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The magnitude of West Africa’s Ebola outbreak has been underestimated, the World Health Organisation (WHO) said, warning that unknown numbers of people were dying in “shadow zones” unrecorded by medical authorities.
Official estimates place the number of known, suspected and probable cases of Ebola at nearly 2,500, just over half of which have been fatal. However, in a detailed assessment of the true extent of the crisis, the WHO described a bleak situation in which “an invisible caseload of patients… are not being detected by the surveillance system”.
Recording of Ebola cases has been hindered for a number of reasons, particularly in Sierra Leone and Liberia, which have seen the worst of the epidemic, the WHO said in its latest situation report.
Families are hiding infected loved ones, on the assumption that, because Ebola has no cure, it would be better for them to die at home rather than in hospital. However, effective treatment can improve chances of survival – a message that health authorities have been struggling to communicate to increasingly fearful populations.
Isolation wards for Ebola patients are instead being viewed by many Africans as an “incubator for the disease”, the WHO said. Many medical facilities throughout the affected countries have closed, in many cases because medical staff have fled.
In the Liberian capital, Monrovia, where curfews aimed at slowing the spread of the virus have led to clashes between security forces and residents, hospitals and clinics have remained closed since authorities ordered them to be disinfected, and medical staff retrained to cope with Ebola three weeks ago. The WHO said that “virtually all health services have shut down” in the city, leading to a healthcare crisis beyond the impact of Ebola itself, with people forced to go without basic medical care.
The Ebola outbreak has been traced to a suspected 'patient zero' - a two-year-old boy (AFP/Getty Images) Aphaluck Bhatiasevi, a WHO officer in Monrovia, said the re-opening of healthcare units was taking longer than expected, but that maternity services and obstetrics were now operating again at the city’s main hospital.
“The system wasn’t at its best to begin with. We are facing challenges getting the healthcare facilities up and running,” she said. “Roads are not in a perfect condition. We are in the rainy season, and there are patients who do not have Ebola unable to get the necessary healthcare.”
In remote villages, corpses are being buried before authorities are notified. In some cases, according to the WHO, epidemiologists reaching the villages have been forced to “count the number of fresh graves” as a crude indicator of Ebola deaths.
In pictures: Ebola virus Show all 62 1 /62In pictures: Ebola virus In pictures: Ebola virus Ebola virus A health worker from Sierra Leone's Red Cross Society Burial Team 7 carries the corpse of a child in Freetown
In pictures: Ebola virus Ebola virus A health workers from the Sierra Leone's Red Cross Society Burial Team 7 is sprayed with desinfectant after removing a corpse from a house in Freetown
In pictures: Ebola virus Ebola virus Health workers from Sierra Leone's Red Cross Society Burial Team 7 prepare to remove a body from a house in Freetown
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In pictures: Ebola virus Ebola virus Health workers from the Sierra Leone's Red Cross Society Burial Team 7 place a body in a grave at King Tom cemetary in Freetown
In pictures: Ebola virus Ebola virus Mustapha Rogers of the Red Cross talks as health workers from the Sierra Leone's Red Cross Society Burial Team 7 remove a corpse from a house in Freetown
In pictures: Ebola virus Ebola virus A citizen from Mali arrives at a hospital in Murcia city, south-eastern Spain. The protocol for a possible case of Ebola has been activated as the man, who arrived from Mali to Jumilla town in Murcia province five days ago, presents clinical symptoms of high fever and vomiting
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In pictures: Ebola virus Ebola virus Kenyan medical workers show how to handle an infected Ebola patient on a portable negative pressure bed at the Kenyatta national hospital in Nairobi
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In pictures: Ebola virus Ebola virus A health worker sprays disinfectant onto a college in Monrovia, Liberia
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In pictures: Ebola virus Ebola virus A burial team in protective gear bury the body of a woman suspected to have died from Ebola virus in Monrovia, Liberia
In pictures: Ebola virus Ebola virus Healthcare workers in protective gear work at an Ebola treatment center in the west of Freetown, Sierra Leone
AP Photo/Michael Duff
In pictures: Ebola virus Ebola virus A healthcare worker in protective gear is sprayed with disinfectant after working in an Ebola treatment center in the west of Freetown, Sierra Leone
In pictures: Ebola virus Ebola virus A member of the NGO U Fondation leaves a house after visiting quarantined family members suffering from the Ebola virus in Monrovia
In pictures: Ebola virus Ebola virus An Ebola sign placed infront of a home in West Point slum area of Monrovia, Liberia
In pictures: Ebola virus Ebola virus A Liberian man carries his sick brother suspected of having Ebola after being delayed admission to the Island Clinic Ebola Treatment Unit due to a lack of beds at the clinic on the outskirts of Monrovia, Liberia
