These scenarios consider how migration dynamics within and via West and North Africa (including across the Mediterranean Sea) might evolve in the first half of 2019 and the potential humanitarian consequences.
These scenarios are not attempts to predict the future. Rather, they describe situations that could occur in the coming six months, and are designed to highlight the possible impacts and humanitarian consequences associated with each scenario. The aim is to support strategic planning, create awareness and promote preparedness activities for policymakers and other actors working on migration. The time frame is until June 2019 although the scenarios may remain valid some months longer.
ACAPS has developed these scenarios for the Mixed Migration Centre (MMC) under the DFID-funded Safety, Support and Solutions – Phase 2 programme.
This report documents the secondary humanitarian problems and impacts of largescale Ebola outbreak on the different humanitarian sectors, to provide a non-exhaustive plan to help future responders. A large scale Ebola outbreak, in this document, refers to an epidemic with an unprecedented scale, geographical spread and duration.
At the beginning of the crisis, the international community perceived the outbreak as a purely public health emergency. The response was oriented towards the containment of the epidemic and treatment of the sick patients. The initial focus was on providing beds for patients and mobilising health practitioners. The livelihoods, education or protection needs of the affected communities, indirectly caused by the outbreak, were left unaddressed.
The secondary humanitarian problems and impacts of the epidemic were extensive, and threatened the lives and livelihoods of more than 22 million people in the three most affected countries, Guinea, Sierra Leone and Liberia. The disruption of public and private services created an “emergency within the emergency”. Humanitarian actors failed to activate their surge capacity, or set up emergency funding and coordination structures, as a result of this perception of the crisis. It took time for the humanitarian community to recognise the complexity of the crisis and respond to the secondary impacts on other sectors. One major lesson learned during this epidemic has been the need to broaden the scope of the humanitarian response during a large-scale Ebola outbreak.
Reintegrating those most affected by Ebola back into their communities is central to a country’s post-Ebola recovery. The reintegration process helps those affected to cope with the impact of the outbreak and to regain a sense of normality. It is also an essential part of increasing community preparedness and building resilience to possible future emergencies such as a new epidemic or a natural disaster.
Out of approximately 28,500 suspected, probable and confirmed cases, nearly 11,300 people have died since December 2013. With such a significant caseload, everyone living in Sierra Leone, Guinea and Liberia was affected by the Ebola outbreak in some way. Ebola survivors and their households, grieving families, orphans, quarantined people and frontline workers are among the most affected groups. This report outlines the key challenges these groups face as they reintegrate into their communities, and explores the main challenges for the response in supporting them through the process.
Since the Ebola epidemic started it has killed at least 11,295 people, out of at least 28,295 reported confirmed, probable, and suspected cases. It began in Guinea in December 2013 and rapidly spread to neighbouring Sierra Leone and Liberia.
All three countries were highly vulnerable to external shocks before the crisis, and still are today, due to a combination of low socioeconomic indicators, high risks of natural hazards, and a history of poor governance and political violence. Chronic poverty and weaknesses in public services greatly contributed to the rapid spread of the Ebola epidemic, its scale and severity. The epidemic not only caused severe health issues, including high levels of psychological trauma among communities, it also further weakened health systems, and impacted food security and livelihoods.
As of 5 October 2015, the transmission of the virus has been confined to several small areas in Guinea and Sierra Leone; reported incidence has remained below 10 cases per week since the end of July this year. While surveillance and treatment efforts to stop the transmission and re-emergence of Ebola continue, the response is moving away from its emergency phase towards longer-term recovery and building a more resilient health system.
There have been 26,339 cumulative Ebola cases as of 4 May 2015, with 10,895 deaths. However, the outbreak shows signs of subsiding. At the end of April, Guinea reported under 30 cases a week, Sierra Leone under 20, and Liberia declared the outbreak over on 9 May 2015. The crisis has highlighted the weaknesses of existing infrastructure and institutions, which have not been able to respond to the additional strain. Many, like the health system, have been weakened further.
The Ebola outbreak appears to have had a limited short-term impact on the WASH sector. Delivery of WASH services in Sierra Leone and Liberia were, for example, far more affected by civil war during the 1990s and 2000s. Despite WASH being addressed by the Ebola response , it necessarily remained secondary to the health sector. Assessments have been planned to scrutinise the impact of Ebola as a whole, at least in Liberia, but there are almost none completed to date. This, coupled with the limitations of available information, has led to a sporadic and an incomplete picture of the exact impact of Ebola on the WASH sector in all three countries.
