In Liberia, Sierra Leone, and Guinea—the countries most affected by Ebola—the outbreak has, according to the latest data from the World Health Organization (WHO), resulted in 5160 deaths.
In Liberia, a country we have been working in for three years, by 29 October 2014 WHO reported 2413 deaths from Ebola. Two weeks later, on 12 November, WHO reported 2836 deaths, an increased number of 423 deaths in two weeks.
Health workers are bearing the brunt of the outbreak: by 12 November 2014, 329 Liberian healthcare workers had contracted Ebola (107 more than three weeks earlier on 22 October), and 162 had died (59 more than three weeks earlier). According to WHO, when the outbreak began, Liberia had only one doctor for every 100 000 people in a population of 4.4 million–that is about 40 doctors in total, and now there are even less.
To achieve the target of the UN Mission for Ebola Emergency Response (UNMEER), of isolating 70% of people infected with Ebola and safely burying 70% of those dying from Ebola by 1 December 2014, 4611 treatment-isolation beds are needed in the three west African countries affected. However, by the latest WHO figures available, only 1129 beds (24% of those urgently needed) are currently available.
Adequately equipped hospital facilities are urgently needed for all Ebola patients. The number of available isolation and treatment beds in west Africa is insufficient to meet the UNMEER target, and this situation could create global spread of the epidemic. But the question is: how can such a huge amount of hospital beds be made available and staffed in time to halt the epidemic, and to provide a humanitarian level of care for Ebola patients?
Based on our experience in Liberia, and with the support of the Liberian Ministry of Health and Social Welfare, our suggestion is that the international community urgently establish properly equipped military field hospitals within each country, and also provide hospital ships anchored off the coast of west Africa.
These facilities will provide proper isolation care, high level appropriate medical care, and safe waste disposal—all of which are readily achievable. There are two feasible options for the use of hospital ships: 1) the conversion of a cruise liner into a hospital ship, as was undertaken over four days as part of the response to the Falklands War; and 2) the use of existing naval hospital ships, such as those within the US, Chinese, and Russian fleets. Military hospital ships, including the two 1000 bedded vessels already available in the US navy, are perfectly fitted out with modern medical equipment, are much safer and more comfortable to work in for international volunteers, and would provide an ethical and humanitarian way of properly caring for west African people suffering from this terrible disease.
This approach of military field hospitals and hospital ships has the full support of the European Leadership Network, which recently wrote open letters to the NATO secretary general, the director general of WHO, and the secretary general of the United Nations.
In addition, there is a lack of international medical volunteers—a situation made worse by the inherent dangers of the disease, of working safely and for a clinically appropriate amount of time in temperatures of 35-40°C, and the lack of available medical equipment and supplies conforming to international standards. Without proper facilities, it is unreasonable to expect highly trained health workers—for example, from the UK’s NHS—to work under such conditions.
And, crucially, medical evacuation is not guaranteed: the UK Government has said that medical evacuation for UK volunteers is only available on a case by case basis, with no guarantee that they will be returned home where they can be near their families during their treatment.
Although national and international health workers are doing their best to provide humane care to west African patients in existing Ebola isolation and treatment units, according to our personal experience in Liberia, too few of them are able to provide treatment of a minimum international and medically ethical standard for a disease with a potential 70% survival rate.
Treatments with appropriate oral, intravenous, or intraosseous electrolyte solutions; blood products; antiemetics; antacids; and adequate analgesia (including morphine when needed), all supported by carefully documented vital signs and basic laboratory measurements, are essential. The focus must be on ethically adequate medical treatment, not just isolation, and must include adequate nutrition.
In our experience, sufficient numbers of international volunteer nurses and doctors willing to provide treatment for west African patients with Ebola will only be achieved if a) there is an explicit policy of medical evacuation for the small number of volunteers who contract Ebola, and b) if the treatment facilities provide minimum supplies of drugs, laboratory facilities, medical supplies, and essential equipment so that volunteer health workers can appropriately treat patients to international ethical standards.
We urge the international community to address these points as a matter of urgency.
David Southall and Rhona MacDonald, honorary medical and executive directors, Maternal and Childhealth Advocacy International.
Competing interests: None declared.