Following the roadmap structure, country reports fall into two categories: those with widespread and intense transmission (Guinea, Liberia, and Sierra Leone); and those with an initial case or cases, or with localized transmission (Nigeria, Senegal). An overview of the situation in the Democratic Republic of the Congo, where a separate, unrelated outbreak of Ebola virus disease (EVD) is occurring, is also provided (see Annex 1).

1. COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

5843 (probable, confirmed and suspected; see Annex 2) cases and 2803 deaths have been reported in the current outbreak of EVD as at 20 September 2014 by the Ministry of Health of Guinea, as at 17 September 2014 by the Ministry of Health of Liberia, and as at 19 September 2014 by the Ministry of Health of Sierra Leone (table 1).

Le calme est revenu depuis lundi 22 septembre dans la matinée après des affrontements qui ont opposé samedi et dimanche derniers les Forces armées de la RDC aux Maï-Maï à Kisenga, à près de 105 kilomètres de Mitwaba (Katanga). Selon les sources militaires de ce territoire, le bilan fait état de plusieurs morts du côté des miliciens, sans donner des chiffres.

Aucune perte n’a été enregistrée du côté de l’armée, ajoutent les mêmes sources.

Certaines sources proches des FARDC indiquent que les militaires ont mené un assaut samedi 20 septembre à Kisenga-un ancien bastion des Maï-Maï Kata Katanga-suite à la plainte de la population locale sur des tracasseries dont elle est souvent victime de la part de certains hommes armés.

Le bilan de cette attaque fait état de plusieurs Maï-Maï tués et plusieurs autres blessés, ont indiqué des sources militaires sans donner un chiffre.

Les FARDC ont aussi récupéré deux armes AK 47 et des paquets des flèches.

A en croire les mêmes sources, le village de Kisenga est sous contrôle des FARDC et tous ceux qui avaient fui leurs villages commencent à regagner leurs maisons.

Coordination/ Keys developments

• *Four suspected cases were negative after laboratory tests on two different samples and therefore discharged and declared "non-case", bringing down to 68 the total number of cases on 18 September (see table above for details ) of which 41 deaths; an overall lethality rate of slightly over 60%.

• **8 health personnel have died of Ebola Virus Disease (EVD) since the outbreak of the epidemic.

• The centrifuge of the mobile laboratory in Lokolia has broken-down, making it impossible to carry out on-site laboratory tests in Lokolia. A centrifuge parts is expected from the National Institute of Biomedical Research (INRB) in Kinshasa

• INRB is facing the shortage of reagents and inputs for both its laboratory in Kinshasa and the mobile laboratory in Lokolia. A request for reagents and laboratory inputs has been made to the DRC Ministry of Health for an urgent solution.

• The death rate of animals and poultry continues to be very high in the area affected by the EVD, requiring thorough veterinary investigations

• According to the National Coordination Committee (NCC), the overall analysis of the epidemiological situation suggests that Ebola outbreak declared on August 24 in the area of Djera is under control.

• The Food Security Cluster and the Ministry of Social Affairs, Humanitarian Action and National Solidarity will distribute over 1,000 tons of food, including 4.9 tons to members of the response team, the indoors patients and to the family members of people affected by the EVD. This distribution is facing important logistical constraints related to poor road conditions in the area of Djera.

• Two hotline numbers have been set up to allow the population to get information on the disease and ongoing efforts: 081 08 000 20 and 099 99 710 05. An additional hotline for information on the prevention of the EVD is available using Tigo: 119.

Overview 2013/14 Crop Production Season

Well distributed rains were received in most parts of the region facilitating good production in most countries

Late start of the season in north-eastern and some southern parts of the Region, including parts of Lesotho, Malawi, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe

Improved rains in Angola, Botswana, Namibia and South Africa assisted drought recovery in many areas though not completely covering all parts.
Dry spells in parts of Lesotho, Malawi, Namibia, and Swaziland and Zambia negatively affected production

Excessive rains, waterlogging and/or flooding was experienced in parts of Lesotho, Malawi, Mozambique, Namibia, Seychelles, Swaziland and Zambia

22 September 2014 – United Nations Secretary General Ban Ki-moon today said that addressing the root causes of the conflict in eastern Democratic Republic of the Congo (DRC) and the region requires a recommitment to all national and regional commitments under the agreed-to peace Framework.

“In recent months, there has been progress on several commitments under the Framework. The capacity of armed groups to attack civilians in eastern DRC has been impaired, particularly after the defeat of the former M23 at the end of 2013. This has improved security in the region,” said Mr. Ban at a Headquarters meeting of the signatories of the Peace, Security and Cooperation Framework for the DRC and the region, who wrapped up their work with the approval of a Communiqué.

On 24 February 2013, recognizing the recurring cycles of conflict and violence that permeate the eastern DRC, 11 African countries Framework, which represents an avenue of hope for the region’s people to build stability by addressing the root causes of the conflict and fostering trust between neighbours.

At today’s fourth meeting reviewing the progress of the Framework, Mr. Ban was joined by several high-level officials including President Mohamed Ould Abdel Aziz of Mauritania, President Robert Mugabe of Zimbabwe, and Vice-President Manuel Domingos Vincente of Angola. Several officials from the African Union and the South African Development Community (SADC) were also in attendance.

