Pat Breen (Clare, Fine Gael)
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This is probably the largest group of witnesses I have ever seen and it is great to see so many people. We are discussing a very important subject, which is the outbreak of the ebola virus affecting countries in west Africa. To consider this issue the joint committee has requested that representatives from four bodies meet us this afternoon.

I extend the sympathy of the Oireachtas Joint Committee on Foreign Affairs and Trade to the family and friends of the Concern worker whose death was reported this morning. His death brings ebola that bit closer to the people. I heard the report of his death on RTE radio this morning, in which it was stated he had to go for treatment for his illness elsewhere even though he presented some of the symptoms of ebola, and that at the end of the day he was not seen and he died queueing to be tested. This is a real sign of the chaos which exists in west Africa at present.

We have a packed agenda and committee members are very anxious to hear what the witnesses have to say. I remind committee members, witnesses and those in the Visitors Gallery to ensure their mobile telephones are switched off completely for the duration of the meeting as they cause interference, even in silent mode, with the recording equipment in the committee rooms. This is particularly important today because our proceedings are being broadcast live on Oireachtas TV.

In advance of today's hearing and presentations I remind members of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person or body outside the Houses or an official either by name or in such a way as to make him or her identifiable.

By virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the joint committee. If they are directed by the Chairman to cease giving evidence on a particular matter and they continue to do so, they are entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice that, where possible, they should not criticise or make charges against any person or entity by name or in such a way as to make him or her identifiable.
I welcome all the witnesses. We will hear first from Caitríona Ingoldsby from the Department of Foreign and Trade. Her presentation will be followed by presentations from Barry Andrews of GOAL, and from Dr. Gabriel Fitzpatrick of Médecins Sans Frontières. We also have with us Dr. Colette Bonner, deputy chief medical officer from the Department of Health. I thank her sincerely for attending because I am sure some of our members may want to ask some technical questions. Dr. Bonner will not make a formal presentation but is at the disposal of the members. We are also joined by Karl Gardner, director of human resources in the Department of Foreign Affairs and Trade, and Nicola Brennan, senior development specialist. They are all very welcome.
The ebola crisis that has affected Liberia, Sierra Leone, Guinea and other regions in west Africa is a real concern to all of us in the Western world. It is a situation that has got out of control. We are not sure whether the statistics we are hearing about are accurate. Some people estimate that the real figures have not been collected because of the difficulty of the terrain. We are conscious that every district in these countries is affected, not just the urban areas. Sometimes the rural areas are the most difficult areas to get people into because of the geography and the fact that people are concentrating on the urban areas where there are large numbers of people. The situation is very difficult, and I am delighted that our Department of Foreign Affairs and Trade was able to allocate funding to help in the control of the ebola outbreak, not just in terms of money but also resources, which are extremely important. We are hearing that many health workers do not have the training or the resources - simple items such as gloves at times - to deal with the outbreak. Ebola is highly contagious; it is spread through bodily fluids. We are hearing also that there is a problem with the disposal of bodies. All of these difficulties contribute to what is happening.
The other area we are concerned about is that many of the commercial airlines have stopped flying into these regions. We are asking doctors, nurses, health workers and aid workers to come into these areas, yet if they go in they find it very difficult to leave because flights no longer fly in and out of these regions, other than Royal Air Maroc and United Nations flights. It is a difficult situation, and many people here do not realise the seriousness of it for health workers and all our non-governmental organisations, NGOs, working extremely hard in the region, many of whom are compromising their own safety and working extremely hard. We have heard about some of the cases being treated but we have to pay tribute to our health, embassy and aid workers in the area.
The latest statistics indicate that by January 2015, over 1 million people could be affected by this outbreak. That is why it is important that every country deals with it, and we are delighted to have a team of experts before the committee today. Without further ado I call Ms Caitríona Ingoldsby from the Department of Foreign Affairs and Trade.

Ms Caitríona Ingoldsby:

The Department of Foreign Affairs and Trade welcomes this opportunity to brief the committee on the ongoing work being undertaken across the Department in response to the current outbreak of ebola in west Africa. The Chairman mentioned some of the figures but I will talk about the official figures from the World Health Organization, WHO. As of 20 September, the WHO reports that the total number of probable, confirmed and suspected cases of ebola in Guinea, Liberia and Sierra Leone was 5,843, with 1,680 confirmed ebola related deaths and a further 1,123 deaths where ebola is the suspected or probable cause. That brings the total of probable, suspected or confirmed ebola related deaths in those three countries to 2,803. Both Senegal and Nigeria have also reported cases, but it should be noted that according to the WHO, the pattern in those countries is different. It is not one of widespread and intense transmission but rather cases of localised transmission that are linked in a transmission chain to individuals who previously were in Guinea or Liberia.
Separately, there is also a smaller outbreak of ebola in the Democratic Republic of the Congo. There are 68 cases there as of 18 September, but this outbreak is unrelated to that affecting the west African countries, and it is that outbreak in the west African countries which poses the greatest risks and remains the clear priority for international action.
Given the complexities and the wide range of issues the ebola outbreak entails, the response of our Department to date has involved significant internal co-ordination across various divisions in our headquarters in Dublin, with multiple bilateral embassies, and our representatives in multilateral missions such as the UN in Geneva. In terms of our external co-ordination, we are also working domestically with our colleagues across Government Departments and State agencies, particularly with our colleagues in the Department of Health and the Health Service Executive. We are also maintaining close contact with Irish NGOs and other organisations that are active in the region. Internationally, we are actively engaged principally with EU partners, both bilaterally and through our Permanent Representation in Brussels, and through the UN system in New York and Geneva.
In terms of our Department's specific response, we can view it as being across two main pillars: the consular response and our development co-operation response. In terms of our consular response, we are asking all Irish citizens in the affected area to register on our citizens' registration page on the Department's website at . While this is a voluntary registration mechanism and may not represent an absolutely accurate total of the number of Irish citizens in the area at a given time, we are constantly monitoring those numbers as they change and using that information to inform both our internal co-ordination and the risk assessment element of wider domestic interdepartmental emergency planning. It should be said that none of the most affected countries or areas are frequented by large numbers of Irish tourists or independent travellers. As of yesterday evening, based on our citizens' register and embassy information, we have 50 Irish citizens in Sierra Leone, Guinea and Liberia. Separately, in Nigeria and in Senegal, we have a total of 405 citizens, 165 of whom would be deemed to be in an affected area. However, I would stress the point made earlier that the WHO deems the situation and level of risk in Nigeria as fundamentally different from that in Sierra Leone, Guinea and Liberia, and also that the number in an affected area in Nigeria appears high because the city of Lagos is deemed an affected area.
Our embassies in Freetown and Abuja are in ongoing contact with those citizens registered, and have issued clear advice to them based on updates to our travel advice and the WHO guidelines to ensure that they are aware of the precautions necessary to best ensure their health and safety.
In addition to their role in keeping Irish citizens in the area informed, more broadly, our missions in the area are playing a crucial role in information gathering, reporting and co-ordinating with local and international partners on the ground. Our embassy in Freetown in particular is playing a key role in local co-ordination. Colleagues there are working closely with the local authorities and international partners to identify the type of assistance most needed to try to manage the current outbreak, to support the local health and government infrastructure, and to prevent further spread of the virus.
With regard to the Department’s travel advice more generally, we continue to update the travel advice for the affected countries. Again, this advice is firmly based on WHO guidelines and information we are receiving from a number of sources, including our missions on the ground and information from EU and other international partners.

