A shortage of international health workers and delays in building Ebola treatment clinics in west Africa are forcing the UN to change course in fighting the virus, and to call for smaller and more mobile treatment units that make greater use of local staff — and in turn require more money.
The shift comes eight months after the Ebola outbreak in west Africa was identified. The virus is waning in some places and growing stronger elsewhere, and the international response so far has been unable to get the outbreak under control.
The most prominent international efforts have so far been focused on building large treatment centers, but by the time they are completed, they may not be where they are most needed.
Photo: AFP
For example, four 100-bed centers are to open soon in the Liberian capital, Monrovia, where reports of new cases have slowed significantly, while Sierra Leone, where new cases are escalating, is seriously short of treatment centers.
“We need to be more nimble and flexible,” Senior UN System Coordinator for Ebola Anthony Banbury said in an interview.
“Instead of trying to build 100-bed facilities, I believe we need smaller facilities, more geographically dispersed and to rely more on trained national medical professionals to provide the clinical care,” he said.
However, the UN health system is not known for being nimble.
Many health advocates say the UN’s call for help in mid-September was very late and the trust fund that UN Secretary-General Ban Ki-moon established — he asked for US$1 billion in contributions — is still not fully funded.
His special envoy, David Nabarro, a medical doctor who is organizing the UN’s response to Ebola, said recently that an additional US$500 million would be needed to pay for Ebola operations through March.
Nabarro and Banbury are to brief the UN General Assembly today.
The UN’s ability to curb the virus in west Africa is widely seen as a critical test for the organization.
The WHO says that even as 4,700 treatment beds are needed, fewer than one-quarter of that number are in place, chiefly because there are not enough trained doctors and nurses to run Ebola treatment units, known as ETUs.
Civil strife and poverty had crippled healthcare systems in much of west Africa long before the Ebola outbreak began.
The UN says at least 5,000 more healthcare workers will be needed to control Ebola over the next year if the virus continues to spread in the three worst-affected countries.
“Had the international community decided they wanted to send what had been asked for early on — a lot of treatment facilities, with teams to manage them, the ETUs-in-a-box kind of thing — that would have been great,” Banbury said.
“That would have given us better capability on the ground now, and that would have led to a stronger response, but they didn’t,” he said.
Banbury said that in places where concentrated efforts had been made and more precautions were being taken, matters had improved and the spread of the virus had slowed.
Yet the positive effects of practices like safer burials of victims have been hard to measure. The majority of those who are known to have succumbed to Ebola are being buried safely, Banbury said, but it is not known how many victims die without ever coming to the attention of the authorities. Data is sparse.
According to the latest WHO figures, 13,268 cases of Ebola have been reported, the overwhelming majority in Guinea, Liberia or Sierra Leone, and at least 4,960 people have died.
The medical aid group Doctors Without Borders issued a call this week for the training of rapid response teams that could investigate new hot spots and coordinate contact tracing and treatment.
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