“Over the next few years, several countries of the Great Lakes region will be holding pivotal elections. This should strengthen the democratic culture in the region. I hope these countries will emerge from the elections stronger, more united and more stable,” said Mr. Ban.

But several armed groups continue to hamper these efforts. The Nairobi Declarations of the Kampala process have been implemented too slowly. And there remains a lack of trust among some countries of the region.

“We must speed up the implementation of the Nairobi Declarations of the Kampala Process, including the repatriation of eligible former M23 elements to the DRC. And we must continue building trust and confidence among countries of the region,” Mr. Ban added.

He recalled that at the third meeting, held at the African Union Headquarters in Addis Ababa in January, participants endorsed the regional Plan of Action and 15 priority activities for implementation of the Framework. They also requested that the Technical Support Committee submit a progress report on the implementation of the regional Plan of Action.

Presented by the Secretary-General’s Special Envoy and the Special Representative of the African Union Chairperson, the report documents progress and offers recommendations.

“I welcome the collective and unequivocal message to the FDLR that they should voluntarily surrender and disarm before the 2nd of January 2015,” the UN chief said.

The Secretary-General also underscored the need for donors, especially the African Development Bank, the European Union, the World Bank and bilateral partners, to remain committed to supporting initiatives for peace, security and cooperation in the region.

“We should spare no effort to end the instability that has affected millions of people and impeded development and prosperity in the region for far too long,” Mr. Ban reiterated.

In their remarks, the regional leaders expressed their appreciation to former Special Envoy Mary Robinson for her valuable efforts to achieve peace and stability in eastern DRC and the region, and welcomed Mr. Said Djinnit as the new Special Envoy of the Secretary-General for the Great Lakes Region.

Speaking to the leaders for the first time, Special Envoy Djinnit noted: “The Great Lakes region is at a crossroads. It can only realize its vast potential once sensitive security concerns are fully resolved and relations between neighbouring countries improve.” He pledged to work closely with all key stakeholders to ensure that the regional accord, which has become known as the “Framework of Hope”, delivers on its promises.

22 septembre 2014 – A l'occasion d'une réunion du Mécanisme régional de suivi de l'accord-cadre pour la paix dans l'Est de la République démocratique du Congo (RDC), le Secrétaire général des Nations Unies, Ban Ki-moon, a appelé les pays de la région des Grands Lacs à consolider les progrès réalisés.

« Nous devons intensifier les efforts nationaux et régionaux, avec un soutien international, pour répondre les causes profondes du conflit dans l'Est de la RDC. Nous devons éliminer la menace posée par les groupes armés. Nous devons accélérer la mise en œuvre des Déclarations de Nairobi du processus de Kampala, dont le rapatriement en RDC des anciens éléments du M23 qui sont éligibles », a dit M. Ban dans un discours lors de cette réunion. « Et nous devons continuer à bâtir la confiance entre les pays de la région. »

Il s'agissait de la quatrième réunion du Mécanisme régional de suivi (13+4) de l'Accord-cadre pour la paix, la sécurité et la coopération pour la République démocratique du Congo et la région. Elle était organisée conjointement par M. Ban et la Présidente de la Commission de l'Union africaine, Mme Nkosazana Dlamini-Zuma. La précédente réunion s'était tenue au siège de l'Union africaine, à Addis-Abeba, à la fin janvier.

« Ces derniers mois, des progrès ont été faits par rapport à plusieurs des engagements énoncés dans l'Accord-cadre. Les groupes armés sont moins à même d'attaquer les civils dans l'est de la RDC, surtout depuis la défaite de l'ancien M23, fin 2013. Les conditions de sécurité se sont ainsi améliorées dans la région », a noté le Secrétaire général.

Toutefois, plusieurs groupes armés continuent leurs activités, a-t-il relevé. « Les Déclarations de Nairobi du processus de Kampala ont été mises en oeuvre trop lentement. Et il reste un manque de confiance entre certains pays de la région », a-t-il souligné.

Le Secrétaire général a estimé que malgré ces défis, il était possible de maintenir le processus sur les rails. « Je salue le message collectif et sans équivoque adressé aux (rebelles des) FDLR leur demandant de rendre les armes volontairement avant le 2 janvier 2015 », a-t-il dit. « Je vous invite à élaborer un plan global pour traiter avec les FDLR par des moyens non militaires et, si nécessaire, par une action militaire. Nous ne devons ménager aucun effort pour mettre fin à l'instabilité qui a touché des millions de personnes et entravé le développement et la prospérité de la région depuis trop longtemps. »

Selon le Secrétaire général, « pour que les causes profondes du conflit qui déchire la RDC et la région puissent être réglées, il faut que soit réaffirmée la volonté de donner effet rapidement à tous les engagements nationaux et régionaux énoncés dans l'Accord-cadre ».

Il a rappelé que dans les années qui viennent, des élections déterminantes se tiendront dans plusieurs pays de la région des Grands Lacs. « La culture démocratique de la région doit s'en trouver renforcée. J'espère que les pays concernés en sortiront plus forts, plus unis et plus stables », a-t-il dit.