We are advising Irish citizens to avoid all non-essential travel to Sierra Leone, Liberia and Guinea and we are advising those who are already in these countries to consider carefully their need to remain. It should be said that, according to the WHO, the risk for a general traveller to the affected area of becoming infected with the ebola virus is extremely low and that health workers can protect themselves by properly applying infection prevention and control measures when caring for patients. From the consular point of view, in addition to this threat of ebola, even if it is at a low level for our citizens, the outbreak brings further challenges in the region, including restrictions on travel and, perhaps more importantly, significant strain on the local health care systems, which are now completely overwhelmed. Any medical emergency for an Irish citizen there for which medical treatment might ordinarily have been obtained locally could now have much more severe consequences. Improving local medical facilities and building additional capacity in-country is a key priority for the international community in managing the current outbreak and curtailing its spread. I will return to this aspect in a few minutes in the context of our development co-operation response, but it is probably worth noting, with regard to our consular response, that building additional treatment capacity on the ground in these areas would also have a knock-on positive impact from the point of view of protecting the welfare of any of our citizens who are there. As part of the ongoing interdepartmental engagement, we are working with colleagues in other Departments to examine all possible options and to have protocols in place to ensure preparedness should a case arise in respect of an Irish citizen.

At EU level, the European Council of 30 August discussed the ebola crisis and called for "increased coordination at EU level of the assistance provided by EU Member States". The Commission has been tasked with taking this EU co-ordination forward, including the co-ordination of assets that could support the evacuation of ebola-linked cases from the region. EU partners have also been considering a French proposal for a co-ordinated EU response to medical evacuation and for the sharing of resources, expertise and information. Under this proposal, countries with repatriation capacity will take the lead in possible evacuations on a rota basis. In the meantime, pending the agreement of a co-ordinated EU response in respect of repatriation, we are also discussing possibilities for bilateral cooperation with international partners which have suitable repatriation capacity.

It is important to note that any proposed repatriation of an ill EU citizen would be a complex task requiring significant and close co-ordination between a number of actors both domestic and international. First and foremost, we would be governed by the medical situation. There are stringent WHO criteria in place around repatriations and each case would be different in terms of the gestation of the illness at the time the patient presented and the timeframe within which a repatriation could take place. Such consideration would include complex factors such as the availability of necessary isolation units, medical teams and aircraft capacity and the local transport and infrastructural capacity in the particular area at the time.

I now move on to our development co-operation response. Ireland has provided direct funding of €350,000 to date to organisations working on the ebola response in Sierra Leone and Liberia, both of which are partner countries for Ireland. This funding is supporting much-needed NGO-led awareness-raising programmes in local communities in affected areas. The lack of such awareness in both countries has hampered response efforts and contributed to the spread of the virus. Funding has also been provided to the Liberian Ministry of Health and Social Welfare for contact tracing, which is another very important aspect of the response. This funding is in addition to Irish Aid's ongoing programmes in both countries. In 2013, Ireland provided €3.9 million in bilateral aid to Sierra Leone, with over €2 million spent on health and nutrition programmes. In the same year, Ireland provided €5.6 million in bilateral aid to Liberia. The largest part of this funding - €4 million - was channelled through the Ministry of Health and Social Welfare for strengthening basic health and primary health care services. In addition to bilateral aid, Ireland provides funding of approximately €6.8 million per annum for long-term development assistance to NGOs, as well as Irish missionaries, in Sierra Leone, Liberia and Guinea. This supports programmes in the areas of health, food and livelihoods, education and human rights. Irish Aid is currently adopting a flexible approach in these countries to facilitate reallocation of funds towards the ebola crisis.

At the weekend, the Minister of State with responsibility for development, trade promotion and North-South co-operation announced an allocation of over €600,000 to UNICEF to provide life-saving nutritional supplies for children affected by the ebola outbreak. He also announced that over 42 tonnes of Irish stocks of practical items such as blankets and soap, to a total value of €350,000, will be airlifted from the UN humanitarian response depot in Ghana for distribution by the World Food Programme, Goal and Concern to assist survivors of ebola and affected children in Sierra Leone. A member of the Irish Aid rapid response corps was also deployed at the weekend to Dakar in Senegal to work with the World Food Programme to set up an air transit centre for use by the UN Humanitarian Air Service.

Ireland is also contributing much-needed human resources. Through the Department of Health, two public health specialists were deployed to work with the WHO to assist efforts in both Liberia and Nigeria. An Irish virologist is based in Guinea working under the auspices of the EU and another Irish public health specialist, Dr. Gabriel Fitzpatrick, whom the committee will hear from later on, has recently returned from working in a treatment unit in Sierra Leone with Médecins Sans Frontières, MSF. We remain in ongoing contact with Irish and international NGOs and earlier this week hosted in our Department a well-attended briefing for NGOs on the ebola crisis.

At the UN, Ireland co-sponsored the Security Council resolution adopted on 19 September which called for co-ordinated action to combat the crisis and established a new UN mission, the UN Mission for Ebola Emergency Response. Ireland very much welcomes this mission, which has five priorities: stopping the spread of ebola, providing treatment for affected people, supporting health and other public services in the three affected countries, maintaining stability in these countries and taking preventative action to forestall a recurrence. The global response to the current ebola outbreak is on the agenda for a number of high-level meetings during the UN General Assembly Leader's Week this week, for which the Minister for Foreign Affairs and Trade has travelled to New York.

Hopefully, this gives the committee a good overview of where we are and what the Department has done so far. We will continue to work with our missions in the area, with our international and EU partners, with our colleagues in other Departments and domestic agencies and with Irish aid organisations to ensure that Ireland's development co-operation and consular responses continue to be part of the co-ordinated international response at this time of acute need in Sierra Leone, Liberia and Guinea in particular.

Pat Breen (Clare, Fine Gael)
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I thank Ms Ingoldsby. The committee visited Freetown two years ago and met Ms O'Reilly there, so we wish the team there every success in its difficult mission. We also wish well Mr. Sean Hoy, our ambassador in Abuja, who accompanied us to Ghana last year. I welcome Ms Jane-Ann McKenna from MSF and Ms Sinead O'Reilly from GOAL, who are accompanying our two key witnesses today. Our two key witnesses are coming at this from two different angles - Barry Andrews, whom we all know very well, as CEO of an NGO, namely GOAL, and Dr. Gabriel Fitzpatrick, who is a medical practitioner. Both have been on the ground and have just returned from some of the affected regions, so I am sure they have stories to tell. Without further ado, I invite Mr. Andrews to make his presentation.