Yet its impact must not be ignored. Pervasive unhygienic conditions and use of unsafe water have been identified as a key underlying factor in thousands of deaths prior and during the Ebola outbreak. In the medium to long-term, lack of development in the WASH sector is a constant burden to the three countries’ recovery and development. Addressing WASH development offers the opportunity to greatly increase the quality of life. In Liberia it has been estimated that improvements to the water supply could reduce diarrhoea morbidity by 21%, while improved sanitation facilities could reduce diarrhoea morbidity by 37.5%.
This document summarises the baseline data on WASH available for each country. It then provides an overview and analysis of the known and probable impacts of the Ebola outbreak on the WASH sector at both the community and facility level. Relevant aggravating factors not linked to Ebola are described, and WASH-related areas that present a possible risk to the people of Liberia, Sierra Leone, and Guinea are highlighted. Information gaps and lessons learned are outlined at the end.
Au 19 avril, 3 151 cas confirmés d'Ebola avaient été signalés en Guinée, et 2 358 personnes avaient succombé à la maladie (OMS, 20/04/2015). Une certaine réticence visà-vis la réponse humanitaire contre Ebola a été constatée. Des incidents violents ont éclaté dans certaines régions, ce qui a entravé l'acheminement de l'aide et l'accès du personnel humanitaire aux communautés. Des agents humanitaires ont parfois été contraints d'interrompre leurs activités à cause de problèmes d'insécurité. Des cas de réticence ont également été recensés au Libéria et en Sierra Leone, mais c'est en Guinée que l'opposition était la plus forte et la plus virulente.
Un ensemble complexe de facteurs sous-jacents a été identifié. Un certain nombre de facteurs, qui existaient déjà avant la flambée de l'épidémie, ont été aggravés. D'autres facteurs sont apparus en raison de la nature de l'épidémie et suite aux interventions mises en œuvre. Le présent rapport vise à analyser le niveau de réticence de la population à l'égard de la réponse humanitaire contre Ebola en Guinée en dressant un bilan de la situation actuelle et future en fonction de l'évolution de l'épidémie, et en étudiant les facteurs sous-jacents et aggravants.
As of 19 April, the Ebola outbreak has infected 3,151 people in Guinea, 2,358 have died (WHO, 20/04/2015). The epidemic has been characterised by incidents of resistance to the response. In several areas these incidents have been violent and this has impacted humanitarian access to certain communities. At times humanitarian actors have had to temporarily suspend their activities because of insecurity. Liberia and Sierra Leone have also reported resistance, but it has been much more frequent and violent in Guinea.
There is a complex network of underlying causes. Some were factors dating from before the outbreak, which have been exacerbated during the epidemic. Others are factors at play specifically because of the nature of the outbreak and the response. This report aims to analyse the resistance to the Ebola response in Guinea, by outlining the current situation and the evolution over the course of the outbreak, and exploring underlying and aggravating factors.
Le nombre cumulé de cas d'Ebola signalés en Guinée, au Libéria et en Sierra Leone est de 23 694. Au 22 février, 9 589 personnes avaient succombé à la maladie. Il s'agit donc de la plus grande flambée d'Ebola de l'histoire. Depuis janvier 2015, le taux d'incidence de la maladie s'est stabilisé dans les trois pays et les opérations devraient progressivement céder la place aux activités de relèvement.
Le grand nombre de cas d’Ebola a ébranlé les systèmes de santé fragilisés et défaillants des trois pays les plus touchés. Les ressources (humaines et financières) limitées ont été redirigées vers les programmes de lutte contre Ebola et les établissements de santé ont soit fermé leurs portes pour une durée indéterminée, soit réduit leurs activités.
La défaillance des systèmes de suivi et de surveillance des maladies autres qu'Ebola ont entraîné d'importantes lacunes en matière d'information. Peu de données sont disponibles en ce qui concerne les autres problèmes de santé, y compris les flambées potentielles de maladies, l'accès au traitement contre le VIH/sida ou la tuberculose, l'incidence du paludisme et l'accès aux services de santé maternelle, aux campagnes d'immunisation et aux médicaments.
