Ebola 29 Sept 2014

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EBOLA
SITUATION
REPORT
Compiled by Songhai Advisory LLP with
input from BCA In-Country Directors
ABSTRACT
This briefing updates members of the
Business Council for Africa (BCA) on the on-
going Ebola outbreak and its implications for
the affected countries.

1
Songhai Advisory LLP 2014. All Rights Reserved

Contents
BRIEF OVERVIEW ............................................................................................................ 2
GUINEA ........................................................................................................................... 4
LIBERIA ............................................................................................................................ 4
SIERRA LEONE ................................................................................................................. 8
NIGERIA ........................................................................................................................ 10
SENEGAL ....................................................................................................................... 13

METHODOLOGY
The Situation Report draws on information gathered from open source government,
media and international actors such as the World Health Organisation. Importantly, it
also incorporates the on-the-ground experiences of the BCA In-Country Directors in
Guinea, Liberia, Sierra Leone, Nigeria and Senegal. A special thanks goes out to them
for sharing their invaluable insights at this time.
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BRIEF OVERVIEW

Ebola in Numbers

The World Health Organisation (WHO) has confirmed that
there have been 3091 reported deaths owing to the Ebola
virus, at the time of writing.
4507 confirmed and probable cases were reported to the
WHO between December 30, 2013, and September 14,
2014 a 37-week period.
718 confirmed and probable cases and 289 deaths were
reported in the week of September 8 through September 14 alone.
By September 23, a total 211 deaths had been reported among health care workers.
According to the WHO, 90% of reported Ebola cases have been recorded in 14 of 63 districts
spread across Guinea, Liberia and Sierra Leone. The concentration of cases in these 14 districts
can be explained in part by the inter-connectivity of these border areas, through trade and free
movement of persons in densely populated areas coupled with ineffective control measures.
The US Centre for Disease Control (CDC) estimates that if trends continue without scale-up of
effective interventions, by September 30 2014, Sierra Leone and Liberia will have a total of
approximately 8000 Ebola cases. A potential under-reporting correction factor of 2.5 was also
calculated. Using this correction factor, approximately 21,000 total cases will have occurred in
Liberia and Sierra Leone by September 30
th
2014.
Similarly, the WHO has stated that up to 20,000 risk infection in the next six weeks. Months
ahead of earlier projections. WHO Director General warned we should expect things to get
worse before they get better.

International Interventions

US to send up to 3000 troops to build 17 treatment centres and train thousands of healthcare
workers. But camp hospital will have only 25 beds according to UNDP head in Liberia. The
Pentagon to build a field hospital and treatment unit in Liberia, Guinea, and Sierra Leone along
with the establishment of a United Nations emergency mission to respond to the Ebola outbreak
as positive steps.
UK is boosting its first military and humanitarian mission it said, on 23 Sept. 164 staffers from UK
National Health Service volunteered to work in West Af
Cuba, China, Uganda, France will also send medics.
United Nations: UN Secretary General, Ban Ki Moon: states that the UN should consider creating
a corps of health workers, a standby-force, deployed to countries in emergencies.
World Bank: It will double its funding to fight the disease, to US$400 million to assist worst
affected countries. 230 emergency response 170 for medium and long term projects.
WHO: Coordinating global outbreak response.
Medecins Sans Frontiers: It is calling for a centralized system, which can be used each time an
aid worker falls sick. Desperate need for isolation centres for those infected.
African Union (AU): The AU has formed its AU Support to Ebola Outbreak in West Africa
(ASEOWA) drawing 30 volunteers from Uganda, Rwanda, Democratic Republic of Congo, Nigeria
and Ethiopia.

It should be noted that the WHO
considers these figures to be an
approximation only and that the
actual number is far higher
because of unreported cases.

