Saturday August 9, 2014 - The WHO has said the apparent - that the Ebola outbreak is now an international threat, but as one aid agency noted, words alone are not enough. Action on the ground is what is sorely needed in the battle to contain the beast. Danger warnings - the aftermath of trying to quarantine the two districts of Kailahun and Kenema.

The World Health Organization on Friday August 8, 2014 declared the Ebola epidemic ravaging Sierra Leone, Liberia and Guinea an international health emergency and appealed for global aid to help afflicted countries. One report says the WHO stopped short of calling for global travel restrictions, urging airlines to take strict precautions but to continue flying to the west African countries hit by the outbreak. WHO Director-General Margaret Chan has also called on countries around the globe to be prepared to "detect, investigate and manage" Ebola cases if they should arise while appealing for greater help for those worst hit by the "largest, most severe and most complex outbreak in the nearly four-decade history of this disease."

However before delving into the ramifications of this WHO pronouncement, we have to get to grips with the decision of the government of the rat to quarantine two districts - Kailahun and Kenema. This in itself on paper sounds good but it is the implementation, the modus operandi of such an ideal that worries us given the security forces and their penchant for punishing, harassing and intimidating civilians. And yes they do call them "bloody civilians" whenever there's interaction between the two.

The Chinese News Agency Xinhua has this report - "The epicenters of the ebola virus in Sierra Leone were completely quarantined on Thursday as the military and the police surrounded the two eastern districts preventing all vehicular traffic from leaving or entering the areas.

A local journalist in the Kenema district informed Xinhua that the order came from the local unit commander, Karrow Kamara who was following the president's order to quarantine the area to contain the spread of the disease. The action would last 60 to 90 days.

About 750 military men and 50 nurses were deployed in the Kenema and Kailahun districts. Troops have also been deployed in isolated areas near the border giving unhindered access to health workers.

Journalist Ahmed Kallon in Kenema said the movement of journalists were also effected, noting that if the act continues both radio and newspaper journalists in the districts would down tools. A resident in the area told Xinhua that some people tried to travel to Freetown but were stopped by the police. The deployment mechanism, according to the Military spokesman Col. Mohamed Samura, is part of the inter-border isolation strategy agreed by the three Mano River Union leaders on last Friday."

According to the pro-government New Citizen news outlet -

"Minister of Defense, retired Major Alfred Paolo Conteh yesterday disclosed to journalists at the usual Government press briefing organized by the Ministry of Information and Communications that 1,501 military and 2,000 police personnel have been deployed nationwide to fight against the Ebola outbreak in the country. He said this is as a result of the public health emergency declared by the President for the security forces to assist health workers and NGOs to do their work as well as to enforce the quarantine of the epicenters of Kailahun and Kenema Districts.

According to Alfred Paolo Conteh, the army has deployed 750 personnel in Kenema and Kailahun Districts to ensure that medical workers do their work unhindered, especially contact tracing asserting that vehicles and people would not be allowed in and out of the two epicenters in addition to ensuring that people adhere by the preventive measures, assured that the lives and property of people would be secured and revealed that houses suspected of harboring Ebola patients would be quarantined and the suspects observed for twenty-one days."

This raises a number of questions that have to be addressed. Getting the troops deployed requires quite a lot of planning and the accompanying logistics. Having deployed all these troops in an area that has the contagion, what protective gear do we have for the security forces so deployed and what about their feeding and bunkering/housing? Are they going to terrorise residents from their usual places of abode so that they can behave as they did during the war years - as occupation forces?

Having catered for the need of the security forces - and we hope this does not contain the "moral boosters" of cheap alcohol and drugs, what about the thousands of civilians now caught up in this dragnet?

If they, the affected civili

Has the government provided for their needs that would definitely include health needs for the treatment of ailments like other fevers that are not Ebola related, illnesses and other diseases that need urgent medical attention and since they are now prevented from travelling to other parts of the country?

What programmes do we have in place that will assure them that this campaign is not a political ploy aimed at marginalising and politically isolating them from the rest of Sierra Leone?

These are questions that need to be addressed immediately. They could provide fodder for the opposition and people who view this move by the government through political lenses.

The last and we think the most important point is this -

how were the troops/security forces for this operation selected?

What part of the country are they from?

Who is leading them and what part of the country is the security forces commander from who would ensure that the local inhabitants of the districts of Kailahun and Kenema are treated with the respect and cultural sensitivity they truly deserve?

We are stating these concerns given the experiences of the past especially during our troubles when rank and file would openly talk about not willing to die defending the inhabitants of a place to which they owe no allegiance, unwilling to defend territory inhabited by a people who spoke "strange" dialects and who did not trust them.

What was even more scary then was that the senior officers heard these things and never reprimanded their subordinates for fear of being killed/murdered in one of those many mysterious "ambushes" that were a feature of our troubles.

The US-based Newsweek magazine has this picture which encapsulates some of our fears -

"In Kenema, people are adapting to the reality of living in lockdown. The motor bike taxis usually seen swarming the streets day and night are adjusting to their curfew—no one is allowed on the street between 7 PM and 7 AM. The prices in the market have stabilized for now, but already there is no fish left for sale. Though the panic has passed, it will take longer to get used to the regular military patrols.

Today, for Friday prayers, by decree of the regional head Imam, all 148 mosques in Kenema have made special prayers for the safety of their city from Ebola. In today’s address in the main mosque downtown, the Imam urged everyone to limit the spread of virus by not shaking hands and alerting the authorities of any symptoms.