Mr. Barry Andrews:

I thank the Chairman and I also thank the committee for allowing us to be here. Ms Sinead O'Reilly, who is our global health adviser, has been introduced to the committee.

We have circulated a paper to members of the committee who will have an opportunity to read it later. I will pick out key issues that we wish to share.

I wrote to the committee on 22 August in seeking to appear before it to speak about the seriousness of the outbreak of ebola. This purpose is now redundant because everyone appreciates we are dealing with a crisis of international dimensions and an outbreak that is out of control. People understand this is a real and dangerous issue that requires co-ordinated responses at national and international level. This is evident in the significant announcements of the US Government in the past week or so, while today the British Government has announced a co-ordinated plan involving the National Health Service, NHS, and other key resources in the UK system. For the first time since 2000, the UN Security Council has passed a resolution on a health issue which underlines how seriously the outbreak is being taken. It is significant for organisations such as GOAL that there has been a call for greater non-governmental organisation, NGO, capacity in the affected areas and more medical practitioners and health officials. GOAL will try to rise to the challenge and I want to use this platform to call on Irish health workers, including doctors, paramedics and nurses, to come forward and assist in the effort, as this is what is required. Until now Save the Children, the Red Cross, the International Medical Corps and, particularly, Médecins Sans Frontières, MSF, have been at the sharpest end of the response, but other NGOs must now come out of their comfort zones. I take the opportunity to send a message to Irish health worker who wish to come to GOAL. We will talk to them because their help is desperately needed, if they have the capacity to assist in the coming months. We aim to assist in the effort, with our partners, the US and British Governments.

When I visited Sierra Leone last weekend, I saw the situation at first hand - our workers have been there since 1999 and 200 GOAL staff members are in place. They have been engaged in development work, as committee members saw on their visit two years ago. GOAL members of staff have now turned their work into an emergency response, although the work is difficult. However, it is even more difficult for workers in Liberia where the health system has almost completely collapsed. The thoughts of everyone at GOAL are focused on the Concern worker who passed away over the weekend in a suspected case of ebola. GOAL and Concern work closely together in Sierra Leone and have done so for many years.

Another purpose of this presentation is to call on the Irish Government to prepare and publish a national response plan. We have heard details of this plan today and appreciate the various moving parts of the response. The plan is encouraging. I had the good fortune to meet the ambassador in Freetown and she has had an influence on NGOs and the Government that goes far beyond the call of duty. One cannot help but be proud of her contribution. The Irish Government should publish a national response plan, which would be in keeping with what the World Health Organization and the UN Security Council requested. Earlier responses were based on earlier projections for the development of the disease. Two weeks ago the worst case scenario was 20,000 cases in the next six to none months, but this is expected to change significantly in the coming weeks. Yesterday a worst case scenario was outlined, based on the current trajectory, of 1.4 million cases. The Irish Government has done much up to this point, but the time is right for a national response plan that would pull together and deploy military, health and other resources. That is how we will fulfil our obligations to the multilateral organisations to which we belong.

During my brief visit to Sierra Leone I was in awe of the health workers from the Red Cross, Kings College, London and from MSF who I met on the aeroplane. Their total dedication and selflessness were evident. Occasionally the aid community gets a hard time which sometimes is deserved, but situations such as this, when individuals answer the call of a country in its darkest hour, show the aid community at its best.

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.

Pat Breen (Clare, Fine Gael)
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I thank Dr. Fitzpatrick and Mr. Barry Andrews for their presentations, which paint a disturbing and graphic picture of what they witnessed during their time spent at the MSF centres. It is hard not to be moved and motivated by what we have heard. The story of the mother arriving with her four children and her dying within a week or so speaks volumes, as does the description of the death of the woman from ebola as witnessed during a visit to a family home.

Before handing over to Deputy Brendan Smith I would like to ask some questions. Reference was made to survivors. I am unsure if these people survived following treatment or without it. Does it affect some people more than it affects others and why do some people die and others survive? Do some people survive following treatment or because they have a strong immune system, or whatever?

Dr. Gabriel Fitzpatrick:

Based on my work in the region and having read the literature on ebola in my view we do not know a great deal about the ebola virus and how it affects different people. It is an area that requires a massive amount of research. What we have noticed in the areas where we have been working is that if patients arrive early to the treatment centres their chances of survival marginally improve. It is not that the treatment is a cure for ebola it is simply a case of the earlier the intervention the greater the chance of survival. We have not noticed a difference between the number of females, males, adults or children dying from the virus. The simple answer to the Chairman's question is we still do not know as much as we need to know about ebola.

Pat Breen (Clare, Fine Gael)
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Perhaps Dr. Bonner would also respond to that question when replying to members' questions.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I welcome the witnesses and compliment Ms Ingoldsby, Mr. Andrews and Dr. Fitzpatrick on the clarity of their presentations, which paint a horrific picture. I take this opportunity to thank everybody working in this area in exceptionally difficult circumstances, including members of our own NGOs and Department officials.

The number of identified cases of ebola to date and the expected loss of life between now and January is frightening. It must be a wake up call to the international community. It is a pity the public has not heard the presentations made here today. I know people would be as moved by them as we have been. Mr. Andrews said that the World Health Organisation deemed the current situation as a public health emergency of international concern. Surely, in responding to a crisis of that magnitude speed is of the essence. I recently read some research on infectious diseases carried out by the London School of Hygiene and Tropical Medicine, a quotation from which states: "The window for controlling this outbreak is closing".

International co-ordination is key to dealing in a meaningful way with this crisis.

The current piecemeal approach will not resolve it. I ask Ms Caitríona Ingoldsby or her colleagues if they have any indication whether a political will exists in the European Union to put together a European rapid reaction force to help the humanitarian situation in west Africa. Quite a number of European countries are assessing the resources available to them to help fight this disease. In many instances the work of putting together a meaningful response is only at a planning stage. I refer to a comment day or two ago by the Italian Presidency of the European Union that only four or five countries in Europe are equipped and that the Presidency will work to co-ordinate the aid effort. If there was ever a tardy response to a humanitarian crisis that comment from the Presidency of the EU surely indicates that the urgency we all want to see is missing from the efforts to support the people working in exceptionally difficult circumstances.

Mr. Barry Andrews said in his presentation that the British National Health Service has announced a co-ordinated plan for medical workers. If the details of that co-ordination are available, could it be used as a prototype or model for our response if the Department of Health and the HSE are willing to allow workers to spend a month or two in the area?

Is there a good co-ordinated effort in the region to ensure that the best return is being achieved from the work of so many NGOs and the assistance given by different governments? Dr. Gabriel Fitzpatrick gave a harrowing commentary on the month he spent working in the region putting his expertise and skills to use and on which I compliment him. He stated that children made up a significant proportion of admissions. Is it true that the age cohort comprising children up to middle-aged adults is the most affected by this disease?

