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30 December 2014

7,419 Confirmed Cases of Ebola

2,410 Confirmed Deaths from Ebola

7,938 Registered Ebola Orphans (latest data

31 Dec)

3.12 million (1 million

under-5) Children living in affected areas

UNICEF funding needs to June 2015 US$ 178 million

UNICEF funding gap US$ 85 million

Situation Overview & Humanitarian Needs As the Western Area Surge continues in and around the capital Freetown, the number of new confirmed cases in the last seven days reported in Urban and Rural Western Area (186) represented more than half of overall new cases. Nevertheless, National Ebola Response Centre (NERC) officials reported decreasing numbers of corpses testing positive for Ebola and a decreasing number of corpses. Away from the capital, the nearby Port Loko district is a major hotspot with 51 new confirmed cases in the last seven days and 220 in the last 21 days. Bombali, Kono and Tonkolili districts also continue to be of concern; UNICEF has Community Care Centres (CCCs) in all three hotspots. The overall number of confirmed cases in the week to 28 December (351) was the highest in three weeks, but down from the record high seen in the week to 16 November (577). Four districts in the south and east (Kailahun, Kenema, Pujehun and Bonthe) saw no cases in the last seven days, while just Bonthe out of the four districts has seen a case during the past fortnight.

HIGHLIGHTS

Sierra Leone Ebola

Situation Report 31 December 2014

SITUATION IN NUMBERS

As of 30 December 2014, the cumulative number of laboratory confirmed Ebola virus disease (EVD) cases is 7,419. The number of confirmed deaths is 2,410, while 1,808 have been discharged from treatment.

The outgoing head of the United Nations Emergency Ebola Response Mission (UNMEER), Anthony Banbury, visited a UNICEF-built Community Care Centre in Bombali District on 30 December where he heard positive feedback from the community on levels of trust, and how CCCs can help cut the chain of transmission.

The UNICEF-led Family Tracing and Reunification (FTR) network have identified 14,766 children as being directly affected by the Ebola crisis (7,410 girls & 7,356 boys), with 7,938 children having lost one or both parents to Ebola and 1,578 unaccompanied or separated from their caregiver. The Ministry of Social Welfare, Gender and Children’s Affairs’ (MSWGCA) figures have jumped markedly in the reporting period as child protection networks strengthen across the country.

UNICEF Sierra Leone requires USD 178 million for its response to the

Ebola crisis until end of June 2015. To date, USD 93 million has been received – 52 percent of the total.

A 14-year-old Ebola survivor explains his experiences at a social mobilisation event in Moyamba District UNICEF/Sierra Leone 2014

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UNMEER and NERC have initiated district level planning exercises across the country. The purpose of the exercise is to design district specific plans for each pillar for the coming few months. UNICEF Field Support Officers and field based C4D Specialists have been actively involved in the process on the social mobilization and community engagement component. The Health Specialists managing the CCCs have been involved in the surveillance and case management pillar plans. The planning exercise is expected to be completed by 5 January. Subsequently the plans will be reviewed at the national level by the technical pillars. The consolidated national plan will be presented to the donors on 7 January. A total of 7,419 people have contracted the virus of whom 2,410 have died. 14,766 children are directly affected by the crisis, nearly half of whom have lost one or both parents to Ebola. The number of people infected by Ebola in Sierra Leone, Guinea and Liberia has now passed 20,000, according to the World Health Organization.

Summary Analysis of Programme Response Health

In partnership with the NERC, Ministry of Health and Sanitation, and the Centre for Disease Control (CDC), the national scale up of trainings at all 1,188 PHUs in the country on Infection Prevention and Control (IPC) and the screening of suspected Ebola patients continues. As of 27 December a total of 4,368 health personnel and 2,698 supportive staff including cleaners and security personnel have benefitted from the roll out of the IPC trainings. Existing agreements with the International Rescue Committee and Save the Children were updated. The addendums will allow 5,224 Community Health Workers in six districts to continue providing lifesaving interventions to women and children in the context of Ebola. The CHWs will also disseminate messages on Ebola prevention and procedure to communities, many in hard to reach areas.