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Control Measures: where Ebola is suspected i.e. Illness in any person, alive or dead, who has (or
had) sudden onset of high fever and had contact with a person with a suspected, probable, or
confirmed Ebola case or with a dead or sick animal; any person with sudden onset of high fever and
at least three of the following symptoms: headache, vomiting, anorexia or loss of appetite, diarrhea,
lethargy, stomach pain, aching muscles or joints, difficulty swallowing, breathing difficulties, or
hiccupping; or any person who had unexplained bleeding or who died suddenly from an unexplained
cause the below control measures are employed

o Tracing all the people with whom an infected person has come into contact
o Isolation of infected persons
o Improved clinical management
o Supervised and safer burials
o Community engagement
o International support from partners

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LIBERIA

Recent Developments

Norway to Donate US$150 million: Norway is to donate US$150 million over the coming six
years to Liberia for the purpose of helping the government to halt illegal logging. It is
considered by some scientists that illegal deforestation is the cause of the latest Ebola
outbreak, by ridding the fruit-bats- carriers of the disease- of their natural habitats.
Liberian Diaspora Mobilising Funds: Liberian Association of Metro Atlanta is an association of
the Liberian Diaspora community in Atlanta, Georgia, home to an estimated 25% of the
80,000 Liberians resident in the US. It is a not for profit organization designed to promote
peace, unity, progress and social awareness among citizens of the Republic of Liberia
residing within Metropolitan Atlanta which has reportedly been mobilizing its members to
channel money back home to help in stemming the onslaught of the virus.
The WHO records four new deaths in the south-western Grand Kru district

Impact on Economy/ Business Activity:

Liberia was forecast to grow above regional averages this year on the back of iron production and
associated foreign direct investment. The present Ebola crisis looks set to retard activity across
services, agriculture and industrial sector activity alike this year. Market closures make it difficult for
market traders-some goods prices have risen by 10% since the crisis began according to local
traders. Sime Darby, one of the largest palm oil producers, has slowed output in Liberia.
ArcelorMittal, the worlds biggest steelmaker, has put plans for expansion on hold as contractors
transfer staffers outside of country. Dangote, the largest cement producer in Africa, has evacuated
some staffers out of Liberia and estimates growth levels will be reduced by one percentage point as
a result of the Ebola virus.

Population: 4 million approx.
GDP: USD2 billion approx.
Healthcare:
- Physicians per 1000 population:
0.014
- Total expenditure on health as
%GDP: 19.45
- Total cases: 3280, according to
CDC
- Deaths: 1677, according to CDC
- Reported cases in Liberia are
doubling every 15-20 days,
according to CDC.
-
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View from The Ground: Interview with BCA In Country Director, David Frankfurt

How has the Ebola crisis impacted upon your daily life in Liberia?
A big new stress being careful, limited contact with people, very limited socializing

How would you describe the effects on the economy?
Severe - arrival of health workers, USA forces will be a "band-aid" for the time they are
here - mainly in areas of hotels, food.

Do you have confidence in the domestic and international community response where you
are and why?
This stage of the epidemic is more than the majority if not all the world can handle -
coordination of supplies, having qualified personnel in health care and so many other areas,
and working with NGOs, worldwide organisations that have specific remits - is in itself
overwhelming

We re trying to maintain a certain level of normality [at work], just to keep the
offices going, because this is going to end soon, it wont be forever. Some of [the
mining companies] have scaled down but some of them are still there, maintaining
some level of skeleton staff.
Mining Sector Executive

6
GUINEA

Recent Developments:

Abduction & Killing of Journalists/Health Workers:
Last week (16
th
September) eight health workers and
journalists were killed in the village Wome, South
Eastern Guinea. This week, a Red Cross team faced
attack when collecting bodies believed to have been
infected by Ebola. One worker is reportedly
convalescing in Forecariah. The perpetrators were reportedly family members of the
deceased who reportedly threw rocks, vandalised cars and attacked the regional health
office.
The virus spreads for the first time to the mineral rich Kindia district, 80 km from Conakry.

