The practical challenges of fighting Ebola on the ground

What is now known as the world’s largest Ebola outbreak in history just got worse. According to the latest statistics released Oct. 25 by the World Health Organization, the number of Ebola cases has now crossed the 10,000 mark, with nearly 5,000 recorded deaths. As countries and organizations scramble to find ways to control the Ebola crisis, the international community continues to face mounting criticism about the slowness of its assistance to Liberia, Guinea and Sierra Leone — the three countries most badly hit by the deadly virus. But beyond the obvious gaps in funding, health personnel and equipment — the international response is still a far cry from what it should be — little attention has been paid to the logistical challenges and practical difficulties that continue to hinder global efforts to curtail the West African epidemic. The information flow challenge Many aspects are crucial to contain and overcome epidemics. But in light of the alarming spread of the Western African Ebola outbreak, rapid and accurate flows of information about suspected and confirmed Ebola cases and deaths from the virus are critical to plan an adequate response and reduce vectors of transmission. “The ability to quickly collect information and pass it on is ‘make or break’ in terms of identifying new cases, getting those cases to a treatment facility, establishing contact relationships for tracing, and picking up the bodies of the deceased,” stressed Nicole Walden from the International Rescue Committee. She leads a consortium of five nongovernmental organizations combating Ebola in Monrovia, Liberia. To be accurately collected, however, data requires well-oiled state systems, decent bureaucratic capacities and sizable manpower — all of which are desperately lacking in Guinea, Liberia and Sierra Leone. Stretched to the breaking point, public authorities across the three hardest-hit countries don’t have the capacity to carry out effective Ebola-tracking activities. This is hardly surprising when considering the long sequence of events that needs to unfold to confirm an Ebola case: first, suspected victims need to reach out to a health facility or an emergency team; responders then have to collect samples and relay them to special laboratories, which will be in charge of communicating the results to surveillance teams; finally, confirmed cases have to be reported to the country’s ministry of health. Each step requires proficient collaboration between a multitude of specialized teams — a process that even experienced nonprofit groups find hard to accomplish. “Steep challenges exist in getting teams out in a timely fashion to investigate suspected cases, ensuring that their investigation information is passed on to the teams responsible for following up, and deploying safe transportation to treatment facilities,” Walden said. But amid the fear, ignorance and stigma surrounding Ebola, information flows about the disease aren’t a one way-street — they also have to trickle down from responders to affected communities. But while many organizations focus the bulk of their efforts on public education and awareness-raising, most of them still fail to harness the full potential of traditional community leaders and propose culturally acceptable alternatives for populations to interact, care for the ill and bury the dead. “Communities themselves know how to communicate information about the virus and how to change behaviors in culturally appropriate and acceptable ways,” IRC’s Walden explained. “But, to date, they haven’t been appropriately engaged in developing and leading these efforts at the grass-roots level.” Participatory approaches to social mobilization don’t seem to be a top priority for donors, either. As Debbie Hillier, humanitarian policy adviser at Oxfam Great Britain, recently told Devex, foreign aid continues to focus on the funding of medical activities instead of Ebola prevention. Bottlenecks related to access Another major component of the fight against Ebola is to get trained medical staff, supplies and equipment to the affected region. The example of Cuba is evidence that the international community’s response could be swifter. Despite being an isolated island nation of only 11 million inhabitants, Cuba has already sent a contingent of 165 health care professionals to Sierra Leone and 83 doctors and nurses to Liberia and Guinea. However, efforts to attract more aid workers and health care professionals are hampered by the limited availability of commercial flights and increasingly complex travel bans. By crippling movements to get in and out of the region, these restrictions — which are often accompanied by a quarantine period for aid workers returning home — are said to make potential responders hesitant to apply. “Uncertainty about what’s going to happen upon departure or what medical options are available in-country in case of an emergency, can lend itself to an understandable insecurity that exceeds the threshold for would-be responders,” explained IRC’s Walden. Oxfam’s Hillier believes the problem is further compounded by Western donors’ reluctance to promise potential volunteers that they will be evacuated back home if they get infected with Ebola. Countries like the United States, the United Kingdom and Germany have all been generous in committing money for the construction of Ebola treatment centers, but have not matched their pledges with dedicated efforts to get more medical personnel on the ground. Just a few weeks ago, the British government warned the 800 medical professionals who signed up to volunteer in Sierra Leone that the airlifting of victims would be done on a case-by-case basis. “For some people [a case-by-case basis] is enough, and they would happily sit back and go, but not for other people,” Hillier said. “So we’re in this frustrating situation where we have volunteers, but [can’t push through] just because there’s no guarantee.” Meanwhile, in spite of their growing number and frequency, the U.N. Humanitarian Air Services and U.N.-chartered cargo planes have been facing increasingly rigid and erratic flight clearance procedures from neighboring countries, combined with bad weather conditions. In its latest weekly situation update, the World Food Program — which spearheads the logistics cluster of the U.N. Ebola response — noted that heavy seasonal rains are delaying the offloading of cargo, as well as road and air transport. This is on top of the problems posed by terrestrial access constraints, such as poor infrastructure, border closures and check points. “[In Liberia] a lot has already been made available. However, the main challenge is being able to transport all the materials upcountry, as the road infrastructure is in a bad condition,” noted Alex Gasasira, acting representative for the World Health Organization in Liberia. “In addition, [the] Monrovia airport can only handle one aircraft at any given time, creating delays.” Further, the shortage of vehicles — including ambulance and mortuary pickup trucks — and telecommunications equipment have considerably hampered Western African governments’ ability to respond to the epidemic. This has prompted humanitarian partners to focus on scaling up the countries’ logistical capacities. “A big part of what we do is provide for logistical needs of the county to be able to effectively respond — fuel for their vehicles, repairs of their vehicles, mobile phone credit, stationary and photocopies of essential in-take forms,” Walden highlighted. Coordination is never easy In view of the unprecedented complexities of the current Ebola outbreak, mounting an effective response to the epidemic is, above all, a daunting administrative and operational task. Encouragingly, coordination and decision-making structures are slowly taking shape. “Coordination among partners is improving with strong support from the government at the national and county levels,” Jolene Mullins, Liberia country representative at Project Concern International, told Devex. “Ebola task forces at the national and county levels bring the partners together weekly to discuss their activities and program objectives.” But as the international community ramps up it response, coordination will only become more mind-bending — a situation that many humanitarian groups are wary about given the limited time frame, infrastructure and airspace. “New actors are arriving in-country every day to help, and the calendar of numerous coordination meetings that take place each day is ever-evolving, always with new faces in attendance. [In such a context], actors struggle to stay informed about who is doing what,” Walden from IRC warned. Jenny Lei Ravelo contributed reporting Check out more insights and analysis provided to hundreds of Executive Members worldwide, and subscribe to the Development Insider to receive the latest news, trends and policies that influence your organization.