Nutrition In the past week, as part of the Integrated Management of Acute Malnutrition (IMAM), a total of 11,987 children under-5 were screened at the community level in 46 out of 149 chiefdoms (274 communities), with 397 referred for treatment at the peripheral health units for severe acute malnutrition (SAM) treatment services.1 The increase in the number screened is due to the fact that the screening was conducted this week in the five supported districts. A total of 271 new cases of severe acute malnourished (SAM) children were identified, of which 185 cases were from communities and 86 cases identified from regular health facility screening. They were referred and admitted for treatment at the OTPs, and 32 children with medical complications were referred to an inpatient facility (IPF) to receive paediatric and nutrition care. UNICEF continues to directly provide nutritional supplies to nine ETUs, three ETU/EHCs, 30 EHCs, three interim care centres (ICCs)2 and two observational interim care centres (OICCs) as well as UNICEF supported CCCs. Supplies include high energy fortified biscuits (BP100), ready-to-use infant formula (RUIF) and Ultra High Temperature (UHT) whole/full cream milk for Ebola patients and survivors – including for children. A total of 1,215 cartons of BP-100, 1,175 cartons of RUIF, 345 of UHT, 16 of F-100 and 15 of F-75 were distributed to replenish all ETUs, EHCs, CCCs, ICCs and OICCs

1 UNICEF currently has NGO partnerships in five districts (Bombali, Kambia, Kono, Moyamba & Port Loko) and is in the process of establishing partnerships in every district. Kono did not provide any data this week. In the remaining eight districts, the district nutritionist through the DHMT, screens children and refers children for SAM but only reports to the MoHS and UNICEF on a monthly basis. UNICEF also provides the nutrition supplies for these children. 2 One centre operates as an OICC and ICC.

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countrywide and ensure uninterrupted supply of nutritional supplies during the festive season. In addition a total of 6,562 cartons of RUTF, 41 cartons of F-75 and 29 cartons of F-100 have also been distributed to 423 PHUs (out of 1,185) with OTP services for treatment of SAM in all 13 districts.

WASH As lead agency for WASH, UNICEF is coordinating the WASH sector Ebola response. UNICEF continues to support 23 ETUs and EHCs in eight districts with an essential WASH package (sanitation facilities, waste management and water supply for drinking, personal hygiene and disinfection), with a total capacity of 476 beds. UNICEF has ensured that newly constructed CCCs of 2x24 beds in the Western Area are fully installed with complete WASH packages. In addition, the construction of four new CCCs with a total capacity of 32 beds in Kono district is in its final stages with a complete package of WASH services. Since the last reporting period, in support of 431 quarantined households (QHHs) in Western Area, UNICEF has provided collapsible jerry cans (four 10L/per QHH), together with a 21-day supply of aqua tabs and soap. To date around 39,953 people in quarantine households and communities benefited from the WASH Supplies distributed through WFP packages. Since the last reporting period an additional 5,440 people including 1,578 children have been reached with Ebola prevention messages including the importance of hand washing with soap. Since June 2014, UNICEF’s WASH partners operating in seven districts have reached more than 562,140 people (approximately 84,550 households) with essential Ebola prevention messages. More than 8,700 persons who visit PHUs daily now practice hand washing through a total of 1,162 hand washing facilities distributed to the PHUs through WFP.

Communication for Development (C4D) and Social Mobilization (SM)3 As part of the Western Area Surge (WAS), UNICEF and the District Health Management Team (DHMT) trained and deployed 400 social mobilizers (SMs) in the two Western Area districts. To date, approximately 8,000 households have been reached by these SMs. Reporting from the districts remain a challenge with only 8 out of 14 districts reporting this week. Based on these reports, 1,799 social mobilizers were trained in Bo, Bombali, Kailahun, Kambia, Kono, and Tonkolili. Social mobilizers reached 9,956 households through inter-personal communication and engaged 356 religious leaders and 66 paramount chiefs in the 8 districts. Under the UNICEF-funded Hot Spot Busters project, 788 trained mobilizers from the Health for All Coalition (HFAC) visited 264 hotspot communities nationwide mobilizing about 66,000 households. The mobilizers referred 48% (350) of 728 suspected cases nationwide to authorized health facilities within 48 hours of identification. Data analysis of calls to the 117 Ebola hotline during the period of 1-14 December revealed that the percentage of calls increased significantly in the second week of the month: sickness (26%+), seek health information (45%+) and or other types of support (80%+). This possibly related to intensified SM outreach, improvements in the 117 system (which now includes a feedback mechanism) and increasing trust in the ability of 117 to respond to calls/provide care.