Dans un communiqué publié à l'issue de la réunion, les pays signataires de l'Accord-cadre ont renouvelé leur engagement en faveur de sa mise en œuvre et réaffirmé leur respect pour la souveraineté, l'intégrité territoriale et l'indépendance politique de tous les Etats de la région.

Le communiqué salue également « les progrès réalisés en vue de la stabilisation dans l'Est de la RDC » et félicite les forces armées de la RDC et la brigade d'intervention de la Mission des Nations Unies (MONUSCO) « pour les efforts qu'elles ont déployés de concert afin de neutraliser certaines des forces négatives qui opèrent dans l'Est de la RDC. »

Les pays signataires de l'accord-cadre ont encouragé les forces armées de la RDC et la brigade d'intervention de la MONUSCO « à poursuivre leurs efforts afin de désarmer toutes les forces négatives dans l'Est de la RDC, notamment les FDLR et ADF-NALU. »

AMNESTY INTERNATIONAL

PUBLIC STATEMENT

AI Index: AFR 01/013/2014

22 September 2014

International assistance and human rights protections vital for Ebola-stricken countries

As the Ebola epidemic spreads and the death toll rises, Amnesty International underscores the legal obligation of the international community to provide assistance to the affected countries.

In addition to the need to mobilize the necessary financial and technical resources, the organisation is highlighting the following issues as requiring particular attention, both within domestic response plans and as part of the international assistance effort:

Protect health care workers and service providers

Address the disproportionate impact on women

Apply a human rights framework to protect the safety, dignity and freedoms of affected communities

Guarantee support for long-term recovery of affected states

Cases of Ebola have been reported in the West African states of Guinea, Sierra Leone, Liberia, Nigeria and Senegal, as well as the Democratic Republic of the Congo. Fourteen of Liberia’s 15 counties have now reported confirmed cases. Current data show that at least 2,600 people have died from Ebola and more than 5,000 are infected. However, data collection is weak and the Director-General of the World Health Organization has stated that these figures are “vast underestimates”.

The World Health Organization has warned of an exponential rise in the number of people infected with the disease in West Africa and the need to significantly scale up the international response. Reports indicate that health centres are overflowing with patients, and that people suffering from the disease are having to move around to seek treatment or are returning to their homes and communities, increasing the risk of spreading the infection further. On 18 September the UN Security Council declared the Ebola outbreak in West Africa a threat to peace and security.

The international response

Human rights cannot be fully realised without international cooperation and assistance. This is reflected by the fact that the vast majority of the world’s states have recognised that human rights obligations include the obligation of international cooperation and assistance, including with respect to the right to health. In the context of a health emergency, such as the Ebola crisis, this obligation is triggered by the appeals of the affected countries or the United Nations (UN) for help. All countries that can respond must do so as swiftly as possible. The response must itself be rights-respecting and should take account of long-term as well as immediate needs.

While recent weeks have seen greater international focus on the situation West Africa, too many aspects of the crises are yet to be addressed. On 5 September the UN Secretary-General, Ban Ki Moon, made an international rescue call, saying the next weeks were “crucial” in the fight against the disease. Since then, although some resources have been mobilised, this has largely been insufficient to meet the needs of the crisis-affected countries. On 16 September Doctors without Borders warned that the world was losing the battle to contain Ebola and that the response continued “to fall dangerously behind” what was needed. On the same day, the UN Secretary-General called for US$1 billion for the response effort.

Mobilizing financial and technical resources is vital; in addition, the following issues should be given attention, both within domestic response plans and in international financial and technical assistance.

Protection of health care workers and service providers

At the frontline of this epidemic are health workers, burial personnel and community workers who are courageously continuing to deliver services despite the personal risks, and despite having lost colleagues, relatives and friends.

Over 300 health workers have been infected, according to the World Health Organization, and at least 144 have so far died of the disease. On 14 September a fourth doctor died in Sierra Leone after contracting the disease in the course of carrying out her professional duties.

Liberia and Sierra Leone, whose health systems were already crippled by years of conflict, struggled to provide health care services at the best of times; they are now collapsing under the strain of responding to the epidemic. There are insufficient personnel to cope with the number of patients. While many health workers heroically continue to work, they are doing so – in some cases – without personal protective equipment or are having to recycle the little protective clothing they have.

The support of the international medical community is vital and foreign medics have joined their colleagues on the frontline, sometimes at great personal cost. However, much more is needed to support national and international medical response teams.

Personal protective equipment, information, training and psychosocial support are all necessary to support nurses, doctors and other response staff. Increased efforts are required to get equipment and technical support to where it is needed. States must also ensure there are mechanisms in place to guarantee support for the families of health workers and others who have died or become ill as a consequence of caring for Ebola victims.

While international assistance should prioritise urgent needs, it must also be forthcoming for long-term rebuilding of health systems. The health communities of the affected countries need to know they will be supported to rebuild their health care systems when the crisis has passed.

Addressing the impact on women

Women appear to be at disproportionate risk of contracting Ebola. According to UNICEF women comprise over 50% of the total number of those dying from this outbreak of Ebola, children 22% and men around 25%. In Liberia, reports attributed to the government claim that between 55% and 75% of those who have died in that country are women.

