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Why response time will make the difference between Ebola calamity and containment

The director of the World Health Organization called Ebola's ravaging effects on West Africa a “crisis for international peace and security.” Jeffrey Brown speaks with David Miliband of the International Rescue Committee about the conditions driving the emergency, the challenges of breaking the cycle of transmission and the existential and political consequences of the epidemic.

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    And now to the devastating effects of the deadly virus overseas.

    Jeffrey Brown has that.


    As we reported earlier, the director of the World Health Organization, Dr. Margaret Chan, issued a dire assessment today of Ebola's ravaging effects on West Africa, saying it's, unquestionably, the most severe acute public health emergency in modern times and a crisis for international peace and security.

    As a former British foreign secretary, our next guest is no stranger to peace and security crises. David Miliband is now head of the International Rescue Committee and just returned from Liberia and Sierra Leone, the two nations hardest hit by the epidemic.

    Mr. Miliband, thank you for joining us once again.

    As we see a first case in this country of a nurse contracting Ebola, what is the situation for health workers in Africa, including those in your organization?

  • DAVID MILIBAND, Former British Foreign Secretary:

    The head of the World Health Organization has used the word dire. That's clearly true. It's a very dangerous place, above all to be a health worker.

    The death rate amongst health workers outstrips that of the civilian public population. And what we're talking about is a very virulent disease which is hard to catch in a Western situation, but in conditions of overcrowding, lack of sanitation, lack of water supply and lack of electricity, it's very dangerous indeed.

    And for health workers, they're on the front lines, because it's the direct bodily contact, an exchange of bodily fluid that makes this dangerous for them. The staff I met were obviously afraid, but they know that they face risks both at work and in their own homes, because there isn't a good enough system yet to get the infected people out of their homes, into isolation centers.


    Well, speaking of systems, there's been a lot of focus of course recently on international support. What about local systems, local government? Are they able to keep up at this point?


    Well, the short answer is no.

    I think that the disease is outstripping the response at the moment. And while it's natural that there should be a focus on emergency treatment for those who have got the disease, it's absolutely essential that we break the chain of transmission. It's people in their homes with the disease, showing the symptoms, who are infecting their relatives and sometimes neighbors, relatives who might live in a house of 20 or 30, in the middle of Freetown, the capital of Sierra Leone, or Monrovia, the capital of Liberia.

    It's those conditions and the failure to get those who are suffering from the disease out of their homes that is spreading it. Just one other point to your question about the health systems in general, if you have got malaria in that — in one of those two countries, you're not getting treatment.

    If you have got basic fever, you have got — you're not getting treatment. If you have got diarrhea, you're not getting treatment, because the health systems have broken them down. And that makes the challenge both for non-governmental organizations like my own and the international system that much greater.


    Is there an understanding in the public, among health workers or officials in these countries, did you sense an understanding that this will be going for we have heard 18 months, two years, this is a long struggle that will be hard to get under control?


    It is a long struggle. But you have got to be careful with long struggles, because it suggests you have got a lot of time.

    I think what is important is that we realize that the next weeks and months — really weeks actually — will decide whether this becomes an epic of absolutely monumental proportions. After all, the Centers for Disease Control have talked about a million people being killed, whether it reaches that calamity, or whether it's contained into the low tens of thousands.

    And I wouldn't want people to think that just because this is a long-term war, will be a long-term fight, that somehow the short-term doesn't matter. The next few weeks and whether or not this disease spreads from the single digit thousands to the tens of thousands is absolutely key to its long-term course. That's why I talk about both countries being at a tipping point.


    Well, and Margaret Chan of WHO pointed to political implications, the state — the potential of states actually failing. So this goes beyond a health crisis.


    I think it's very, very important to see that this is more than a health crisis.

    The president of Sierra Leone has said that the very survival of his nation is at stake. It's a political emergency of major proportions. You don't get NGOs calling for the military to come in, but that's what's happened with Western NGOs supporting the rigor and the logistical capacity that comes with some of the military and the manpower that comes with the military endeavor.

    My point is, though, we have to see this as a system that proceeds from infection, through to treatment, through to burial and disposal of bodies. Unless you deal with all parts of the chain, then you won't be able to contain the disease. And that's why it poses such a dire threat, not just to individuals, but also to the country's concerns.


    David Miliband of the International Rescue Committee, thank you so much.


    Thank you.

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