De nombreuses personnes hésitent à se faire soigner dans les établissements de santé de peur d'être contaminées et en raison d'une certaine méfiance à l'égard du système de santé, ce qui entraîne d'autres répercussions sur le secteur de la santé et risque d'augmenter les taux de mortalité et de morbidité liées à des maladies pourtant guérissables.
The reported cumulative number of Ebola cases across Guinea, Liberia and Sierra Leone is 23,694, including 9,589 deaths as of 22 February, making it the largest EVD outbreak ever recorded. Incidence has been stabilising in all three countries since January 2015, and the response is moving towards early recovery.
The large number of Ebola virus disease (EVD) cases has overwhelmed the weak and under-resourced health systems in the three most affected countries. Scarce resources have been diverted to the Ebola response, and health facilities have been temporarily closed or reduced operations.
The lack of monitoring and surveillance for diseases other than Ebola has led to big gaps in information. Little information is available on other health problems, including potential disease outbreaks, access to treatment for HIV/AIDS or tuberculosis, the burden of malaria, and access to maternal health services, immunisations and medication.
Fear of contracting EVD and mistrust of the health system has made people reluctant to seek treatment from health facilities, further impacting the health sector and increasing the risk of mortality and morbidity from otherwise treatable diseases.
Around 22 million people are estimated to live in the three countries most affected by the Ebola epidemic, Guinea, Liberia, and Sierra Leone. As of 3-4 November, the estimated cumulative number of confirmed Ebola virus disease (EVD) cases reported by WHO in the three most affected countries is 13,241 including 4,950 deaths. However, the numbers of registered cases and deaths seem to underestimate the real magnitude of the outbreak.
If not addressed in the coming weeks, the consequences of the outbreak will lead to long-lasting impacts on farmers' food livelihoods and household economies, resulting in a major food security crisis by March 2015. The most affected areas within each country are also the most agriculturally productive. Reduced food trade and rising prices, as well as expected reductions in domestic harvests, are all undermining a fragile food security situation.
Control measures implemented to contain the outbreak, such as border closures, quarantine, movement restrictions, curfews, have curtailed the movement and availability of food, goods, and services in the region, leading to panic buying, food shortages and increased basic food and commodity prices. Higher food prices and the loss of purchasing power mean an increasing number of vulnerable households are resorting to negative coping strategies in order to access food.
Food insecurity and lack of access to markets have been increasing community tensions. Lack of food in quarantined areas has led to violence.
A multidimensional and multi-sector approach is required to contain the outbreak and stabilise affected areas while safeguarding against a long-term food security crisis.
UN and national officials are warning of the serious threat Ebola is posing to the safety of the countries. In a statement to the UN Security Council on 9 September, the Liberia’s Defence Minister warned its national existence was "seriously threatened" by the Ebola virus.
The Governments’ poor management of the epidemic has generated deep frustration among the three countries’ societies, and the security situation, particularly in Liberia, is gradually deteriorating. The Ebola crisis has exposed citizens’ lack of trust in their governments and exacerbated social tensions, increasing the possibility of profound unrest in these fragile countries. The lack of a prompt, robust, and efficient response from the international community contributes to the mistrust.
Children and women have been deeply affected by the EVD outbreak. Children related to people with EVD have been abandoned. Children are extremely vulnerable and in critical situations in the three most-affected countries due to the loss of a parent.
As of 21 September, the estimated cumulative number of confirmed Ebola virus disease (EVD) cases reported by WHO in the three most affected countries (Guinea, Liberia, and Sierra Leone) is 6,242, including 2,909 deaths. The ‘hidden caseload’, however, is unprecedentedly large, and these figures are believed to include only a fraction of all cases in this rapidly spreading epidemic.
According to a WHO projection, the aggregate caseload of EVD could exceed 20,000 by early November. Other agencies project the possibility of more than ten times as many cases, use different assumptions such as transmission to other countries, and evolution of the virus towards easier transmission between people.
The humanitarian community is already overwhelmed with the management of the epidemic and is greatly challenged in facing all the implications of this unprecedented and complex regional crisis. The current outbreak in West Africa is by far the largest ever recorded, and already numbers more cases than all past Ebola epidemics combined. 26 million people are estimated to live in the three most-affected countries. The epidemic started in Guinea in December 2013 but was only identified in March, and spread to Liberia, Sierra Leone, Senegal and Nigeria.