Is the global pharmaceutical industry making a contribution towards fighting this disease? If all the financial and human resources were in place in those regions tomorrow, is the supply of medication and drugs an issue?

Seán Crowe (Dublin South West, Sinn Fein)
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I welcome the delegation. Many of us will have no concept of the impact of the ebola outbreak on so many people. It seems to be that to combat the disease there is a need to go against the natural human instinct to comfort a person in distress. For example, if someone is crying, the instinct is to go to them and put one's arms around them. The carers are dying because they are close to the victims.

I refer to the fear associated with this virus. I remember the attitude in Dublin to HIV-AIDS when those who died were being buried in sealed coffins. I remember the fear in communities at that time which I presume could be replicated a thousand times in the case of the ebola virus. People with HIV-AIDS said that they missed the close human contact when people would not hug them. In the case of HIV-AIDS we have moved beyond that attitude but the ebola virus terrifies people and they are looking to us to come up with solutions. Mr. Andrews has spoken about the recruitment programme. If young people are looking for role models they should not look at politicians or pop stars but instead they should look at the people volunteering to work on the ground to deal with this crisis.

Education is an important tool in the fight against this virus but I ask how can this be achieved in the countries dealing with the ebola virus where the infrastructure seems to have broken down. A representative of Médecins Sans Frontières explained that much of their work involved setting up incinerators to burn clothing as such facilities and structures had broken down or were non-existent. The United States is considering sending more than 3,000 troops to the region. Would such action be useful? Does MSF require the assistance of such a force to physically install treatment centres? Freetown has one treatment centre for 1 million people and it is reported that people have been turned away from the centre. Is this the case in many of the treatment centres? Victims are going home to be cared for by people who do not have protective equipment such as gloves and aprons and the virus is spread as a result.

How is the education programme delivered to the people? Are radio broadcasts used? Is terror spreading among the people in the way that people in Dublin were terrified by HIV-AIDS? I refer to Spanish and American health workers who have been transported back to their own countries for treatment. I ask how is this viewed by the local population. Do the local people think that these victims are being treated abroad with a secret cure and does it cause resentment? I refer to Cuba sending 62 doctors and 103 nurses to the affected region. How many people would be required for the Irish project?

Sierra Leone imposed a national lock-down to identify and isolate new cases of the virus and its 6 million population were confined in their homes over the weekend. The authorities declared the lock-down a success. Has the delegation any information on the success or otherwise of this lock-down? I ask the delegates to comment on the report that some NGOs criticised the lock-down saying that it destroys trust between patients and doctors. Is a lock-down an effective policy? The situation is similar in Nigeria. I refer to the heavy lifting which MSF was required to undertake. I apologise for asking so many questions.

Bernard Durkan (Kildare North, Fine Gael)
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I welcome the delegates and I thank them for explaining the seriousness of the situation in a meaningful and forceful way. What is the most effective way of containing, slowing down and addressing the outbreak in the areas affected? Are initiatives such as restrictions on travel and interaction and the imposition of curfews helpful and effective? Can the virus recur among those who have been treated? Can a person be a carrier of the virus without being affected by it?

What is the best way for us to do that? How can we be most effective? What can we do that will have the most direct and immediate impact on the areas directly affected?

We were in Freetown and Sierra Leone in recent years and are familiar with the territory. It is quite difficult. What circumstances favour the spread of the infection? What are the easiest circumstances to address? I refer to travel, hygiene, water and contact. We know about the issues regarding contact. What can we do that will be most effective within the shortest possible time?

Pat Breen (Clare, Fine Gael)
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I have to allow other members to speak, because a number of witnesses wish to respond on the various areas mentioned.

Eric Byrne (Dublin South Central, Labour)
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I welcome the witnesses. I lived in Africa for four years and know it very well. We returned relatively recently from Sierra Leone. I thank Mr. Andrews, who applauded the work of our embassy in Freetown. In our last meeting I specifically asked about the welfare of our staff. At the time three women were employed, one of whom is now the ambassador, and they are phenomenal workers. I hope to hear in the answer session that they have been fully briefed on the nature of the illness and are protected or know how to take the proper precautions. As was said, they interact with government ministers in the field. We met a nun in the hospital for the disadvantaged and saw the health services.

Quite frankly, the hospitals we saw before the outbreak of ebola were pathetic. We saw huge numbers of mothers feeding their babies at a clinic. There were health services in place but they looked rather unhealthy. We visited a hospital in Freetown which was not a hospital as we would know St. James's Hospital or St. Vincent's hospital to be. GOAL has asked medical professionals to volunteer, which I support. We have statistics on the deaths of front-line workers. I remember being emotional when I heard that the doctor who led the campaign against ebola in Sierra Leone was infected. There was a major debate about whether he should be given drugs. How can the board reassure any voluntary nurse or health care worker who may want to volunteer for humanitarian work that the systems in Africa are capable of protecting their welfare? The figures relating to the deaths of nurses and front-line workers such as ambulance workers are frightening. If they are not protected and operating within the proper guidelines it will mitigate against those who wish to volunteer.

Is the fact that the area of Liberia affected is war-torn and the infrastructure very weak a contributory factor? What was the strategy of the three-day lockdown in Sierra Leone, and did the delegation support it? What was its purpose and did it succeed? Is it a plan that can be mimicked across the board?

I refer to the departmental presentation which referred to ebola in Nigeria and the Congo. I am particularly interested in Nigeria and Lagos. The presentation said the situation was fundamentally different. Is the strain of ebola in Lagos the same as that which affects Freetown? I ask for reassurance because I have a brother-in-law who regularly visits Lagos as part of the oil industry. Why did the presentation state that the strain of ebola in Lagos was different and not as dangerous as that affecting Freetown?

Maureen O'Sullivan (Dublin Central, Independent)
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I will be brief. The are two words which come to mind, namely "harrowing" and "humbling," when one listens to what people such as Dr. Fitzpatrick have been doing in countries such as Sierra Leone as we sit in the comforts of the developed western world. I visited Sierra Leone to examine it as a post-conflict country. It faces a range of issues, difficulties and problems in terms of health and education, and is now dealing with ebola, which compounds the other problems.

I refer to the need to consider the ebola issue in terms of other major health issues such as malaria and the number of people dying from starvation. One of the witnesses referred to Irish Aid reconsidering the reallocation of funding. I do not think we can afford to reallocate current funding. Rather we need to find additional funding. We cannot afford to take money from areas where it is badly needed.

I read about inefficiency at local level and slowness at international level. I ask the witnesses to comment on the national level in the countries affected. One of the witnesses said the world knows how to stop this. Do we know what causes ebola and why a particular strain is affecting west Africa?

Olivia Mitchell (Dublin South, Fine Gael)
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We have all read about ebola and listened to media reports on radio and television, but it is only when one hears the detail of the impact it is having on families and communities that it is brought home to one how heartbreaking the situation is. I found it particularly tragic that those suffering from curable diseases were being turned away from hospitals and not treated out of fear. Do medical personnel bother to diagnose people with ebola when they go to hospital, or are they admitted under the assumption that is what they have?