Impact on Economy/ Business Activity:

Guinea is replete with iron ore and bauxite and as such, a number of international firms exploit its
resources in the mineral rich regions, some of whom are still operating in the country in spite of the
outbreak. London-listed gold miner Avocet Mining operates the Tri-K project in eastern Guinea,
close to the countrys second-largest city of Kankan. Although there have been reported deaths
resulting from Ebola in Kankan, the mining company says that it has not experienced the effects of
the disease on its operations. Anglogold Ashanti operates a gold mine in Siguiri, in the northeast of
the country, also in the Kankan region. The miner also says that its operations are unaffected
although it notes that there have been reported cases some 25km away from the mine. Its
preventive measures include restricting the movement of its employees and creating more
awareness campaigns on hygiene. For Brazilian firm Vale which has been involved in a legal battle
with the Guinean government over rights to the northern half of the much-coveted Simandou iron
ore mine, it recalled its six international staffers from Guinea back in April of this year. It has also had
to put its local staffers on leave. Rio Tinto, which has a stake in the southern half of the Simandou
iron ore deposit, donated US$100,000 to the WHO in the tackling of the Ebola crisis. France, UK and
the US have all advised against travel for their citizens. Saudi Arabia has said that it will not grant
visas for passengers coming from Guinea Conakry and other affected countries.

Healthcare:
- Physicians per 1000
population: 0.18
- Total expenditure on health
as % GDP: 5.96
- Although the system
remains week, gains in
health outcomes have been
made in recent years e.g.
halving of infant mortality to
100 per 1,000 live births
- Total cases:1022
- Total deaths: 635

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View from The Ground: Interview with BCA In Country Director, Biro Diallo

How has the Ebola crisis impacted upon your daily life in Guinea?
In general, the awareness level is high, hence a strong belief in reducing shaking hands and
cleaning them on a regular basis with appropriate disinfectant solutions. However it is important
to note that the population has different levels of awareness and some are still in denial. Either
way it has an impact on peoples day to day.

How has it affected your business/ your industry in general?
The industry has seen a great reduction in activities, this is mainly caused by the restrictions
imposed in some areas of the country. My industry is spread across the country, hence affected
by Ebola.

The economical impact is slowly coming to surface; most businesses are running slowly or have
stopped. If this continues for too long it may have other consequences such as shortage of food
and bear necessities.

What has been the impact on the political situation in the country?
Politically, the pressure is on the Government to show better control of the situation.
[Government] is reactive to these pressures.

What has been the impact on the security situation in the country?
In my view not much visible impact on the security, some isolated cases of insecure events from
the populations.

Do you have confidence in the domestic and international community response where you are
and why?
The government may have good intentions towards fighting Ebola in Guinea, but not sufficient
capacity at local level where it matters. I do not think there is total control over the people who
have been in contact with infected persons.

What do you think the outlook is for the ebola situation?
The situation will linger around for while in my view, and if not controlled on time with strict
measures could be devastating, and worse if mixed with the political machine could result in
chaos.

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SIERRA LEONE

Recent Developments:
Three-day Lock Down Hailed a Success: A three- day lock-down which took place Port Loko,
Bombali and Moyamba. was hailed as a success by the authorities. It was a means for the
country to assess the scale of the problem as 30,000 volunteers went door to door to sensitize
the population and to ascertain the number of those infected.
Presidents Plea: Joining the UN conference via videoconference, President Ernest Bai Koroma
called for the bans on flights by airlines to be lifted although Sierra Leone has sealed off its
borders to Liberia and Guinea (in spite of AU pledge to lift restrictions).
Impact on Economy/Business Activity:

Sierra Leone was set to perform well economically also, reaching 20% per annum between 2011 and
2013. The IMF was forecasting around 15% for 2014, however the outlook is significantly damaged
by the ongoing crisis. The ban on public gatherings precludes normal market/trading as well as
traditional modes of agriculture which include group farming. One of the main exports of Kailahun,
one of the hardest-hit areas, is coffee and cocoa. But the absence of safe crop seeds will severely
affect output. The ban on fairs and public gatherings has prevented farmers from planting and
harvesting. Average inflation was 10% in 2013. Currently, some newspaper reports describe a 30% or
more increase in the price of basic foodstuffs since the outbreak began. Major foreign companies
such as African Minerals have announced the transfer of some personnel abroad and reportedly put
expansion plans on hold.

