editing by Philippa Fletcher)

#WHO declares Ebola epidemic an international #health #emergency

#GNN - West #Africa's #Ebola epidemic is an "extraordinary event" and now constitutes an international health risk, the World Health Organization (WHO) said on Friday.

 The Geneva-based U.N. health agency said the possible consequences of a further international spread of the outbreak, which has killed almost 1,000 people in four West African countries, were "particularly serious" in view of the virulence of the virus.

"A coordinated international response is deemed essential to stop and reverse the international spread of Ebola," the WHO said in a statement after a two-day meeting of its emergency committee on Ebola.

The declaration of an international emergency will have the effect of raising the level of vigilance on the virus.

"The outbreak is moving faster than we can control it," the WHO's director-general Margaret Chan told reporters on a telephone briefing from the WHO's Geneva headquarters.

"The declaration ... will galvanize the attention of leaders of all countries at the top level. It cannot be done by the ministries of health alone."

The agency said that, while all states with Ebola transmission - so far Guinea, Liberia, Nigeria and Sierra Leone - should declare a national emergency, there should be no general ban on international travel or trade.

"THIS CAN BE STOPPED"
Ebola has no proven cures and there is no vaccine to prevent infection, so treatment focuses on alleviating symptoms such as fever, vomiting and diarrhea - all of which can contribute to severe dehydration.

Keiji Fukuda, the WHO's head of health security, stressed that, with the right measures to deal with infected people, the spread of Ebola - which is transmitted through direct contact with bodily fluids - could be stopped.

"This is not a mysterious disease. This is an infectious disease that can be contained," he told reporters. "It is not a virus that is spread through the air."

Fukuda said it was important that anyone known to have Ebola should be immediately isolated and treated and kept in isolation for 30 days. "Based on scientific studies, people who have infection can shed virus for up to 30 days," he said.

The current outbreak, in which at least 1,711 people have so far been infected, of whom 932 have died, is the most severe in the almost 40 years since Ebola was identified in humans.

The WHO said this was partly because of the weakness of the health systems in the countries currently affected, which lacked human, financial and material resources.

It also said inexperience in dealing with Ebola outbreaks and misperceptions of the disease, including how it is transmitted, "continue to be a major challenge in some communities".

"If we do not in global solidarity come together to help these countries, they will be set back for many years," Chan said. She noted the three hardest-hit nations had only begun to emerge and rebuild after "years of conflict and difficulties".

Although most cases of Ebola are in the remote area where Guinea borders Sierra Leone and Liberia, alarm over the spread of the disease increased last month when a U.S. citizen died in Nigeria after traveling there by plane from Liberia.

After an experimental drug was administered to two U.S. charity workers who were infected in Liberia, Ebola specialists urged the WHO to offer such drugs to Africans. The U.N. agency has asked medical ethics experts to explore this option next week. [ID:nL6N0QB5UH]

David Heymann, a former WHO official and now director of the Chatham House Centre on Global Health Security, who this week urged the WHO to show greater leadership and to consider allowing the use of experimental drugs for Africans affected by Ebola, said governments should step up their response.

The major message, he said, was that the three known measures that stop Ebola outbreaks – hospital infection control, community understanding of risks of infection, and contact tracing - "appear not to have been robustly enough applied".

"Governments appear to not have been engaged as necessary," he said in an emailed response to the WHO's statement.

(GNN)(Reuters)(AIP)(Reporting by Kate Kelland, additional reporting and editing by Kevin Liffey)

Nigeria isolates hospital in Lagos as Obama briefed on Ebola outbreak

#GNN - The #Nigerian city of Lagos shut and quarantined a hospital on Monday where a Liberian man died of the Ebola virus, the first recorded case of the highly-infectious disease in Africa's most populous country.

Patrick Sawyer, a consultant for Liberia's Finance Ministry in his 40s, collapsed on arrival at the Lagos airport on July 20. He was put in isolation at the First Consultants Hospital in Obalende, one of the most crowded parts of a city that is home to 21 million people. He died on Friday.

"The private hospital was demobilized (evacuated) and the primary source of infection eliminated. The decontamination process in all the affected areas has commenced," Lagos state health commissioner Jide Idris told a news conference. He said the hospital would be closed for a week and the staff would be closely monitored.

Ebola has killed 672 people in Guinea, Liberia and Sierra Leone since it was first diagnosed in February. The fatality rate of the current outbreak is around 60 percent although the disease can kill up to 90 percent of those who catch it. Highly contagious, its symptoms include vomiting, diarrhea and internal and external bleeding.