3 UNICEF is the lead agency for the UN for social mobilization and community engagement and is co-chairing the Social Mobilization pillar with the Health Education Division (HED) of the MoHS.

150 10,000-litre water tanks were handed over by UNICEF on 24 Dec to the Minister of Water Resources, Momodu Maligi (left), and the Guma Valley Water Company

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Community Care Centres A 24 bed CCC at Newton, Western area, opened to patients on 27 December. This large capacity CCC is one of two facilities initiated as part of the Western Area Surge. The second site, Hamilton, is scheduled to open in the coming days. The opening of one of four sites in Kono (Condama) is being fast-tracked to 2 January to respond to the recent spike in cases in the district. The remaining three sites are scheduled to open early January. During the period 23-28 December, 56 new CCC admissions were reported, 50% of which had attended the CCC within 48 hours of symptom onset. By year end, a total of 36 CCCs (320 beds) will have been established across the country with capacity expected to rise to 46 CCCs (400 beds) early January.

Child Protection4 Registration 3,429 children were documented by UNICEF and partners during the reporting period as being affected by the Ebola Virus Disease. Of this number 433 children (235 boys and 198 girls) are in quarantine in their homes as a result of exposure to an infected person; 264 were confirmed to be Ebola positive (146 boys and 118 girls). 2,803 children or 82% (1,451 boys and 1,352 girls) of the children documented are single or double orphans and 51 are documented as unaccompanied. The total number of children documented by UNICEF through the Family Tracing and Reunification (FTR) network is 14,766 (7,410 girls and 7,356 boys) of which 7,938 have lost one or both parents and 530 are unaccompanied. Interim Care Centres (ICCs) and Observational ICCs (OICCs) There are currently 13 OICCS providing interim care for contact children in 10 districts. Plans are in place to open an additional 4 shortly with 10 directly supported by UNICEF. There are 17 operational ICCS providing care and support to vulnerable children without caregivers (non-contact) in 11 districts. In the last fortnight 54 contact children were placed in the OICCs and 399 in the ICCS. The ICCS and OICCss are last resort measures with the majority of children reunified with their families without placement in either OICC or ICCs. Family Tracing and Reunification Between 17 December and 31 December, 401 children were documented for Family Tracing and Reunification in 11 out of 14 districts (there were no registered requests in the other 3). Of these 298 or 74% children were provided with FTR services including family and community assessment and mediation, family reunification, placement of into kinship and foster care and follow up. All children were documented using nationally approved FTR forms. A cumulative total of 674 children out of 1214 (56 percent) have received FTR and reunification services in all 14 districts through UNICEF

supported FTR network supervised by the MSWGCA. Relief Items 2,848 out of 3,422 (or 83%) in eleven districts were provided with relief items for care and reintegration either during discharge from treatment centres or during reunifications or follow ups. Relief items included clothes, hygiene and sanitation materials, blankets, slippers, beddings and toys. Psychosocial Services A total of 3,174 out of 3,296 in need of psychosocial services received one-on-one counselling and group counselling support within their communities during

4 UNICEF is the lead agency for the UN on child protection in the Ebola response and is co-chairing the Child Protection, Psychosocial and Gender pillar with MSWGCA.

On 23 December, 2,500 UNICEF Family Tracing and Reunification kits were packed in Freetown

UNMEER head, Anthony Banbury, visits the CCC in Mayagba, Bombali District, on 30 December

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this reporting period. Counselling support is provided as part of the follow up on children when they are reunified or placed in alternative care. 54 adults of which 30 males and 24 females also received counselling support during follow up visits in their homes at community level. All 54 are survivors who are reintegrating well into their families and communities. To date 14,766 Ebola affected persons (8,976 children and 5,790 adults) have benefited from various psychosocial support services.

Education As part of the roll-out of the Emergency Radio Education Programme (EREP) a house-to-house monitoring and sensitization exercise has been undertaken. While data entry has not yet finished, initial raw findings show that more than 75% of the households had children who had heard of the programme. The channels through which a largest number of the children had heard about the EREP were through the radio (82%), friends/neighbours (40%), and teachers in the community (33%). More than 70% of the households had functional radios.