A View from the Ground, In Country Director, Sheka Forna

How as the Ebola situation affected your daily life?
One voluntarily restricts ones movements and actively discourages unnecessary visits - not
always easy in the African context. More care is taken of hygiene (hand washing) and physical
contact limited (no handshaking or hugging). Schools are closed, with those who can afford to
sending their families abroad. Restrictions on bars, cinemas and night-clubs will no doubt be
affecting the younger generation. Otherwise its life as normal.
Healthcare:
0.2
- Total expenditure on health as %
GDP: 15.1
Total cases: 1940, according to CDC.
Total Deaths: 597, according to CDC
Reported cases are doubling every
30-40 days, according to CDC

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How has it affected your business/ your industry in general?
Two of my clients have suspended operations. Others are less active.

Business generally is slow. The slow down is referenced in almost all conversations. The economy
is driven primarily by the activities of the mining companies, most of which are operating under
virtual lock-down conditions. The tourism and entertainment sectors are hard hit. Agriculture is
reportedly affected. Discretional businesses have closed shop or cut back. The Minister of Finance
has revised growth forecasts.

GoSL has taken a good deal of criticism for their handling of the crisis, particularly from
opposition supporters, but increasingly from the middle classes. Although some newspapers are
openly critical, outright criticism in-country is rare, with social media the preferred medium. The
stirring of middle class voices is interesting as they are normally loath to enter political debate,
which appears to be of concern to GoSL with some reporting threats to them or their families by
government sympathisers.

What has been the impact on the security situation in the country?
There have been reports of instances of unrest in Kailahun, the epicentre of the outbreak, with
isolated cases elsewhere. Generally the situation appears calm and the populace unconcerned
with regard to possible unrest.

and why?
The domestic response seems confused, with a continuing flow of mixed messages, while recent
reports by CDC and WHO do not inspire confidence. However there has been a noticeable step up
in efforts by all parties at home and abroad.

What do you think the outlook is for the Ebola situation?
Contact tracing and the altering of traditional practices seem to hold the key to stemming the
outbreak. There is no reason otherwise for the continuing rate of infection. Unless the various
agencies engaged in containing the virus can address these two areas the predictions of the CDC
and WHO may prove to be accurate.

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NIGERIA

Latest Developments

President Goodluck Jonathan Declares Nigeria Ebola Free: Addressing the UN General Assembly
in New York this week, Jonathan said We can confidently say that today Nigeria is Ebola-free.
While Nigeria appears to have contained the virus, as noted by the WHO, the emergency centre
for Ebola in Lagos says that in order for the outbreak to be officially declared over, there cannot
be any cases within a 42 day period. No new cases have been recorded by the WHO since 8
September.

View from The Ground: Interview with BCA In Country Director, Peter Crabbe

How has the Ebola crisis impacted upon your daily life in Nigeria?
Initially, at least in Lagos, there was certainly a reduction in social intercourse, with many people
refusing to shake hands with anybody, even their own family and friends. Indeed one Christian
church suggested that the traditional peace sign/action be dropped from Sunday services.
Once it became clear that EVD was not spreading quickly, old courtesies quickly returned.
All hospitals and the bigger companies quickly insisted that staff and visitors should use hand
sanitizers before entering their premises and this is still in place. Once they became available,
many companies now also apply body temperature checks to staff and visitors. Many social
clubs and private houses also now voluntarily have hand sanitisers available.

The fact that the Federal Government stopped all schools from resuming after the long vacation,
had a major effect on family life. The public schools were only allowed to resume last week but in
some states, Lagos especially, this has been deferred to October 8
th
, to allow additional washing
facilities to be provided in schools and to give training to staff in recognizing the EVD symptoms.
Private schools in Lagos were allowed to resume on September 22
nd
provided that their staff had
adequate training and that a qualified nurse would always be available on-site. Even so,
GDP: USD510 billion
Healthcare:
0.4
%GDP: 6.1
Total cases: 20, according to CDC
Total Deaths: 8, according to CDC
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everybody entering is still subject to temperature checks, although these will probably be slowly
and quietly dropped.

One beneficial effect of the schools being closed, is of course that morning traffic flow has
improved.
There has been little disruption to international flight arrivals and departures. Body temperature
checks are being undertaken on arrivals but whilst they are in the immigration queue, so there
has not been any further delay. The airport health authority staff havs been polite and efficient
and nobody has complained.