There are a number of reasons why women are more vulnerable to contracting the disease; in many of the affected areas it is women and girls who shoulder the burden of caring for sick relatives and washing the bodies for traditional burials. Most nurses in the region are women and nursing staff make up the majority of medical staff in most facilities.

In addition, women are particularly vulnerable to infection during pregnancy because, amongst other things, they have more contact with health facilities. They may also lack relevant information on how to protect themselves. For example, men who have recovered from Ebola continue to secrete the virus in their semen for up to several weeks after recovery. However, medical experts have noted that this fact is not well known.

Proper assessments are needed to identify the particular gender dimensions of this epidemic. Women should be engaged in strategy development and assisted in addressing any particular obstacles they face in adhering to protective procedures, due to prevailing attitudes about gender roles, lack of access to information or other pre-existing inequality.

The international community has an important role to play in ensuring that considerations are given to gender, and that they involve women and women’s rights experts in the design of both their short- and longer-term programmes to respond to the epidemic. Specific action plans should be developed to address gender-related risks, and resources provided to implement action. International cooperation and assistance will be vital in this regard.

Using a human rights framework to protect the safety, dignity and freedoms of affected communities

Containing and controlling the spread of Ebola is vital and the affected countries face significant challenges in doing so. While recognising the complexity of the challenges, certain containment measures are of concern.

For example, in Sierra Leone, the 2014 Bye-laws for the Prevention of Ebola and Other Diseases introduces prison sentences of up to six months for anyone harbouring a person who has, or may have, contracted Ebola. Such uses of criminal law may be counter-productive, increasing fear and suspicion within communities and between communities and the authorities.

Medical professionals have raised similar concerns about some of the quarantine measures that have been used. Sierra Leone’s three-day “lock-down” from 19 to 21 September was criticised by Medecins Sans Frontieres. The organization stated: “it has been our experience that lockdowns and quarantines do not help control Ebola as they end up driving people underground and jeopardizing the trust between people and health providers."

Quarantines, which restrict the right to freedom of movement, may be justified under international law only if they are proportionate, time bound, undertaken for legitimate aims, strictly necessary, voluntary wherever possible and applied in a non-discriminatory way. Such an approach is needed to maintain the trust of the population – an essential part of a successful response to infectious diseases.

There have also been reports of people in quarantine being left without food and other basic necessities and use of force by police in enforcing quarantines. The international community must assist affected states to ensure that where quarantine and isolation measures are being implemented, they are done so in a safe and respectful manner and the rights of those under quarantine are respected and protected.

The police have an important role to play in controlling the spread of the disease and ensuring public safety. Policing of quarantine and other containment measures must be in line with international standards on policing, including the UN Code of Conduct for Law Enforcement Officials and the UN Basic Principles on the Use of Force and Firearms by Law Enforcement Officials. These principles, which apply at all times, including during times of public emergency, stipulate that law enforcement officials may use force only when strictly necessary and to the extent required for the performance of their duty, and that as far as possible, they should use non-violent means before resorting to the use of force, which should only be used if other means are ineffective. Firearms must not be used except in self-defence or defence of others against the imminent threat of death or serious injury.

Guaranteeing support for long-term recovery

In addition to medical support the international community must make a commitment to support the Ebola-affected countries’ longer-term recover and to look at the wider impacts. The World Bank has noted, for example, that Ebola-related restrictions on people’s movements are “leading to food crises in the quarantined and most affected areas … and that: “1 million people in the region are facing a food crisis in the coming months.” The Bank has also warned that the disease will have a potentially “catastrophic” impact on the already fragile economies of Guinea, Liberia, and Sierra Leone.

As vital as international support for the medical response is, the wider impacts on the economies and development of the affected countries must also be addressed. This means new resources must be forthcoming from the international community - through the UN agencies and well-coordinated donor engagement – and not only a reallocation of existing aid funding. When the crisis is past, those who survive must not be left to endure grinding poverty and hardship as international attention moves on: commitments to ongoing support should be made now in line with States’ legal obligations.

See: http://www.who.int/mediacentre/news/ebola/8-september-2014/en/

See speech made by Dr Margaret Chan, Director General of the World Health Organisation to the Security Council made on 18 September 2014, available at: http://www.who.int/dg/speeches/2014/security-council-ebola/en/

WHO Director-General addresses UN Security Council on Ebola, 18 September 2014. See: http://www.who.int/dg/speeches/2014/security-council-ebola/en/

See: http://www.who.int/mediacentre/news/statements/2014/ebola-roadmap/en/

See for example, http://www.who.int/mediacentre/news/ebola/overview-august-2014/en/

See http://www.who.int/mediacentre/news/ebola/8-september-2014/en/

See: UN News Centre, http://www.un.org/apps/news/story.asp?NewsID=48746

Article 2(1) of the International Covenant on Economic Social and Cultural Rights provides that “Each State Party to the present Covenant undertakes to take steps, individually and through international assistance and co-operation, especially economic and technical, to the maximum of its available resources, with a view to achieving progressively the full realization of the rights recognized in the present Covenant by all appropriate means”. Article 12 of the Covenant guarantees the right to health for everybody within a State party. The Covenant has been ratified by 162 states.

http://www.un.org/sg/offthecuff/index.asp?nid=3531

For example, China and the USA have made contributions http://www.who.int/mediacentre/news/statements/2014/chinese-ebola-contri...http://www.who.int/mediacentre/news/statements/2014/usa-ebola-support/en/

http://www.who.int/dg/speeches/2014/security-council-ebola/en/

http://www.msf.org.uk/ebola

http://www.nytimes.com/2014/09/18/world/africa/ebola-world-bank-west-afr...

