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EBOLA OUTBREAK VASTLY UNDERESTIMATED, WHO SAYS



Agencies call for global response as WHO admits extraordinary measures are needed to
contain disease amid rampant fear

The magnitude of the Ebola outbreak in west Africa, which has killed more than 1,000
people, has been vastly underestimated and will require extraordinary measures, on a
massive scale if it is to be contained, theWorld Health Organisation has warned.

The admission came as Mdecins sans Frontires (MSF), the medical charity, said the disease
was spreading faster than we can respond to, and accused the WHO of being too slow to
react.

The outbreak, which is the worst to date, has killed 1,069 people, with 1,975 cases recorded
in Guinea, Liberia, Sierra Leone and Nigeria. However, the WHO fears the figures are
unreliable.

Staff at the outbreak sites see evidence that the numbers of reported cases and deaths vastly
underestimate the magnitude of the outbreak, it said.

WHO is coordinating a massive scaling up of the international response, marshalling
support from individual countries, disease control agencies, agencies within the UN system,
and others.

It was using practical, on-the-ground intelligence to map the outbreak, pinpoint the areas of
ongoing transmission, and decide where health workers and new isolation facilities were
most needed.
The WHO said the US Centres for Disease Control and Prevention were equipping the
hardest-hit countries with technology to enable real-time reporting of cases and analysis of
trends.

Efforts are under way to help those trapped in quarantined areas, with the World Food
Programme seeking to deliver food to more than 1 million people trapped on the borders of
Guinea, Liberia and Sierra Leone.

Such steps, said the WHO, had been taken in recognition of the extraordinary measures
needed, on a massive scale, to contain the outbreak in settings characterised by extreme
poverty, dysfunctional health systems, a severe shortage of doctors and rampant fear.

Ernest Bai Koroma, Sierra Leones president, painted a stark picture of the outbreak in the
country with the highest death toll, admitting that the governments initial response had been
too slow but saying more help could have come from countries with greater resources and
expertise.
After observing a minutes silence in memory of those who died, a sombre-looking president
said:I wasnt happy with the response because we have all been slow, and this is a crisis that
requires quick action in terms of response. What we can do as a government, I believe we
have done. We look forward to the international community to increase their response.

This is a call were now making to the world because we need treatment centres. And in the
treatment centres, we need clinicians that require specialised training. We dont have that.
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And if people are dying the response should be an extraordinary response. We must limit
bureaucracy.

Sierra Leone, which has no labs capable of testing for the virus, had received less than $2m in
direct international funding, Koroma said, although millions more had been channelled
through aid organisations.

MSF, which warned almost a month ago that the outbreak was already out of control,
issued a bleak assessment of the situation on Friday.
It is deteriorating faster and moving faster than we can respond to, said Joanne Liu,
MSF international president. It is like wartime.
Speaking at a press conference in Geneva, Liu criticised the WHO for not declaring the
outbreak an international public health emergency until 8 August, adding: I think the wake-
up call was too late.

Now that a common understanding had been reached, she said, the world needed to see
concrete action in the field.
If we dont stabilise Liberia, we will never stabilise the region, she told Reuters. Over the
next six months we should get the upper hand on the epidemic; this is my gut feeling.

Lius warning was echoed by Dr Unni Krishnan, Plan Internationals head of disaster
preparedness and response, who said a decisive moment had been reached in the battle
against the disease.

Time is running out fast and millions of lives are at stake, he said. Turning the tide of this
deadly disease is now the collective responsibility of the world.

The best way to deal with the outbreak and prepare for future ones, Krishnan added, was to
invest in public health systems and improve the care of infected people.

Although some airlines have suspended flights to parts of west Africa, the WHO has stressed
that the danger posed to air travellers remains low.

Unlike infections such as influenza or tuberculosis, Ebola is not airborne, said Dr Isabelle
Nuttall, WHOs director of global capacity alert and response. It can only be transmitted by
direct contact with the body fluids of a person who is sick with the disease.

Nuttall said the risk of Ebola transmission on flights was so low that the WHO did not
consider airports to be a particular danger.

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