Supply and Logistics The logistics team have undertaken a number of priority distributions in support of the establishment of six new CCCs, four in Kono and two in Western Area. Local procurement and distribution activities continue at pace in support of the CCC needs. Further preparation of CCC support kits are being established at the Ferry Junction warehouse, and consolidation of warehousing/stock control and inventory reconciliation activities continue. Over 36 MT of supplies in fifteen 40’ containers were cleared from customs and relocated to UNICEF or Central Medical Store (CMS) warehouses.

Human Resources To boost UNICEF’s Ebola response in Sierra Leone a significant number of international posts were established to provide the necessary support. Currently there are 52 international, 136 national staff, and 15 staff on surge and standby partner arrangements deployed in Freetown and 12 districts in Sierra Leone. In addition, there are 742 outsourced third party and government staff deployed across the country. Below is the total staff strength as at 31 December 2014.

UNICEF Personnel in Sierra Leone

Freetown In the field Total Staff Strength

International Staff 51 1 52

National Staff 121 15 136

Staff on Surge and SBP 12 3 15

Outsourced third party/ government staff for CCCs

742

Media & External Communication The External Relations and Advocacy (ERA) team accompanied a group of local journalists from the national broadcaster SLBC and national newspapers to cover the restart of survivor conferences in the south-east. UNICEF issued a national press release at the end of the four survivor meetings / distributions (in Kailahun (2), Kenema, Bo). In addition, the ERA team prepared video and photo material which were shared globally, including an interview with a survivor highlighting issues of stigma and also showing the role survivors can now play in caring for Ebola contact children. With many UNICEF staff working over the holiday period, BBC radio (5live and World Service) carried an audio diary with a UNICEF staff member on his Christmas day experience, which was also followed up with a live interview. An AP interview with health specialist, Dr Nuhu Maksha, also led to coverage in the NY Times, while our anti-malaria medicine drive was highlighted by Nature. Social media postings continued on a daily basis on Facebook and Twitter. During the reporting period on Facebook there were 27 new page likes, 61 shares, 485 post likes and 7,944 posts viewed on the site. On Twitter we gained 32 new followers and received 1,426 mentions with 17 retweets.

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Funding

In line with the UN inter-agency response strategy for the Ebola Outbreak, UNICEF humanitarian action for children (HAC) is appealing for USD 178 million for Sierra Leone to support the needs of women and children affected by the Ebola crisis until end of June 2015. To date, USD 93 million has been received, 52 percent of the current appeal. UNICEF greatly appreciates the contributions that have been received to date including from the Governments of Canada, Germany, Ireland, Italy, Japan, The Netherlands and United Arab Emirates, DfID, ECHO, OFDA/USAID, SIDA, OCHA, the World Bank, and the Swedish, UK and US Fund for UNICEF, as well as the private sector.

Security Nothing to report. Next Situation Report: 7 January 2015

UNICEF Sierra Leone Facebook: https://www.facebook.com/unicefsierraleone UNICEF Sierra Leone Twitter: https://twitter.com/UnicefSL UNICEF Sierra Leone YouTube: https://www.youtube.com/user/UNICEFSL

Who to contact for further information:

Roeland Monasch, Representative UNICEF Sierra Leone Tel: +44 2033579278/9 x1001 Mobile : +232 79 250 230 Email: rmonasch@unicef.org

John James, Communication Specialist UNICEF Sierra Leone Tel: + 232 76 601 310 Mobile: +232 76 102 401 Email: jjames@unicef.org

Gopal Sharma, Deputy Representative UNICEF Sierra Leone Tel: +44 2033579278/9 x2001 Mobile: +232 76 291 023 Email: gsharma@unicef.org

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Programme Results

UNICEF and Pillar/Sector Results for EVD response (insert Date)

Indicators Pillar / Sector UNICEF

Target Results Target Results

Percentage of EVD cases with onset in the past week

0% 1.7%

(344/19,788) N/A N/A

Percentage of EVD cases with onset in the past week due to contact at community level, within the health sector, or during funeral / burial procedures

SOCIAL MOBILISATION / C4D

Percentage of District, Social Mobilization taskforces (SMT) reporting on the dashboard each week (UNMEER)

100% (14) 57% (8/14) 100% (14) 57% (8/14)