One long term benefit flowing from the EVD crisis could be that schools and people generally are
much more aware of the need for personal hygiene and more hand washing facilities are being
made available in schools.

A number of expatriate families with children have deferred their return to Nigeria, because of
the closure of schools because of the EVD. This is particularly true for the American International
School which was due to resume in mid August, some weeks before the other schools. A number
of these families have put their children into new schools overseas, rather than have them sitting
at home for 2 months; it remains to be seen whether they will now return to Lagos.

What has been the Effect on business/industry/economy/security in general?
Apart from the additional sanitization procedures referred to above, which are not unduly time
consuming, there has not been any appreciable impact on business life. Clearly there has been
some disruption to family life with working mothers having to make alternative arrangements for
looking after the children at home during the day but this does not seem to have been a serious
issue.

There is evidence that several regular business visitors to Nigeria have deferred trips planned for
September; they should now be preparing to come out in October.

With national elections looming in 2015, the Nigerian political scene is very active at present but
the presence of EVD, proven in only 2 states, has not had any effect on the political planning and
scheming. There has been some mud-slinging in that the considerable sums, estimates of which
vary greatly, made available by the Federal Government for the purchase and distribution of EVD
test kits and educational materials have not, it is alleged, reached the States Ministries of
Health, so there are the usual allegations.

and why?
Generally the Government is perceived as having responded surprisingly well to the crisis.
In the very first instance, the initial EVD case was taken to a private hospital for treatment,
rather than to a public facility as the public hospitals were largely inactive, due to a strike by
public service doctors. That private hospital did not pick up the possibility of EVD for 24 hours, as
they were not told that the patient had originated his journey in Sierra Leone. Once EVD was
recognized the hospital was put into quarantine, and indeed it still is. Very sadly the lady doctor
who first treated the initial case caught the disease and subsequently passed-away.
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There has been some criticism in the less well informed press that no vaccines were made
available and that none of the experimental drugs were sent to Nigeria, but that apart the
international response is perceived as being helpful and supportive. The fact that the WHO has
been publically active in advising the various levels of Government is acknowledged.

What is the Outlook for Ebola in Nigeria?
EVD is seen very much as an imported disease and it is important that checks on arriving
passengers from west African countries continue to be vigorously undertaken. One concern is of
course that with air travel to affected countries virtually shut down, there could be a greater use
of land transport, given the propensity for Africans generally to move about and to trade. The
land borders are impossible to police effectively and it has to be hoped that the disease is not
brought in again, say by a long distance truck/bus driver.

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SENEGAL

Latest Developments

WHO declares Ebola to be contained in Senegal:
The UN health agency announced this week that
it has not recorded a new case of Ebola since 29 August and that along with Nigeria, the
outbreaks are pretty much contained.
A View from The Ground, BCA In Country Director, Landing Goudiaby.

How has the Ebola crisis impacted upon your daily life in Senegal?
Regarding Ebola in Senegal, the only case which existed in the country came from a young
Guinean who had gone through the Guinean-Senegalese border. There is no more fear
because the young patient (a student) was admitted and was treated at a University Hospital
in Fann. The doctors here declared that he had been treated, at which point, he returned
back to Guinea.
Also, the Ministry of Health in Senegal placed the people who had been in contact with him
into quarantine. In the end, none of these people showed signs of Ebola. Thus the Minister of
Health, Awa Marie Colle Seck confirmed that there is not a single case of Ebola in the
country.

The campaign for the prevention of the disease is intensifying because even the private
companies have come together, even companies like Orange is giving away hygiene kits and
is offering money to support the government through the Ministry of Health.

Furthermore, preventive and detective measures are in place at the International l'Aroport
and at the port of Dakar. In terms of communication, one continues to see messages being
circulated around to sensitize the population about the fever and the sanitation practices to
adopt in order to detect and prevent the illness.

Population: 13 million
GDP: USD15.5 billion
Healthcare:
%GDP:
Total reported cases: 1
Deaths: 0

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