Other people asked my question in a slightly different way. It was said that the world knows what to do to solve the problem and it is a question of providing more treatment centres and tracing contacts and so on. What exactly happens in treatment centres? Does treatment work or does the fact that people are isolated deal with the illness? Is isolation the key factor in stopping the disease? I appreciate that it is a virus about which we do not know a lot, and perhaps the witnesses do not have that information. Do people assume isolation is important?

Michael Mullins (Fine Gael)
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I welcome our witnesses. Today is a real wake-up call for all of us. Until we heard from people who have worked in the area I do not think the seriousness of the situation had hit home with many of us, and I would include myself in that category. Deputy Byrne asked a question I was going to ask, but I will ask it in another way. We all hope there will be a positive response to the call made by Mr. Andrews and Dr. Fitzpatrick for Irish doctors, nurses and health professionals to volunteer. There is great concern among parents and relatives about those volunteering to go to west Africa. Is there a vaccine which can be administered to volunteers before they travel to Sierra Leone or an area affected by ebola?

The other frightening statistic Dr. Fitzpatrick of MSF mentioned was that 50% of all cases were being treated by MSF personnel. How long more can MSF sustain handling that percentage of the cases, who is taking care of the other 50%, are other agencies helping now and are other countries coming to MSF's assistance? Dr. Fitzpatrick might clarify exactly what MSF wants the committee and the European Union to do, and the top three issues it wants addressed as a matter of urgency.

Pat Breen (Clare, Fine Gael)
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There the witnesses have it. Members asked a lot of interesting and important questions. There is one question Mr. Andrews might answer for me as well. We have not spoken about the government response in these areas where there is a department of health. I hear stories of ministers leaving the country and that there is no plan put in place by government officials. Maybe Dr. Fitzpatrick would also comment on the earlier comments I made about local health officials not having resources or being trained properly. I will leave it up to the witnesses to comment on the variety of questions. It was a good way to deal with it because they have all the questions. Does Mr. Andrews want to kick-start it?

Mr. Barry Andrews:

I thank the Chairman. On the first question, the treatment centre that was opened at the weekend in Freetown is, in fact, a Sierra Leone run centre. To the best of my knowledge, the local ministry is involved in that. That is a strong local response and it has to be acknowledged. There is no doubt that the local administration is doing everything within its power and deploying all the resources at its call to contain the transmission of the illness.

Obviously, I defer to Dr. Fitzpatrick on the vast majority of these questions. Ms O'Reilly might want to come in as well. It is a fact that every 30 days delay in funding will double the cost in the requirement of medical staff. Some 70% of cases need to be hospitalised and at present less than 40% are. It takes six weeks at a minimum to build a medical treatment centre. Therefore, mathematics tells one that it is out of control. It is hard to catch up with it. Therefore, people are thinking in terms of care in the community. That is a developing area.

The WHO designated this as a public health emergency of international concern on 8 August, and since then much has happened in terms of our understanding and the dimensions and projections. The NHS has developed a response and has created a web portal for anybody interested in volunteering, and no doubt the HSE could do something similar.

As to the question about the safety of individuals who volunteer, aid workers work in difficult circumstances, not only in Sierra Leone but in the massive humanitarian responses in Syria and the famine conditions in South Sudan. These all are challenging conditions and aid workers put themselves in those circumstances because of vocation and their commitment to their work. We manage risk to the best of our ability. We cannot eliminate risk in those circumstance and volunteers understand that to be the case.

Deputy Crowe asked the question about the role of education. MSF, as I said, is at the sharp end of this in terms of treatment, but we also need to have the educational element because it is counter-intuitive to talk about not touching and caring for a dying relative. It runs completely against any human instinct anybody has. It is a cultural norm not only of west Africa. It is the same everywhere. It is a considerable challenge to break down that cultural practice. That is one of the key jobs GOAL has been doing over the past three or four months, since May when the outbreak began. There are more details about that in our submission to the committee today.

Deputy Crowe asked a tough question as to why we NGOs are not doing the work, that MSF put it up to us and we should lift our game. We are trying to do that. We see that the dimensions of it are much greater than probably earlier anticipated and we do not shrink back from that call. Deputy Eric Byrne asked about the conditions and I will let Dr. Fitzpatrick deal with that.

On the question from Deputy Maureen O'Sullivan on Irish Aid funding being reallocated, such reallocation is useful. Effectively, the longer-term development work that the committee might have seen when it visited two years ago is more or less suspended at present. It will be useful for GOAL, Concern and the other agencies which are funded through Irish Aid if that can be allocated now to this particular response because we are building isolation units where the diagnoses take place. If an individual is diagnosed with ebola, he or she is sent to the treatment centres. At present, however, these centres are full. Any funding we can get access to will assist us in that work of building isolation centres.

Ms Sinéad O'Reilly:

Education is something on which GOAL is working. We are working, for example, with police officers and the military, training them around isolation and how to manage an ebola case. We can build treatment centres until every person is infected, but that alone will not solve ebola. We also need to look at door-to-door work with community members, individuals and community leaders about how to change attitudes and beliefs around ebola, and that is something we are trying to work on.
It needs both. The health system is being destroyed in Liberia and Sierra Leone because the health system is trying to deal with ebola. We almost need to take the treatment of ebola away from the health system, encourage the health centres to keep functional as much as they can and treat the infectious diseases such as malaria and diarrhoealdisease, and in the meantime work on changing community behaviours around ebola.

Pat Breen (Clare, Fine Gael)
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I now will bring in our two doctors, Dr. Fitzpatrick and Dr. Bonner.

Dr. Gabriel Fitzpatrick:

I thank the committee for that wide range of questions. When I was going into very remote regions of Sierra Leone looking for cases, I was being told initially that there were no cases in the village I was going to. When I would turn up in the village, I would find a number of cases. This would happen regularly, day in, day out. One has various models predicting how many cases will occur in the next three months or six months, but we know from basic information of going into villages and finding cases that nobody has told us about previously that there are a lot more cases than are documented.

Ebola is a viral haemorrhagic fever. MSF has been containing ebola outbreaks since the 1970s. If one looks at the literature, one will see that every time an ebola outbreak or a viral haemorrhagic fever outbreak occurred in Africa, it was MSF dealing with it. MSF controlled those outbreaks and performed effectively because the outbreaks were small. The major components were building the treatment centre, going out into the community, educating the community, bringing those sick cases into the ebola treatment centre, following up all the contacts of those cases in the community, and doing that for 21 days. We have been doing that for decades with viral haemorrhagic fever such as ebola, and it works. That is why I stated the world knows what to do. We need to do it.

However, this is a totally different ball game we are dealing with. The scale is unprecedented and we cannot do what we could do previously in terms of building enough treatment centres, enough case finding and enough contact tracing. We cannot do it. From being on the ground, as many will agree, the NGOs cannot deal with this either. That is why we are making this unusual call to get the military from larger countries involved with this outbreak. We need military organisation to set up large numbers of ebola treatment centres across the region. The NGOs there at present cannot do that and that is what we need.