Percentage of districts, counties etc. with list of identified key religious leaders (including priests, imams, pastors, tribal leaders) or community groups who promote safe funeral and burial practices according to standard guidelines (UNMEER)

100% (14) 100% (14/14) 100% (14) 100% (14/14)

Percentage of Districts with at least one security incident or other form of refusal to cooperate in past week (UNMEER)

0% (0) 14% (2/14) 0% (0) 14% (2/14)

Percentage of CCCs established after a community dialogue process aligned with Global SOPs or according to norms established in country (UNMEER)

100% (200) 25% (50) 100% (42) 100% (42)

Percentage of patients who present at a CCC within 48 hours of becoming ill with any symptoms that could be EVD (UNMEER)

100% (60) 53% (32/60) 100% (60) 53% (32/60)

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Radio stations airing daily messages on Ebola

100% (64) 97% (62/64) 100% (64) 97% (62/64)

Districts where all radio stations air Ebola content every day

100% (14) 100% (14/14) 100% (14) 100% (14/14)

House Holds receiving Inter-Personal Communication on Ebola prevention messages this week

100% (886,480) 9%

(83,956/886,480) 100% (886,480)

9% (83,956/886,480)

Percentage of CCCs functional against target set for the current reporting period (up to 30 Nov) (UNMEER)

100% (200) 25% (49) 100% (46) 59% (29/46)

WASH

Percentage of all Ebola community treatment and holding centers with essential WASH services

100% (90) 100% (90/90) 100% (65)

100% (65/65)

CCCs provided with essential WASH services

200 NA 100% (42)

100% (42/42)

Non-Ebola health centres in Ebola- affected areas provided with hand-washing stations

N/A N/A 100%

(1,162) 100% (1,162/1,162)

People in quarantine households receiving WASH support (as part of “home protection and support” kit)

N/A N/A 100%

(420,000) 10%

(39,953/420,000)

CHILD PROTECTION

Percentage of EVD-affected children provided with care and support, including psychosocial support

100% (14,766)

79% (11,594/14,766)

100% (14,766)

79% (11,594/14,766)

Percentage of children who have lost one or both parents/caregivers or who are separated from their parents/caregivers reintegrated with their families or provided with appropriate alternative care.

100% (1,578)

59% (935/1,578) N/A N/A

EVD-affected children and caregivers provided with psychosocial support.

N/A N/A 100%

(14,766) 79%

(11,594/14,766)

EVD-affected children placed in interim care

N/A N/A TBD 456

EVD-affected children reunified with their families N/A N/A TBD 650

EVD-affected children and adult survivors who receive non-food items

N/A N/A TBD 8834

HEALTH and HIV

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Percentage of patients admitted to CCCs with a provisional diagnosis of possible EVD who receive a confirmatory positive or negative test (rapid or laboratory test) within 36 hours of admission to treatment facility

TBD TBD N/A N/A

Health structures in EVD affected areas provided with essential commodities package

N/A N/A 100% (1,185) 100% (1,188/1,185)

Health personnel in health facilities trained in infection prevention and control and Ebola triage

N/A N/A 100% (2000) 218% (4,368/2,000)

Community Health Workers (CHW) trained on revised guidelines on provision of community-based maternal, new-born and child health (MNCH) care

N/A N/A 100% (6,000) 40.4% (2,422/6,000)

HIV positive women (including pregnant women) continuing to receive ARTs

N/A N/A 100% (1,142) 75% (856/1,142)

HIV positive children continuing to receive ARTs N/A N/A 100% (539) 20% (109/539)

NUTRITION

Treatment centres providing nutrition support to Ebola patients

N/A N/A 100% (75) 100% (75/75)

Children 6-59 months screened for SAM and referred for treatment

N/A N/A 70% (18,885) 29% (5,451/18,885)

EDUCATION

Radio Lesson Listenership Coverage during EREP monitoring

100% 52.5% 100% 52.5%

Teachers trained on psycho social support, Ebola prevention, and safe and protective learning environments

7,000 NA 7,000 NA

Radio stations broadcasting emergency learning programmes

N/A N/A

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100% (41)

SOCIAL POLICY

Extremely poor households directly affected by the EVD that receive a cash transfer through the national safety net programme

8,000 8,000 NA NA