WHO: Ebola Response Roadmap Situation Report 3, 12 September 2014 See pages 4 and the table on page 5.

http://www.theguardian.com/society/2014/sep/14/ebola-outbreak-fourth-doc...

WHO, ‘Unprecedented number of medical staff infected with Ebola’, 25 August 2014. See: http://www.who.int/mediacentre/news/ebola/25-august-2014/en/

The WHO Ebola Response Roadmap makes many suggestions along these lines, including on remuneration, training, equipment and medical care for health workers, and the need for personal protective equipment. See pages 10 & 11, http://apps.who.int/iris/bitstream/10665/131596/1/EbolaResponseRoadmap.p...

See: VOA News, ‘Ebola Has Devastating Impact on Children in Liberia’, 12 September 2014, at http://www.voanews.com/content/ebola-has-devastating-impact-on-children-...

The figure of 75% is attributed to the Liberian Ministry of Health,. See: VOA News, ‘Ebola Has Devastating Impact on Children in Liberia’, 12 September 2014, at http://www.voanews.com/content/ebola-has-devastating-impact-on-children-... A report by UN Women noted that the Liberian Ministry of Health and Social Welfare had put the figure at between 55 and 60% See: http://www.unwomenwestandcentralafrica.com/news1/ebola-toll-on-women-app.... The different percentages were given at different times, with 75% referred to in an early August briefing and the lower percentages (but still majority of those affected) referenced by officials in September. http://www.unwomen.org/en/news/stories/2014/9/ebola-outbreak-takes-its-t... This statement by UN women puts the figure of women dying in Sierra Leone at 59% http://www.independent.co.uk/news/world/africa/ebola-virus-outbreak-this...

There is little data available for the current crisis. The gendered vulnerabilities to infectious diseases, including Ebola, are discussed in World Health Organization, Addressing sex and gender in epidemic-prone infectious diseases’, 2007, ISBN 978 92 4 159534 6.

World Health Organization, Addressing sex and gender in epidemic-prone infectious diseases’, 2007, ISBN 978 92 4 159534 6.

See: http://www.parliament.gov.sl/Portals/0/BILLS/PUBLIC%20EMERGENCY%20REGULA... %20AUGUST%202014.pdf

http://www.dw.de/msf-sierra-leone-lockdown-will-not-stem-ebola-spread/a-...

See ICESCR General Comment 14 which describes the legitimate contexts in which states can take measures which may limit the exercise of other fundamental rights. “Issues of public health are sometimes used by States as grounds for limiting the exercise of other fundamental rights. The Committee wishes to emphasize that the Covenant’s limitation clause, article 4, is primarily intended to protect the rights of individuals rather than to permit the imposition of limitations by States. Consequently a State party which, for example, restricts the movement of, or incarcerates, persons with transmissible diseases such as HIV/AIDS, refuses to allow doctors to treat persons believed to be opposed to a government, or fails to provide immunization against the community’s major infectious diseases, on grounds such as national security or the preservation of public order, has the burden of justifying such serious measures in relation to each of the elements identified in article 4. Such restrictions must be in accordance with the law, including international human rights standards, compatible with the nature of the rights protected by the Covenant, in the interest of legitimate aims pursued, and strictly necessary for the promotion of the general welfare in a democratic society.”

http://allafrica.com/stories/201408151535.html

UN Code of Conduct for Law Enforcement Officials, Adopted by General Assembly resolution 34/169 of 17 December 1979, Article 3

UN Basic Principles on the Use of Force and Firearms, principles 5 and 9.

http://www.worldbank.org/en/news/press-release/2014/09/16/ebola-world-ba...

http://www.worldbank.org/en/news/press-release/2014/09/17/ebola-economic...

This has been emphasised by the UN Committee on Economic, Social and Cultural Rights in its General Comment 3 on the nature of States Parties Obligations when it notes in particular the importance of the Declaration on the Right to Development adopted by the General Assembly in its resolution 41/128 of 4 December 1986 and the need for States parties to take full account of all of the principles recognized therein. It emphasizes that, in the absence of an active programme of international assistance and cooperation on the part of all those States that are in a position to undertake one, the full realization of economic, social and cultural rights will remain an unfulfilled aspiration in many countries.

Voici le quatrième numéro d’une série de rapports réguliers sur la feuille de route pour la riposte au virus Ebola.1 Il renferme un examen de la situation épidémiologique fondé sur les informations officielles communiquées par les Ministères de la Santé, et une évaluation de l’action par rapport aux indicateurs essentiels de la feuille de route, lorsque ceux-ci sont disponibles. Des indicateurs supplémentaires seront communiqués à mesure que les données seront réunies.

Les données figurant dans le présent rapport se fondent sur les meilleures informations actuellement disponibles. Des efforts importants sont en cours pour améliorer la disponibilité et l’exactitude des informations sur la situation épidémiologique comme sur la mise en œuvre de la riposte.