Obviously, Ireland would not be in a position to provide a large-scale military biohazard capacity simply because we are a small nation, but there are larger nations.

We welcome the response from the US, which is sending 3,000 personnel to the area and setting up 17 ebola treatment centres, with possibly 100 beds in each centre. That is the sort of response we need. No response can be too big at this time, because we do not know how big the problem is. We do not have all the information.

A question was asked in regard to the benefit of an ebola treatment centre. Obviously, patients who arrive into an ebola treatment centre earlier have a marginally improved chance of survival, but that is not the main reason for bringing people to these centres. We are bringing patients into the ebola treatment centres to try to stop them spreading the virus among families and friends who visit them. We are asking the patients affected to come with us in our ambulance to our ebola treatment centre to save members of their community. This has worked previously, but the scale of the spread of the virus is much larger this time.

In the Irish context and in regard to staff, while there are many NGOs in the world, very few of them have experience with treating and containing viral haemorrhagic fevers such as ebola. We believe it is a good idea that if countries are sending out staff, they should send them out with organisations that have a track record of dealing with this issue in order that they will know they will be working in a relatively safe environment and with people who have done this previously.

On the issue of ebola in Nigeria versus in Sierra Leone and Liberia, there are five different types of ebola. We can take the fingerprint of each of those types and tell which ebola is which. The ebola in Nigeria and in Sierra Leone has the same fingerprint. It is the same type of ebola, but the response in both countries has been hugely different. Nigeria is a much richer country than Sierra Leone. It has a stronger, though not perfect, public health infrastructure and has been able to respond more swiftly and widely to the cases that arrived in the country than Sierra Leone was.

In regard to diagnosing ebola, we have case definitions we try to disperse within the community in order that people with certain symptoms and signs will respond to our invitation and come to our treatment centre. When they arrive, we will assess them and make a medical judgment as to whether they fit the case definition. If they fit the case definition, we will admit them and perform the ebola test to see whether they are positive or negative. If they are positive, they will be admitted to the confirmed tents and if negative, they will be sent home. Prototype rapid diagnostic tests for ebola are in development and, when developed, these will mean we can take a finger prick of blood, put it on a small card device and see from the lines that develop whether ebola is present. These tests would be similar to the tests available for malaria, but they have yet to be validated.

The question as to how Ireland can respond in this situation has been asked repeatedly. First, it can make funds available to organisations working on the ground and, second, it can funnel experienced staff from within our health care system through agencies we know are safe. It is not ideal to send staff out without the backup of an agency with a track record of working in the area.

Pat Breen (Clare, Fine Gael)
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I thank Dr. Fitzpatrick. Does Dr. Bonner wish to contribute on some of the questions?

Dr. Colette Bonner:

I congratulate Dr. Fitzpatrick. This is the first time I have heard his presentation. It is clear health care workers are providing an invaluable service in these countries, but it is only a drop in the ocean.

I do not have any clinical experience and therefore cannot provide the type of information Dr. Fitzpatrick can, but I support what he says in regard to staff. I believe the HSE has sent a paper to its management team to see whether there is a way it can seek staff who may be interested in travelling to these regions to provide cover, but I do not know whether there has been an outcome to that yet. I support Dr. Fitzpatrick's suggestion that any staff who come forward should be funnelled through an experienced organisation that is used to dealing with this kind of emergency situation.

It is clear that the systems in Liberia and Sierra Leone are underdeveloped. Part of the reason for this is that these are post-war territories. It is well known in terms of epidemiology that severe infectious diseases can spread more rapidly in those type of environments where health care systems are underdeveloped. Therefore, how the disease is spreading so rapidly is understandable. The identification and isolation of cases and prevention of transmission is the way to stop its spread.

We have not spoken much about the development of a vaccine for ebola. I believe the WHO has spearheaded work in this area, but I cannot say when a vaccine will become available. An effort is being made to release a vaccine for ebola as soon as possible. All these streams of action are happening concurrently in an effort to bring this crisis to an end.

Bernard Durkan (Kildare North, Fine Gael)
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The ebola crisis is reminiscent of the Black Death or plague, when there was little information available to the people directly affected. At the time the problem could not be addressed until people discovered how it was carried and how it could be limited. Some communities isolated themselves completely so that it could not be spread to them. How best can we provide information to communities in these countries who are affected or likely to become affected, particularly in Sierra Leone which is densely populated and has poor sanitary, water and hygiene services? It would be easier for communities in rural areas to isolate themselves. In those circumstances, what advice can be given to the people on how best to protect themselves? I recognise that health providers must deal with the cases that occur. They must identify them quickly, and where ebola occurs, those communities must inform the health providers as soon as possible.

Eric Byrne (Dublin South Central, Labour)
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In regard to the decision on the three-day lock-down by the Government of Sierra Leone, who instigated this? Was it a government decision or part of a WHO strategy to contain the spread of the disease?

Have any of those present experienced what has been reported as riots or violence against NGOs by native people who resent the arrival of those providing health assistance or who believe NGOs are bringing the disease with them? Are the reports of this in the press exaggerated?

Dr. Fitzpatrick said the ebola strain in Lagos is the same as that in Sierra Leone. I do not have the same confidence in the Nigerian Government as he has. We know what is happening in northern Nigeria and know the military is incompetent. More than 300 young people have been kidnapped. I hope the WHO is keeping a close eye on what is happening in Nigeria. Anybody who has visited Africa knows how much people move around. There is significant movement of people from Lagos to other regions and I am concerned by that. I am just a lay person, however, and perhaps Dr. Fitzpatrick can reassure me that the health services in Nigeria are so sophisticated that we have nothing to worry about.

Pat Breen (Clare, Fine Gael)
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To add to what Deputies Byrne and Durkan have said regarding government awareness and plans the Nigerian Government has in place, Dr. Fitzpatrick spoke about people all having mobile phones. On visits we have made to Africa, we have seen that everybody has a mobile phone.

No matter where one goes, in the most isolated regions of Africa, everybody has a mobile phone or maybe two. Has any government awareness campaign on the prevention of ebola been communicated through mobile phone technology?

Dr. Gabriel Fitzpatrick:

The Lagos question seems to be the most pressing. I completely agree. Lagos is a city teeming with a phenomenal number of people, and with ebola cases confirmed in Nigeria, there is significant potential for spread. While governments can cover up information to a certain extent, if ebola were spreading rapidly through Nigeria, as it is through Liberia, we would know about it through social media and other sources. However, we are not seeing it. I am not saying the cases reported in Nigeria are all the cases there are, as we do not know. However, a situation like that in Liberia is not happening in Nigeria. While I worked in Sierra Leone I had a mobile phone from the local telephone company, and approximately twice a day I received a message telling me to watch out for ebola. The government is using mobile technology to send health promotion messages about ebola. How effective it is is another question.

