H.E. Dr. Sinéad Walsh:

I think we will probably understand the death rate much better in retrospect. There have been death rates of up to 70%, as I mentioned. We had that in July and August in Sierra Leone, particularly in Kenema, and much of it was because we did not have proper treatment centres. We know there is no cure for ebola. The important thing is hydration but, of course, it is very difficult to do that and do it quickly enough and so it goes back a lot to the logistics. How quickly can an ambulance get to someone and how quickly can they get a bed? I think that since December we have enough staffed beds and enough ambulances in Sierra Leone. In Liberia we were at that stage, I would say, in late October. As a result then we saw the death rate go down a lot. We still do not really understand why we have some differences in death rates between the three countries. Sierra Leone's death rate is actually quite good at the moment. I think chances of survival are something like 63% at the moment which is very good but we do not really know why. There are various factors. At least we can say from the international side that on the clinical side we have enough labs, beds, and ambulances. Now the challenge comes back to, as Deputy Maureen O'Sullivan said, community engagement and stopping the spread. I think once we have someone we can give them the best, nationally possible, chance of survival so now it is about getting them in early enough because one of the biggest things leading to the high death rate is people just coming in too late. I visited the Goal treatment centre in Port Loko in north Sierra Leone a couple of weeks ago and they said that that was their biggest problem. They see people come in and they know it is already too late.

We have seen no mutation that we know of so far but time will tell. We have read a lot, particularly in the international media, about mutation. I think it is quite a popular topic. At the moment the WHO are saying there is no evidence of that.

To answer the Deputy's second question about women and children, yes, this is huge. I think mortality rates for ebola are more or less equal. Again, there are small differences between men and women. Ebola mostly kills the most productive age group, as HIV often does, which, of course, has its own issues. So children actually have a better chance of survival from ebola. Under-30s have a better chance of survival from ebola. Where we are losing so many children is in the secondary impact, the fact that people either do not have a health clinic to go to any more because maybe the health worker has died or they do have a health clinic but do not trust it because so many people have gone and caught ebola in the health system. These are the challenges. We know that Sierra Leone, before ebola, had the highest infant and maternal mortality rates in the world. Ebola is making that even worse.

In terms of what we are doing, I think Ireland's focus in Sierra Leone when it comes to the issue of child mortality is within the nutrition programme and this was long before ebola. We are the main donor working on the nutrition of severely malnourished children and moderately malnourished children to prevent them from becoming severely malnourished. We are working very closely with the government on the national nutrition programme. That is the main thing we do on that.

In terms of women, the Deputy referred to the protection agenda. Our main focus on women's rights in both Sierra Leone and Liberia is on sexual and gender based violence. Anecdotally we think we are seeing an increase of that during ebola. We do not know why. Maybe it is because people are not working or children are not in school. We are certainly seeing an increase in teenage pregnancy. We fund the only sexual assault response centres in the country. There are three of those in Sierra Leone. We have been the funder of those for the past 10 years. Their numbers have gone up. We are trying to figure out why and we are trying to give them more resources so that they can cope with the increased numbers.