Suivant la structure de la feuille de route, les pays qui font rapport appartiennent à trois catégories : les pays ayant une transmission étendue et intense (Guinée, Libéria et Sierra Leone) ; ceux ayant un premier cas ou quelques premiers cas ou bien une transmission localisée (Nigéria, Sénégal) ; et ceux qui sont frontaliers avec des zones de transmission active (Bénin, Burkina Faso, Côte d’Ivoire, Guinée-Bissau, Mali, Sénégal). On trouvera également dans ce rapport un panorama de la situation en République démocratique du Congo, où une flambée distincte est en cours (annexe 1).

APERÇU GÉNÉRAL

Au 14 septembre 2014 (fin de journée), le nombre total de cas probables, confirmés ou suspects de la flambée actuelle de maladie à virus Ebola en Afrique de l’Ouest était de 5335, avec 2622 décès (Tableau 1). Les pays touchés sont la Guinée, le Libéria, le Nigéria, le Sénégal et la Sierra Leone. La Figure 1 ci-dessous indique le nombre total des cas qui ont été notifiés par pays durant chaque semaine épidémiologique allant du 30 décembre 2013 inclus (semaine épidémiologique 1) au 14 septembre 2014 inclus (semaine épidémiologique 37 allant du 8 au 14 septembre).

Today the UN established the Ebola Response Multi-Partner Trust Fund, which will ensure a coherent UN System contribution to the overall Ebola outbreak response. The Fund will be guided by the priorities set out in the OCHA appeal document, launched on 16 September in Geneva by Valerie Amos, and amounting to nearly US$ 1 billion. The Trust Fund seeks contributions from Member States, regional legislative bodies, inter-governmental and non-governmental organizations, businesses and individuals. If you would like to contribute please go to http://mptf.undp.org/factsheet/fund/EBO00.

Le chef de poste d’Etat de Ziralo, Melchior Nsengo Witanene, demande au gouvernement de déployer les éléments de l’armée et de la police dans ce groupement du Sud-Kivu. Il affirme que l’absence des forces de l’ordre permet aux groupes armés « d’imposer leur loi » à Ziralo.

« Nous demandons à la hiérarchie de voir comment déployer dans un délai bref une force afin de sécuriser cette population longtemps tracassée par des groupes armés : des Maï-Maï, des Raïa Mutomboki, des Nyatura », plaide le chef de poste.

De son côté, le colonel Guinaro Nzomoni, commandant du 1000e régiment de l’armée basé à Nyabibwe se dit préoccupé par cette situation. Il propose au chef de poste de Ziralo d’en discuter pour discuter des modalités de ce déploiement.

Plus de dix sept millions d’enfants âgés de 0 à 5 ans ont été visés par la campagne nationale de vaccination de routine contre la poliomyélite à Kinshasa et à l’intérieur du pays du 18 au 20 septembre dernier.

-Comment prévenir efficacement la poliomyélite en RD Congo ?

Jody Nkashama discute ce thème avec Titus Makolo, médecin coordonnateur du Programme élargi de vaccination (PEV/Bandundu).

Les notables de Lubero dénoncent l’absence de l’armée et de la police dans plusieurs villages de ce territoire du Nord-Kivu. Il s’agit notamment des localités de Kasugho, Bunyatenge et Mukaramba.

Le président des notables de Lubero, Donatien Mongane, regrette que ces grandes agglomérations soient dépourvues de forces de l’ordre.

Cette situation favorise l’activisme des groupes armés. Le mardi 16 septembre dernier, les miliciens NDC de Cheka ont enlevé 93 habitants de Bunyatenge et Muhanga. Ces personnes ont finalement regagné leurs domiciles deux jours après.

HIGHLIGHT

• The official transfer of authority from the African Union (AU)-led International Support Mission in the Central African Republic (MISCA) to the UN Multidimensional Integrated Stabilization Mission (MINUSCA) took place on 15 September. The UN Secretary-General, Ban Ki-moon expressed his great appreciation of the “exemplary collaboration” between the UN and the AU but said deep concerns remain about the ongoing violence in the country. He stated that the current support from regional organizations including the Economic Community of Central African States (ECCAS) and the AU would remain vital.

• On 12 September the Protection Cluster in the Central African Republic (CAR) met with a delegation of the UN Independent Expert on the human rights situation in CAR. Following a briefing by the Cluster Coordinator on the protection situation and challenges in CAR, as well as the current protection response, discussions focused on some key issues including gender based violence, children associated with armed groups and communities at risk. With regards to communities at risk across the country, the UN Independent Expert encouraged the Protection Cluster to continue communicating on the situation and mobilizing the humanitarian community to ensure protection and assistance. The mission advised the Cluster to not only focus on the prevention and response aspects of GBV issues but also to widely communicate the scale of such violence based on available statistics to enable advocacy at the highest level and consequently provide further support to actors to fight against the phenomenon.