In mid-August there was a lock-down in Sierra Leone and I was there for that. The only effect we saw was a dip in cases for two to three days after the lock-down, followed by a spike in cases seven to ten days after the lock-down. This fits in with the typical incubation period of ebola, which is approximately seven to ten days, and up to a maximum of 21 days. Most NGOs would agree that the quarantine that is being effected in those areas is of no use whatsoever and spreads fear among the local population.

There will always be members of any community who, when they see a lot of foreigners arrive in 4X4 vehicles and the new disease arrive at approximately the same time, will ask whether these people are bringing it. MSF has hundreds of health promotion workers in eastern Sierra Leone and we are trying our best to get the message out that NGOs are not bringing ebola in and to get the basic knowledge of ebola into the community. I have never felt any fear working in that area of Sierra Leone, and I have travelled widely through very remote jungles and have met only very welcoming people who are happy to receive support.

Pat Breen (Clare, Fine Gael)
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Is there resentment towards NGOs? Tribes have all these customs that foreigners are spreading it and that they did not have it until the foreigners arrived.

Dr. Gabriel Fitzpatrick:

It is understandable for people to think that. I arrived a month after our treatment centre was operational and there were some initial reports from the people who had started at the beginning that they had to meet the chiefs and village elders, some of whom raised the point. It was dealt with at the beginning when the treatment centre was being established. During my month there I did not come across anything like it.

Mr. Barry Andrews:

Given that we have been there for 15 years and 90% of our staff are local people from Sierra Leone, we have very close connections with the community, local government and the ministry of health. We are very well positioned to understand how to gain the trust of local people to respond as best we can. There is a debate about whether NGOs should scale up and the British Government has called on NGOs to scale up and provide a better response. MSF has also called on NGOs to scale up. Some of our representatives were in Washington during the week and the US Government has specifically requested that GOAL assist in this. We are a very trusted emergency partner with these key donors and have responded to every major disaster over the past 30 or 40 years. The fact that we have history in Sierra Leone gives us a certain traction with the community and local authorities and we hope to build on it and meet the challenge.

Bernard Durkan (Kildare North, Fine Gael)
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What is the treatment for ebola and over what period is it given? While we realise what the witnesses are saying, we find it a little difficult to understand how best the intervention can be made. Those on the ground can see it at the coalface. There must be conditions that are conducive to the spread of the disease. What are they and can they be isolated? What is the success rate of the treatment?

Dr. Gabriel Fitzpatrick:

With the permission of the ministry of health in each country, MSF collects data on each patient in its treatment centres. We collect epidemiological and outcome data. When collecting the data we look for risk factors that we find recurring for patients who contract ebola. Two major risk factors stand out and will be published in scientific journals by MSF in the near future. One of these risk factors is close family contacts when family members of patients clean away vomit and diarrhoea without gloves or aprons. This is the primary type of intimate contact we are seeing. The second is in health care facilities where doctors are physically examining patients without gloves or appropriate protective equipment when the patients are actively having gastrointestinal symptoms such as vomiting and diarrhoea. Ebola loves compassion and people's need to help close family members. We particularly see it with children, and 25% of admissions to our facility are aged under 18. When we see children come in, we know older family members will be following closely, because when children are ill, their parents and older siblings will help them and clean away those bodily fluids they are, unfortunately, producing.

Although there is no treatment for ebola, there is a reduction in mortality if people arrive early. There are different results for different areas for a large number of reasons. In the centre where I worked, there was a 10% to 20% reduction in the chance of mortality among those who came in early. That is because we give people anti-malarial treatment, a broad-spectrum antibiotic such as cephalosporin, oral rehydration and, if required, intravenous rehydration. These are not treatments but they can help some patients over the edge from becoming somebody who may die to becoming somebody who can be a survivor. It is a gentle move along the way to helping them, not a treatment. There are treatments in the pipeline. There is hyperimmune serum for people who have recovered, various types of monoclonal antibodies and trial vaccines.

What worries me about this is that people may think there are treatments coming down the line and that we do not have to worry about the outbreak. They may believe that if we focus on treatments, they will come on stream and that the outbreak will be dealt with. The problem is that, even if these treatments work - I hope they will - it will be months at a minimum before they are available on the front lines of the outbreak. That is why we keep going back to the basics of outbreak control, which are finding cases in the community, bringing those affected to the ebola treatment centres, following up on contacts and educating the community. Unfortunately, as I said before, this task is now too big for any NGO. We need to be bigger in terms of our intervention such as involving the US military and its dedication of more than 3,000 personnel. We hope this will be followed up by other organisations.

Pat Breen (Clare, Fine Gael)
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Was the vaccine used on the American doctor successful?

Dr. Gabriel Fitzpatrick:

Obviously, I have no available scientific paper on these vaccines because they have not been subject to large trials. One cannot make a judgment on whether to implement a vaccine programme on the basis of one or two people receiving a vaccine. A large number need to receive a vaccine and the results need to be compared with the results for those who have not received it. We do know that some physicians who have been infected have received the trial monoclonal antibody treatment and seem to have had a good response to it. However, we cannot make an inference that it will work for the general population because the numbers are too small.

Ms Caitríona Ingoldsby:

I want to address some questions members asked. Deputy Brendan Smith asked about the international response. The recent adoption of the UN Security Council resolution and the establishment of the new UN mission indicate the seriousness with which the international community is treating the issue. The appointment of Dr. David Nabarro to lead the response co-ordination at the WHO and the United Nations is also a very important development. In 2005 he was the United Nations' senior co-ordinator during the avian influenza pandemic. I hope the timing is right in that this is UN General Assembly Leader's Week. The Minister for Foreign Affairs and Trade, Deputy Charles Flanagan, is in attendance and a number of high level meetings are taking place, including one called by the UN Secretary General, as well as a transatlantic meeting hosted by the US Secretary of State, Mr. John Kerry. The European Union has announced funding of €140 million in additional development aid to go towards strengthening health systems, setting up mobile laboratories and accelerating vaccine innovation. The United Kingdom has announced that it will host an international donor conference in London at the beginning of October to further raise awareness and seek additional funding. All of these developments are pointing in the right direction and I hope we will see better international co-ordination of the response to the crisis.

Deputies Seán Crowe and Bernard J. Durkan asked about the education campaign. We absolutely agree that education in local areas is key, which is why Irish Aid has given €350,000 specifically for that purpose. This feeds into the questions about recent developments in Sierra Leone raised by Deputies Eric Byrne and Seán Crowe. I was in touch with our ambassador in Freetown this morning to ask whether the recent campaign there was successful. She said initial reports, including the results of a monitoring exercise conducted by the UN development programme, suggested the campaign was a success. It was a house-to-house sensitisation campaign and apparently 85% of households in the country had been reached with education messages and soap. That might sound simplistic, but soap is so important in the fight against ebola. There is an ebola hotline in Sierra Leone and the number of calls to the hotline increased, including calls about suspected cases and requests for assistance with burials. The ambassador's initial assessment was that the campaign had certainly been successful in galvanising local momentum in trying to curtail the outbreak.