In Sierra Leone, which has the highest number of Ebola cases in the current outbreak at 525, President Ernest Bai Koroma visited an Ebola center in the northeastern district of Kenema.

An administration official said President Barack Obama was receiving updates, and noted that U.S. agencies had stepped up assistance to help contain the virus.

Susan Rice, Obama's national security adviser, said in a televised interview on Monday the outbreak was of "grave concern."

"We are very much present and active in trying to help the countries of the region and the international authorities like the World Health Organization address and contain this threat. But it is indeed a very worrying epidemic," Rice told MSNBC.

HOSPITAL STAFF, OTHERS MONITORED
Authorities were monitoring 59 people who were in contact with Sawyer, including airport contacts, the Lagos state health ministry said, but it said the airline had yet to provide a passenger list for the flights Sawyer used.

Derek Gatherer, a virologist at Britain's University of Lancaster, said anyone on the plane near Sawyer could be in "pretty serious danger," but that Nigeria was better placed to tackle the outbreak than its neighbors.

"Nigerians have deep pockets and they can do as much as any Western country could do if they have the motivation and organization to get it done," he said.

Nigeria's largest air carrier Arik Air has suspended flights to Liberia and Sierra Leone because of the Ebola risk, Arik spokesman Ola Adebanji said in an email on Monday.

"RED ALERT"
David Heymann, head of the Centre on Global Health Security at London's Chatham House, said every person who had been on the plane to Lagos with Sawyer would need to be traced and told to monitor their temperature twice a day for 21 days.

The World Health Organization said in a statement that Sawyer's flight had stopped in Lomé, Togo, on its way to Lagos.

"WHO is sending teams to both Nigeria and Togo to do follow- up work in relation to contact tracing, in particular to contacts he may have had on board the flight," spokesman Paul Garwood said.

Liberia closed most of its border crossings and introduced stringent health measures on Sunday, a day after a 33-year-old American doctor working there for the relief organization Samaritan's Purse tested positive for Ebola.

Nigeria's airports, seaports and land borders have been on "red alert" since Friday over the disease.

Exacerbating the difficulty of containing the virus, Nigerian doctors are on strike over conditions and pay.

The WHO said that in the past week, its regional director for Africa, Luis Sambo, had been on a fact-finding mission to Guinea, Liberia and Sierra Leone, which have 1,201 confirmed, suspected and probable cases among them.

"He observed that the outbreak is beyond each national health sector alone and urged the governments of the affected countries to mobilize and involve all sectors, including civil society and communities, in the response," the WHO said.

(GNN,Reuters,AIP)(Reporting by Tim Cocks, additional reporting by Oludare Mayowa in Lagos, Tom Miles in Geneva, Kate Kelland in London, Roberta Rampton in Washington, and Umaru Fofana in Freetown; writing by Toni Reinhold, editing by G Crosse)

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#Liberia shuts border crossings, restricts gatherings to curb Ebola spreading

#GNN - The Liberian government on Sunday closed most of the West African nation's border crossings and introduced stringent health measures to curb the spread of the deadly Ebola virus that has killed at least 660 people across the region.

The new measures announced by the government on Sunday came as Guinea, Liberia and Sierra Leone struggle to contain the worst outbreak yet of the virus.

Speaking at a task force meeting, Liberia President Ellen Johnson Sirleaf said the government is doing everything to fight the virus including inspecting and testing all outgoing and incoming passengers by Liberia's airport authority.


"All borders of Liberia will be closed with the exception of major entry points. At these entry points, preventive and testing centers will be established, and stringent preventive measures to be announced will be scrupulously adhered to," she said.

Ebola can kill up to 90 percent of those who catch it, although the fatality rate of the current outbreak is around 60 percent. Highly contagious, especially in the late stages, its symptoms include vomiting and diarrhea as well as internal and external bleeding.

Under the new measures, public gatherings such as marches, demonstrations and promotional advertisements also will be restricted.

The outbreak has placed a great strain on the health systems of some of Africa's poorest countries.

"No doubt, the Ebola virus is a national health problem. And as we have also begun to see, it attacks our way of life, with serious economic and social consequences," Sirleaf said in a statement.

Still, despite efforts to fight the disease, the virus continues to spread. A 33-year-old American doctor working for relief organization Samaritan's Purse in Liberia tested positive for the disease on Saturday.

The charity said on Sunday a second American, who was helping a team treating Ebola patients at a case management center in Monrovia had also tested positive.

Samuel Brisbane, a senior Liberian doctor, who was also treating infected patients has died after contracting the virus, authorities said on Sunday. In Nigeria's commercial capital Lagos, a Liberian man who tested positive died in on Friday.

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