Dr. Gabriel Fitzpatrick:

I thank committee members for giving me this opportunity. I have just returned having spent one month working as a doctor and an epidemiologist with Médecins Sans Frontières, Doctors Without Borders, in Kailahun, Sierra Leone where it built an 80-bed treatment centre. It is one of six such centres operated by it in the west African region.

During my time at the ebola treatment centre I witnessed some of the most heartbreaking scenes I had ever encountered. On many occasions I helped with triage and the admittance of patients to the centre. This job entailed reviewing people arriving at the centre and deciding who to admit. I remember a mother who had arrived with all four of her children, the youngest of whom was under two years of age. They were all sick and the father was already dead. The mother was terrified as she knew something awful had infected her family and within days all were dead. I saw ebola cause heavily pregnant women to curl up and die. I watched in despair as brothers and sisters passed away side by side within hours of each other. I recall admitting entire families to the treatment centre and watching very few leave. A significant proportion of admissions were of children and seeing them die was a damning sight, as their suffering cannot be described.

I worked as an epidemiologist at the MSF treatment centre, which involved trying to figure out how ebola was spreading in the community and, crucially, predicting where new cases might occur. I regularly travelled in a two vehicle convoy to remote jungle regions looking for potential cases. One day I arrived at a designated village after a three hour journey. I spoke to the village chief to obtain his permission to talk to the villagers. He was honest and stated he did not know how many were sick because he was too scared to check in case he contracted ebola. We were directed to a suspect house and as I approached, I could see an ill lady sitting outside in a chair. She was trying to breastfeed her infant son who was crying. I asked her to stand in order that we could take her temperature, but she was incapable of doing so. Instead bloody diarrhoea poured down the insides of her legs. She was too exhausted to care, but, despite her condition, she held her child as tightly as possible. When we eventually managed to take her temperature, it was over 38 degrees. I spoke to her husband and indicated that it was most likely that his wife had ebola. He broke down crying, as he did not want his wife to leave, but he did not want her to stay either owing to the risk of infection for the rest of the family. This conflict of emotions caused him to fall to his knees on the ground in desperation. The mother continued to embrace her child but eventually agreed to accompany us to the MSF treatment centre, leaving her family behind. I took the husband's mobile phone number and promised to telephone him every day with an update on his wife's condition. Less than 48 hours later we called him with the news that she had died. The separation of families in the community during this outbreak is a devastating daily fact of life.

During my work at the MSF treatment centre it was clear that a large number of health care staff from Sierra Leone were infected with the ebola virus and subsequently died. In the MSF centre we treated doctors, nurses, laboratory technicians and ambulance drivers from local hospitals and local health care centres. It was an extremely disturbing sight to see health care colleagues die from this disease.

On a personal level, I worked with one of the nurses in the MSF treatment centre who, unfortunately, contracted and died from the virus at the end of August. He was a very hard-working individual who tended to his patients with the utmost care and was admired by all members of staff. He was born in and grew up in Sierra Leone and immediately signed up to work with the MSF facility when it opened as he knew these types of facilities were critical to stopping the outbreak. We admitted him to our centre on a Saturday morning and the died the following Wednesday evening.

The case fatality rate at the ebola treatment centre in Kailahun was a little less than 70%. This means that 7 out of 10 people confirmed to have the disease died within five days of being admitted to the centre. I sometimes helped with the removal of bodies from the wards and saw how this affects other patients in those wards. During the last week of August a 60 year old lady passed away. Along with a team of four other staff I helped to prepare her body. We sprayed it in chlorine, wrapped it in plastic and carried the body from the ward. I knew the surrounding patients were terrified. This was another of their neighbours gone.

During my work in remote villages in eastern Sierra Leone it was impossible to ignore that the normal health care system was failing to function. I have met patients who cannot get access to standard drugs for malaria or simple bacterial infections. Government-run clinics were turning away patients fearing they had ebola when in fact they had other infections which could have easily been treated. This developing situation is causing an unknown number of deaths in the community. The one amazing story to come from the ebola treatment centre is that of the survivors. During the time I worked there more than 90 patients survived ebola. I recall the first time I saw a survivor leave the centre. She danced out the front-door as she collected her MSF laboratory certificate which confirmed that she no longer had the disease. Every survivor is exceptional.

The current ebola outbreak is unprecedented in location and scale. There are almost 300 international staff from 70 different countries and more than 2,000 national staff from the affected countries working in MSF ebola treatment centres across the affected region. To date, MSF has treated more than half of all confirmed ebola cases during this outbreak. It is difficult to understand why one single NGO has been asked to carry so much of the burden of responding to this outbreak while other international organisations have not scaled up their interventions. MSF staff are manning the front-line against this ever-spreading ebola outbreak. As a consequence, a number of MSF staff have contracted the illness and died. The world knows how to stop this epidemic. We just need to do it. MSF is stretched beyond capacity. Identifying and treating cases in appropriate management centres in parallel with effective contact tracing and community sensitisation are at the core of what is required but this is not being done. We cannot wait any longer. With each day that passes the outbreak grows in size and complexity. This simply means more families will die.

Western Governments have been preoccupied with preventing an ebola case from entering their territory. While this is understandable it does not negate their duty to assist with this public health emergency of international concern. MSF has repeatedly asked countries which have significant civilian and military outbreak control assets to deploy them in a co-ordinated manner across the affected region. Specifically, MSF has requested the immediate scaling up of isolation centres, the deployment of mobile laboratories beside these isolation centres, the establishment of dedicated air bridges to move personnel and equipment between affected areas in West Africa, and the building of a regional network of field hospitals to treat infected medical colleagues. Some countries have responded to this call. However, more need to do so. MSF asks the Irish Government to follow the lead of countries that have committed to join the fight against ebola with concrete action on the ground. We are asking it to mobilise all possible resources, financial and human, to help bring to an end this medical emergency. We are grateful for all efforts already expended.