KEY FIGURES

487,636 IDPs including 62,636 in Bangui

418,296 Total number of CAR refugees in neighbouring countries

180,011 New CAR refugees in neighbouring countries since Dec. 2013

8,012 Refugees and asylum seekers in CAR

USD 255 million requested for the situation, Funded 31%, Gap 69%

Ebola at 6 months

Immediately after the first case of Ebola virus disease in Guinea was announced, on 23 March, WHO activated its network of specialized biosafety level 4 laboratories that are equipped and staffed to safely work with the world’s most hazardous pathogens. The Ebola virus is among them. Those labs would play a key role in characterizing and differentiating the Ebola outbreak in the Democratic Republic of Congo, or DRC.

On 24 August, WHO was notified of the country’s first confirmed case and subsequent outbreak initially located in the extremely remote Jeera County in the country’s Equateur Province. That county is located some 1200 kilometres from the capital city, Kinshasa. No paved roads connect the two areas. The outbreak is currently concentrated in the Boende district of the Province.

Traditional beginning

The outbreak, which began in the traditional way, with handling of infected bushmeat, was initially small: 24 suspected cases, with 13 deaths, largely among health workers who attended the index case. This was a young pregnant woman, married to a hunter, who is thought to have fallen ill on 26 July, when symptoms of fever, diarrhoea, and bleeding developed. She died of Ebola virus disease on 11 August.

The announcement of those first cases immediately ignited worries that the virus might have spread from west to central Africa. WHO could put those worries to rest on 2 September, when its collaborating laboratory in Gabon, the Centre International de Recherches Médicales, released full sequencing data.

This was indeed Ebola Zaire, as in West Africa, but as the lab report noted, “the virus from Boende district is definitely not derived from the variant currently circulating in West Africa”. The DRC virus showed 99% homology with a virus from the 1995 Ebola outbreak in Kikwit, DRC.

DRC’s 7th Ebola outbreak

The current outbreak is the country’s seventh since the Ebola Zaire virus emerged there in 1976, in an area bordered by the Ebola River. A nearly simultaneous outbreak that same year emerged in South Sudan (then Sudan), but involved a different Ebola virus species – the Sudan species.

By 16 September 2014, the outbreak had grown to more than 70 cases, with 40 deaths. One of the biggest challenges in investigating and containing the outbreak is the remoteness of the affected area. One of the greatest assets is the high level of commitment and dedication shown by the government, from its President to its Minister of Health, Dr Félix Kabange Numbi.

At the start of the outbreak, the Minister of Health travelled the difficult route from Kinshasa to the remote Boende district to conduct a first-hand investigation in a situation where the only communication is by satellite phones, roads are rare and transportation for case detection and contact tracing relies on canoes, motorcycles provided by WHO, bicycles, and some four-wheel drive vehicles.

Rising to logistical challenges

Investigation and response efforts need to be understood in the context of some difficult challenges that go beyond the area’s remote location. Cases are occurring in densely forested communities that are home to around 54 000 people. The weather is extremely hot and humid, punctuated by frequent rains. Reaching safe water supplies requires a 12-kilometre journey through forests with no roads. “Lodging facilities” for technical staff means camping on the ground.

For the initial investigation and containments efforts, the Ministry of Health was supported by a WHO team that included the head of WHO’s DRC office, Dr Joseph Cabore, and Dr Jean-Marie Okwo-Bele, an experienced outbreak responder who helped DRC contain its 1995 Ebola outbreak in Kikwit. Apart from these staff, the response team included 10 epidemiologists, 2 logisticians, several clinicians from Mèdecins Sans Frontières (MSF) and – especially important – 4 psychologists.

A dedicated helicopter was provided by the United Nations, but the densely forested area first had to be cleared to create landing space. The World Food Programme is on the ground, rapidly improving the water and food situation. WHO deployed an IT specialist; communications have improved. Even a WHO videographer, in the area to record images, ended up helping in the construction of the area’s first 12-bed treatment facility. A fully functional mobile laboratory has been installed.

The number of cases and deaths is growing at a rate similar to that seen during other recent outbreaks of Ebola virus disease in this country. No predictions about its evolution or eventual control can be made at this point.

On 23 March, the World Health Organization published formal notification of an outbreak of Ebola virus disease in Guinea on its website. On 8 August, WHO declared the epidemic to be a “public health emergency of international concern.”

This assessment traces the early origins and subsequent evolution of the epidemic, and considers where we stand today, looking at current outbreaks in each affected country and some overarching trends – and surprises – in the overall epidemic. It also gives epidemiological projections of how the epidemic is likely to evolve.

Looking ahead

WHO is currently conducting systematic risk assessments to identify preparedness needs in neighbouring countries that are extremely worried about their susceptibility to an imported case and their capacity to respond. The results of the assessment, which will be made public soon, will guide preparedness support provided by WHO and its many partners in the Ebola response.

Theoretically, given the speed and volume of air travel, any city with an international airport is at risk of an imported case of Ebola. At the same time, worldwide vigilance is exceptionally high: WHO investigates around 20 to 30 rumoured cases each day. To date, all rumoured cases have been discarded.

Moreover, countries with well-developed health systems and services are unlikely to see much – if any – onward transmission of Ebola virus disease following an imported case. As today’s assessment of the situation in Nigeria and Senegal shows, conventional control tools can be highly effective at the start of an outbreak, even under some extremely challenging conditions.

This six-month situation assessment is dedicated to the scores of health workers treating Ebola patients in the Democratic Republic of Congo, Guinea, Liberia, Nigeria, and Sierra Leone, who, as an expression of our innately shared human compassion, risked their lives, and lost them.

