An epidemic of Ebola virus disease (EVD), the most widespread in history, is ongoing in some West African countries. It has caused significant mortality, with a reported case fatality rate (CFR) of about 71%. It began in Guinea in December 2013 and then spread to Liberia and Sierra Leone. A small outbreak of twenty cases occurred in Nigeria, and one case occurred in Senegal. The latter two countries were declared disease-free on 20 October 2014 after a 42 day waiting period. Secondary infections of medical workers have occurred in the United States and Spain but have not spread further. One case has been identified in Mali with as yet no reports of further cases of infection. In August an independent outbreak began in the Democratic Republic of the Congo unconnected to the main epidemic.
As of 25 October 2014, the World Health Organization (WHO) reported a total of 12,008 suspected cases and 5,078 deaths, though the WHO believes that this substantially understates the magnitude of the outbreak with true figures numbering three times as many cases as have been reported. The assistant director-general of the WHO warned in mid-October that there could be as many as 10,000 new EVD cases per week by December 2014. Almost all of the cases have occurred in the three initial countries.
Some countries have encountered difficulties in their efforts to control the epidemic. In some areas, people have become suspicious of both the government and hospitals, some of which have been attacked by angry protesters who believe either that the disease is a hoax or that the hospitals are responsible for the disease. Many of the areas seriously affected by the outbreak are areas of extreme poverty with limited access to the soap and running water needed to help control the spread of disease. Other factors include reliance on traditional medicine and cultural practices that involve physical contact with the deceased, especially death customs such as washing and kissing the body of the deceased.
Some hospitals lack basic supplies and are understaffed, increasing the chance of staff catching the virus themselves. In August, the WHO reported that ten percent of the dead have been health care workers. By the end of August, the WHO reported that the loss of so many health workers was making it difficult for them to provide sufficient numbers of foreign medical staff. In September, the WHO estimated that the countries’ capacity for treating EVD patients was insufficient by the equivalent of 2,122 beds.
By September 2014, Médecins Sans Frontières/Doctors Without Borders (MSF), the largest NGO working in the affected countries, had grown increasingly critical of the international response. Speaking on 3 September, the president of MSF spoke out concerning the lack of assistance from the United Nations member countries saying, “Six months into the worst Ebola epidemic in history, the world is losing the battle to contain it.” A United Nations spokesperson stated, “They could stop the Ebola outbreak in West Africa in 6 to 9 months, but only if a ‘massive’ global response is implemented.” The Director-General of the WHO, Margaret Chan, called the outbreak “the largest, most complex and most severe we’ve ever seen” and said that it is “racing ahead of control efforts”. In a 26 September statement, the WHO said, “The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times.”