Deputy Eric Byrne asked a question about the situation in Nigeria. Dr. Fitzpatrick has already answered it, but I would add that the main differences are scale and methods of transmission.

Mr. Gardner will deal with the question of the safety of our own staff. Deputy Maureen O'Sullivan asked about Irish Aid and the reallocation of funding. I will ask Ms Brennan to answer that question.

Mr. Karl Gardner:

I say "Merci" to committee members for their kind words about our staff in Sierra Leone who are playing a central role in our planning process and will appreciate that the committee has recognised this fact. Like all our staff abroad, we take their health and safety very seriously. We have ensured they are very clear that they must evaluate whatever activities they engage in in order that they do not contribute to the problem or make things worse. There are plans in place should somebody turn up at the mission who might be showing signs of ebola infection. In conjunction with the HSE, we have sent personal protective equipment which Dr. Fitzpatrick has showed the staff how to use. As soap is in very short supply in Sierra Leone, we have sent hand sanitisers, which are a key weapon in the fight against infection. Anyone arriving at the embassy is asked to sanitise his or her hands and make sure he or she follows basic hygiene protocols. Understandably, in the early days staff at the embassy had a number of questions which the HSE was able to answer. It provided the information required. The staff have passed on the information to Irish citizens in the region. It is all about education and sharing information, not just with the local population but also with anyone who comes in contact with the mission. We are in ongoing contact with our staff and very aware that they are working in a very difficult environment. They are under a lot of stress, but they are playing their part, particularly in Sierra Leone where the ambassador and her team are central to the efforts of the wider international community on the ground.

Eric Byrne (Dublin South Central, Labour)
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Given the scenarios outlined, has social interaction stopped for the staff? Are pubs and restaurants still open and functioning? Do the staff live a normal life outside their working day or has this been restricted completely?

Mr. Karl Gardner:

It has been restricted completely.

Ms Nicola Brennan:

Social interaction in pubs, nightclubs, cinemas and so forth has stopped. Some of the markets are still open, but even that is minimal. Big public gatherings are very limited in order to try to prevent the spread of ebola.

Eric Byrne (Dublin South Central, Labour)
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Therefore, is it non-stop?

Ms Nicola Brennan:

Yes. Those committee members who have met our head of mission will know that she is well capable of working 24 hours a day. In response to Deputy Maureen O'Sullivan's question on funding, to date we have provided direct funding of more than €1.3 million for a number of organisations working on the issues of social mobilisation, education, providing nutritional supplies and bringing in practical supplies from our stocks. That is our initial response. As an organisation, we are very flexible in terms of the funding we have allocated to a number of our partners which are working in the countries affected. We are open to requests from them for a reallocation of funds because a number of development activities, including some in our own bilateral aid programme, are not going to happen in Sierra Leone and Liberia as a result of the crisis. The funding for these activities which has been approved can be reallocated quickly. That is our first line and an important response. In addition, the Minister is actively considering further funding contributions to keep treatment facilities in priority areas operational and enable them to address current and future case loads. Funding is also being considered for a contact tracing service, a key prevention mechanism. One of the key issues in the longer term will be the secondary impact of the pandemic in terms of its impact on health and education systems and food security. These are all key priorities of our aid programme. We will continue to work with the governments of both countries in allocating resources to address them.

Pat Breen (Clare, Fine Gael)
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I thank Ms Brennan. It would be remiss of me not to ask Ms McKenna to say a few words. I do not want her to be the odd one out.

Ms Jane-Ann McKenna:

Médecins Sans Frontières and GOAL have been quite explicit about requesting human resources and additional funding for this crisis. We are also actively lobbying at EU level - perhaps Ireland can contribute to this as well - for the organisation of a central medical evacuation system. At the moment there is no co-ordinated system for medically evacuating any international staff on the ground. This situation has an impact not only on Médecins Sans Frontières but on all the international agencies working in the affected countries. We do not have a co-ordinated response, which often leads to delays, particularly in the case of one international staff member who had to be medically evacuated from MSF. We also seek an EU-level response that could be effective immediately for medical evacuation of international NGO staff from affected areas if needed.

Pat Breen (Clare, Fine Gael)
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I thank all the witnesses who attended this afternoon. We have had a very good meeting and achieved a lot. I thank Mr. Barry Andrews of GOAL for first contacting us about coming here and I thank Ms McKenna from Médecins Sans Frontières for its contact as well.
Various other NGOs work in the region, and we cannot forget them. I refer to Plan Ireland, Concern and all the other NGOs. We must pay tribute to all the NGOs and Irish NGOs, as well as our embassy staff.
I also thank the officials from the Department of Foreign Affairs and Trade, which is a major player, for their attendance, and I thank Dr. Bonner from the Department of Health, who made a contribution as well. All are major players in our co-ordinated approach.
The three actions encouraged by all the witnesses this afternoon are important. The first is a recognition of the need for a larger-scale military response. Both Mr. Andrews and Dr. Fitzpatrick have said that it is very important for countries to respond. The Americans have responded, so we will encourage more of the larger countries to send in a large military force to help co-ordinate the crisis.
Both organisations recognised the need for additional funding. Ms Ingoldsby said that the Minister was considering more additional funding to deal with the outbreak. That is important and we are delighted to hear it. Obviously, funding, resources and equipment are extremely important. As Dr. Fitzpatrick has said, some health workers have to work without gloves and the basic essentials necessary to deal with the ebola outbreak. In our future discussions with the Minister for Foreign Affairs and Trade, the Minister of State and the Secretary General of the Department, who are due to come before the committee shortly, we will raise these issues with them.
As Mr. Andrews from GOAL said, there is a need for trained health care personnel. This is a view that was outlined by Dr. Fitzpatrick as well. It is extremely important that such personnel be made available through organisations with a proven track record. GOAL has a proven track record in that area. There is also a need to put in place a central evacuation system at an EU level. Of course, getting in and out is important, as I said at the beginning of the meeting, now that many of the commercial airlines have ceased flying in the region. Dr. Fitzpatrick referred to this matter as well. Aid workers must be able to get in and out of the region in cases of emergency, etc. The UN is probably doing some of this type of work at the moment, but mobility needs to be increased.
The committee will take on board the suggestions made by the witnesses. The timing of this meeting was important given the current state of the ebola crisis in west Africa. We will take on board the suggestions made to the Department. I am delighted that the Department is represented here today. We thank GOAL and Médecins Sans Frontières for attending, and I am sure other agencies want to attend. The crisis is one that we will revisit in the coming months, given the statistics provided by Washington and the World Health Organization which showed what is happening and what could happen. The crisis could even get worse in 2015 and it is definitely an issue that we will revisit, monitor and keep in touch about.
I thank all of the delegations for their work in west Africa, particularly Dr. Fitzpatrick, who has spent some time there, and the other health care workers, who put their safety at risk. They are giving back to society and we appreciate their efforts on this committee. I thank everyone for their contributions this afternoon.