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LIBERIA: Ebola Outbreak Situation Report No LIBERIA: Ebola Outbreak Situation Report No. 12 24 - 30 November 2014 This weekly report is produced by the office of the UNMEER Ebola crisis manager in Liberia with the support of the Office of the Resident Coordinator. It covers all Ebola response efforts undertaken by the government and humanitarian actors in Liberia. Highlights A survey done by the National Dead Body Total Patients in Ebola Treatment Units – 22/10 – 26/11 Management sub-committee reveals that throughout October, 85% of bodies were 400 collected from ETUs, 14.7% from 350 communities and 0.3% abandoned. It also indicates that secret burials are on the 300 decline, thus partly explaining the current flat line epidemiological trend in Greater 250 Monrovia area. 200 Some 20 suspected EVD patients from Rock 150 Hill Community, Montserrado County have been taken at MSF ETU at ELWA after 100 coming in contact with an Ebola patient who Total patients died later. 50 The Supreme Court of Liberia has issued a 0 stay order to the Election slated for 16 December after two Political Parties (Movement for Progressive Change and National Democratic Coalition) filed a lawsuit on the holding of elections amidst the Ebola crisis. Situation Overview 73 117 20 5 16 ˃ 50% Laboratory Total patients under Average new Critical items in December routine health confirmed cases treatment as of 28 admissions per day short supply (incl. Date of Senatorial services operational 22-28 Nov November PPE hoods, aprons) Elections country-wide Acquisition by the Government of a plot to be used as a National Cemetery has been completed. This is a critical step towards a safe burials system without requiring the culturally unaccepted cremation practice. Proper messaging to the population on this topic can now start. For this week, media reported that 377 people have been quarantined in five district in Grand Cape Mount County including Tewor, Porkpa, Garwula, Commonwealth and Gola Konneh for allegedly coming in contact with some suspected EVD patients. Like Montserrado, Grand Cape Mount remains one for the main focuses of EVD since the second outbreak. Several family members from Boesan Town were admitted at the Island Clinic and MOD1 ETUs after been infected by the father who attended a funeral in Bendaja Town, Porkpa District. Human Right Protection Service of Montserrado reported a new surge of Ebola on 27 November, at the Rock Hill community, Paynesville, with up to 20 suspects who came in contact with a dead man from Ebola and have since been taken to the MSF ETU at ELWA. MSF continues to provide support to the Redemption Hospital to separate suspected EVD cases from other patients. Meanwhile, MSF opened a new Ebola Transit Point in New Kru Town, Bushrod Island, Monrovia aimed to initially confirm suspected cases in the immediate vicinity before referral of positive ones at the ETUs. HUMANITARIAN RESPONSE Health Needs: Trends show ongoing transmission; indicating a need to continue and strengthen response efforts especially during the holiday season and election period. Active case finding, early isolation and referral to treatment centres is essential and needs to be tied to contact tracing and preventative measures into the district level Increase access to laboratories in terms of personnel and access to ensure effective turnaround of results will aid in case identification and resource allocation. Restoration of health services needs to be stepped up to ensure a smooth transition from EVD response to routine health services. This requires effective triage, PPE and risk communication. Response: Active surveillance and contact tracing scale-up is proceeding Rapid Isolation and Treatment of Ebola (RITE) strategy is being rolled-out by the MoH; requesting support from partners Training of health workers on case management and management of ETUs is ongoing with efforts to scale-up ‘hot’ zone training Additional case investigators have been trained in Montserrado County and will operate from the ETUs to assure all cases are captured and followed The Infection Prevention and Control Task Force held a two-day workshop for IPC partners on experience sharing, a review of partner activities and SOPs, and IPC activity planning Incinerators are being installed in a number of ETUs for solid waste management; this is a long technical process in order not to damage the units. A plan to remove sludge from ETUs is also underway awaiting tanker trucks, training and final approvals UNICEF is supporting CCC opening with supplies as well as supplies to revitalize routine vaccination Liberian Red Cross safe burial teams are collecting oral swab samples of all deceased patients in Montserrado County to identify the cause of death, and Global Communities has begun expanding the program to other counties A Montserrado County IMS unit has been established at the EOC. Gaps and Constraints: Potential for increasing risk as the population begins to think that Ebola is ‘over’ or ‘gone; social mobilization efforts must continue over the holiday season. Limited sub-national capacities and access at the county and district level to enable swift delivery of a systematic rapid response for early isolation treatment and preventative measures. Food distribution to quarantined persons and communities continues to be cited as a gap and as a reason for people to not accept to be quarantined. Transport and communications means remain significant challenges for those working in remote areas. Resistance from communities in some areas, in particular Grand Cape Mount, is hampering the work including contact tracing, dead body management and case investigation. Only 44% of routine health services are reported by the MOH as operational, despite a large number listed as “open”, due largely to a lack of PPE supplies and triage mechanisms to ensure the infection prevention and control. Nutrition Needs: Nutritional support for Ebola patients during treatment and for convalescent patients. Nutritional support for infants and young children from Ebola-affected households. Train health workers nationwide on the modified nutrition protocols including training of gCHVs on visual active screening in the community. Timely identification, screening, referral and treatment of severely malnourished children. Prevention and control of micronutrient deficiencies through routine vitamin A supplementation of children under five in health facilities. Response: Nutrition Cluster provided mentoring and supervision support to County Nutrition Supervisors in Lofa and Nimba counties in collaboration with Pentecostal Mission United (PMU) and Project Concern International (PCI). Through a partnership with Save the Children, technical guidance on nutrition was provided to clinicians in the newly opened CCC in Margibi. UNICEF donated a wide range of drugs and supplies to run the CCC, including specialized products to improve the nutritional intake of patients. UNICEF supported five infants who lost one or both parents placed in kinship and foster care in Bomi County with 760 bottles of replacement feeding following the recently endorsed national EVD infant and young child feeding guidelines. Gaps and constraints: Inadequate funding to support training, operations and monitoring of nutrition activities on the reactivation of primary health care facilities and services. There is limited number of trained nutritionists (national and international) managing the nutritional care process in treatment centres. Water Sanitation and Hygiene (WASH) Needs: As per request of Health Coordination Committee, WASH Cluster needs to organize a rapid assessment on WASH elements in each health facility in all counties. This is to support restoration of regular health services in addition to ETUs. Subnational coordination is a key element to the WASH response in ETUs/CCCs. WASH coordination focal persons’ names and contacts are available in the Liberia WASH group website and all humanitarian actor are requested to be in touch with them and the cluster at Monrovia level for WASH assessment and other technical support. Collection and safe disposal of infectious solid waste from ETUs/Health facilities and communities remain a challenge. Operation and maintenance of WASH facilities in Ebola Care Centre including solid infected waste management sludge treatment, monitoring of WASH services, testing chlorine concentration is a challenge for the cluster to organize with the support of partners especially concerned departments in Monrovia and country administration in each county. Provision of WASH facilities in Health Centres to support the essential health services in the country to ensure that Infection Prevention and Control procedures can be maintained in all health facilities. Solid Infectious Waste Management projects in urban and rural areas, to ensure that waste is handling safely until its final disposal As the schools are opening assessment and provision of WASH facilities will be a priority to ensure installation of facilities. Humanitarian leaders are requested to take note of this urgent matter. WASH Cluster request all concerned that WASH minimum requirement is ensured in all Ebola and non- Ebola health facilities and schools for safety and prevention of Ebola and other water/sanitation related diseases. Response: WASH Cluster in collaboration with Health Sector has agreed to carry out an assessment on WASH facilities in 667 health facilities in the country. At the same time WASH Cluster also intends to add schools for the same
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