Despite these efforts of solidarity, there is a deep sense of resentment among many residents as they watch new cases arrive at the government hospital. Today a case arrived from Moyamba, 170 kilometers away. Many are finding it unfair they are stuck living next to the country’s major isolation unit for Ebola victims.

Foreigners, too, are stuck in the city. Rupert Day works for a major cocoa trading company and has made Kenema his home for the last three years. He found out he was stuck in town yesterday—when he got a 7 AM phone call from one of his employees:

"I could barely hear him through the cacophony of background noise as he shouted down the phone in Krio: - ‘Boss they don block we… the soldier man dem say nobody nor go able pass’ [‘Boss, they’ve blocked us. The soldiers said no one will pass.’]

The daily stream of buses destined for the second city of Bo and the capital Freetown had been unceremoniously told to turn around by a contingent of armed soldiers.

Later on Thursday, Parliament ratified a minimum 21 day military enforced quarantine of Kenema and Kailahun, the two districts at the center of the outbreak. Feeding, fuelling and appeasing the citizens of this sprawling geographic area will be a massive operation.

Now back to the WHO decision. The BBC's Health Editor Helen Briggs has commented on the WHO decision stating -

"The decision by the WHO to declare Ebola a public health emergency is, by its own definition, an "extraordinary event" which marks "a public health risk to other states through the international spread of disease". 

The WHO has declared emergencies only twice in recent years - swine flu in 2009 and polio in May. Although the recommendations stop short of international flight and trade restrictions, they have symbolic significance. The measures are designed to "galvanise the attention of leaders of countries at a top level," says director-general Dr Margaret Chan.

According to Dr Jeremy Farrar, director of the Wellcome Trust, the recommendations will help provide global leadership. While Ebola continues to pose a very serious health threat for people in West Africa, it remains "very unlikely that the outbreak will turn into a global pandemic", he says.

Keiji Fukuda, the WHO's head of health security, said that with the right steps and measures to deal with infected people, Ebola's spread could be stopped. "This is not a mysterious disease. This is an infectious disease that can be contained," he said. "It is not a virus that is spread through the air."

Prof David Heymann of the London School of Hygiene & Tropical Medicine, said the recommendations were "comprehensive and evidence-based".

Prof Tom Solomon, of the UK's NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, welcomed the emphasis on outbreak control in local areas, including the use of full personal protective equipment (gowns, masks, gloves and goggles) with proper training.

Medical aid groups applauded the designation but said that it alone won't reduce fatalities.

"Declaring Ebola an international public health emergency shows how seriously WHO is taking the current outbreak, but statements won't save lives," said Dr. Bart Janssens, director of operations for Doctors Without Borders, a humanitarian organization. "Now we need this statement to translate into immediate action on the ground.

For weeks, MSF has been repeating that a massive medical, epidemiological and public health response is desperately needed to save lives and reverse the course of the epidemic," said Janssens, using the initials for his organization's French name, Medecins Sans Frontieres. "Lives are being lost because the response is too slow." The agency said it has nearly 700 staff responding to the crisis in the affected countries. "All our Ebola experts are mobilized, we simply cannot do more," he said.

The US-based Disease Control body, CDC, has issued a travel advice in which it recommends that US residents avoid nonessential travel to Sierra Leone -

"If you must travel, such as for humanitarian aid work in response to the outbreak, protect yourself by following CDC’s advice for avoiding contact with the blood and body fluids of people who are ill with Ebola. For more information, visit Outbreak of Ebola in Guinea, Liberia, and Sierra Leone on the CDC Ebola website. This recommendation to avoid nonessential travel is intended to facilitate control of the outbreak and prevent continued spread in two ways: to protect US residents who may be planning travel to the affected areas and to enable the government of Sierra Leone to respond most effectively to contain this outbreak.

CDC remains committed to the multinational effort to assist Sierra Leone in controlling the outbreak and is scaling up its response activities by, among other things, deploying additional staff to the affected countries. International humanitarian assistance must continue, and CDC encourages airlines to continue flights to and from the region to facilitate transport of teams and supplies essential to control the outbreak. On the current situation the last time we visited the CDC website, we found this -

"An outbreak of Ebola has been ongoing in Sierra Leone since May 2014. This outbreak also affects Guinea, Liberia, and Nigeria and is the largest outbreak of Ebola in history. At least three Americans have been infected; two are health care workers in an Ebola clinic. Affected districts in Sierra Leone include Bo, Bombali, Bonthe, Kailahun, Kambia, Kenema, Kono, Moyamba, Port Loko, Pujehun, Tonkolili, and Western Area, including the capital of Freetown. Instances of civil unrest and violence against aid workers have been reported in West Africa as a result of the outbreak. The public health infrastructure in Sierra Leone is being severely strained as the outbreak grows. Sierra Leone’s government has recently instituted enhanced measures to combat the spread of Ebola, many of which will likely make travel to, from, and within the country difficult."

In the latest press statement from the rat, we are reminded of the formation of a Presidential Task Force but what we still have to know is just who are the members of this body. We do know that it is called a Presidential Task Force which, in effect means that the rat is the head, but we know differently and that the man who has been given this responsibility is one of the rat's so-called "advisers" who has no expertise when it comes to such matters. But we'll watch, wait and see.