Cumulative number of cases and deaths

The cumulative number of cases and deaths, officially reported to WHO from 23 March to 22 September, is 5,843 cases and 2,803 deaths. To date, 337 health care workers have been infected, and more than 181 of them have died.

Six-month assessments by country

Ground zero in Guinea: the outbreak smoulders – undetected – for more than 3 months

Liberia: misery and despair tempered by some good reasons for hope

Sierra Leone: a traditional healer and a funeral

Nigeria and Senegal: stable – for the moment

Democratic Republic of Congo: “classic” Ebola in a country experiencing its seventh outbreak

In Numbers

128,000 refugees have been registered arriving in Cameroon since January (in addition to staeless persons and Third Country Nationals)

113,000 persons have arrived in Chad (refugees, returnees) since January

In DRC there are some 63,000 refugees from C.A.R. (new + previous caseload)

In RoC there are 13,000 refugees from C.A.R. in Likouala

Situation Update

Port congestion challenges in Cameroon

Congestion at the port in Douala, Cameroon has resulted in extended lead times for food commodities to arrive in Cameroon. This has impacted the effective delivery of food commodities to WFP operations. WFP is working to explore new ways to overcome the challenges in Douala, including prioritization and diversification of cargos through alternative ports in the subregion and borrowing commodities from operations in nearby countries. The port in Libreville, Gabon has been identified as an alternative corridor and negotiations are under way with the customs authorities.

HIGHLIGHTS

44 Identified unaccompanied minors were assisted by UNHCR in Kinshasa

2,669 Central African refugees entered the DRC during this reporting period

4,226 Protection incidents recorded in North-Kivu. 1,939 in South-Kivu.

638 Former Angolan Refugees repatriated

Ebola in Liberia, Sierra Leone, and Guinea: As a three-day countrywide shutdown came to an end in Sierra Leone, the UN Security Council set up a special mission to lead the global response to the Ebola outbreak. More than 5,800 cases have been reported since the beginning of the outbreak, including 2,800 deaths, and more than 13.5 million people are now considered in need of assistance as the impact of the epidemic spreads.

Syria: Kurds flee IS advance on Kobane, and 138,000 refugees have been counted at the Turkish border. The US has launched airstrikes targeting IS bases, with the support of other states, while government airstrikes in Idleb, Homs, Rural Damascus, and Aleppo have killed over 100 people in the past week. Tens of thousands of civilians are trapped under IS control in Deir-ez-Zor. For lack of funds, WFP will be reducing the size of rations from October, with further cuts planned in November.

Yemen: Sanaa saw a significant escalation in violence, in which the Houthis gained control over much of the capital, including key government buildings, and 200 people are thought to have died. Houthi leaders have denied reports of a peace deal agreed with the Government on 21 September.

Updated: 23/09/2014. Next update: 30/09/2014

09/23/2014 17:46 GMT

KINSHASA, 23 septembre 2014 (AFP) - L'Union européenne a invité mardi la République démocratique du Congo à "dialoguer" avec l'opposition pour l'organisation des prochaines élections, afin d'éviter une "impasse" dans ce pays plongé dans une crise politique depuis la présidentielle de 2011.

"Le refus des autorités de se prêter à un réel dialogue, notamment au sujet de la séquence des élections et du changement de mode de scrutin, risque de conduire le processus électoral à une impasse", écrit la Mission de suivi électoral de l'UE dans le résumé du rapport final sur son séjour dans le pays en mai et juin.

La RDC traverse une crise politique depuis les élections présidentielle et législatives de 2011, remportées par le chef de l'Etat sortant Joseph Kabila et ses alliés. L'opposition n'a jamais accepté ces résultats et la communauté internationale a dénoncé de nombreuses irrégularités.

Aucune des autres élections qui devaient avoir lieu depuis lors ne s'est tenue. En vue d'achever le cycle électoral avant la prochaine présidentielle prévue pour 2016, les autorités ont inversé le calendrier en annonçant la tenue de scrutins locaux pour 2015, avant les élections provinciales et les sénatoriales.

L'opposition et de nombreux acteurs de la société civile ont dénoncé ce changement de calendrier et se sont élevés contre le projet de loi de révision constitutionnelle déposé par le gouvernement afin que les députés siégeant dans les assemblées provinciales soient élus désormais au scrutin indirect.

Dimanche, une coalition de députés de l'opposition ont annoncé qu'ils refuseraient de participer aux débats sur ce texte devant être examiné au cours de la session parlementaire en cours, ainsi que sur les différentes lois devant fixer le cadre des prochaines échéances électorales.

Ils soupçonnent que la révision constitutionnelle ne soit le prétexte à un changement de Constitution pour permettre au président Kabila, au pouvoir depuis 2001, de se maintenir au-delà de 2016.

La mission de l'UE a rappelé que les Vingt-Huit sont prêts à soutenir le processus électoral moyennant "certaines améliorations".

Comme l'ONU, l'UE recommande aux autorités congolaises de publier un "calendrier électoral complet, consensuel et assorti d'un budget détaillé" afin de permettre aux bailleurs de fonds d'aider à l'organisation des élections.

mj/tmo

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