In pictures: Ebola virus Ebola virus Health workers remove the body a woman who died from the Ebola virus in the Aberdeen district of Freetown, Sierra Leone
In pictures: Ebola virus Ebola virus A health worker fixes another health worker's protective suit in the Aberdeen district of Freetown, Sierra Leone
In pictures: Ebola virus Ebola virus Health workers spray themselves with chlorine disinfectants after removing the body a woman who died of Ebola virus in the Aberdeen district of Freetown, Sierra Leone
In pictures: Ebola virus Ebola virus A woman crawls towards the body of her sister as Ebola burial team members take her sister Mekie Nagbe (28) for cremation in Monrovia, Liberia
In pictures: Ebola virus Ebola virus Sophia Doe sits with her grandchildren Beauty Mandi, 9 months (L) and Arthuneh Qunoh, 9, (R), while watching the arrival an Ebola burial team to take away the body of her daughter Mekie Nagbe, 28, for cremation in Monrovia, Liberia
In pictures: Ebola virus Ebola virus Varney Jonson (46) grieves as an Ebola burial team takes away the body of his wife Nama Fambule for cremation in Monrovia, Liberia
In pictures: Ebola virus Ebola virus Family members grieve as Ebola burial team members prepare to remove the body of Nama Fambule for cremation in Monrovia, Liberia
In pictures: Ebola virus Ebola virus A Liberian burial squad carry the body of an Ebola victim in Marshall, Margini county, Liberia
In pictures: Ebola virus Ebola virus An Ebola burial team dresses in protective clothing before collecting the body of a woman (54) from her home in the New Kru Town suburb of Monrovia, Liberia
In pictures: Ebola virus Ebola virus An Ebola burial team carries the body of a woman (54) through the New Kru Town suburb of Monrovia, Liberia
In pictures: Ebola virus Ebola virus An Ebola burial team dresses in protective clothing before collecting the body of a woman (54) from her home in the New Kru Town suburb of Monrovia, Liberia
In pictures: Ebola virus Ebola virus Health workers in protective gear carry the body of a woman suspected to have died from Ebola virus, from a house in New Kru Town at the outskirt of Monrovia, Liberia
In pictures: Ebola virus Ebola virus Volunteers in protective suit bury the body of a person who died from Ebola in Waterloo, some 30 kilometers southeast of Freetown
FLORIAN PLAUCHEUR/AFP/Getty Images
In pictures: Ebola virus Ebola virus Nowa Paye (9) is taken to an ambulance after showing signs of the Ebola infection in the village of Freeman Reserve, about 30 miles north of Monrovia, Liberia
In pictures: Ebola virus Ebola virus Medical staff members burn clothes belonging to patients suffering from Ebola, at the French medical NGO Medecins Sans Frontieres (MSF) in Monrovia
PASCAL GUYOT/AFP/Getty Images
In pictures: Ebola virus Ebola virus A medical staff member wearing a protective suit walks past the crematorium where victims of Ebola are burned in Monrovia
In pictures: Ebola virus Ebola virus A Liberian burial team wearing protective clothing loads the body of a 60-year-old Ebola victim after retrieving him from his home
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In pictures: Ebola virus Ebola virus Sick women rest while hoping to enter the new Doctors Without Borders (MSF), Ebola treatment center near Monrovia, Liberia
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In pictures: Ebola virus Ebola virus Hanah Siafa walks in the rain with her children Josephine, 10, and Elija, six, while waiting to enter the new Doctors Without Borders (MSF), Ebola treatment center in Monrovia, Liberia
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In pictures: Ebola virus Ebola virus UNICEF health workers walk through the streets, going house to house to speak about Ebola prevention in New Kru Town, Liberia. The virus has killed more than 1,000 people in four African countries
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In pictures: Ebola virus Ebola virus Local residents watch as public health advocates stage an Ebola awareness and prevention event in Monrovia, Liberia
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In pictures: Ebola virus Ebola virus Public health advocates stage an Ebola awareness and prevention event in Monrovia, Liberia. The Liberian government and international groups are trying to convince residents of the danger and are urging people to wash their hands to help prevent the spread of the epidemic
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In pictures: Ebola virus Ebola virus Hanah Siafa lies with her children Josephine, 10, and Elija, six, while hoping to enter the new Doctors Without Borders (MSF), Ebola treatment center
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In pictures: Ebola virus Ebola virus A health worker examines patients for Ebola inside a screening tent, at the Kenema Government Hospital
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In pictures: Ebola virus Ebola virus A health worker cleans his hands with chlorinated water before entering an Ebola screening tent at the Kenema Government Hospital, about 86 miles from Sierra Leone’s capital Freetown
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In pictures: Ebola virus Ebola virus Aid workers and doctors transfer Miguel Pajares, a Spanish priest who was infected with the Ebola virus while working in Liberia, from a plane to an ambulance as he leaves the Torrejon de Ardoz military airbase, near Madrid, Spain
AP Photo/Spanish Defense Ministry
In pictures: Ebola virus Ebola virus A Liberian money exchanger washes hands between customers as a precaution to prevent infection with the deadly Ebola virus while conducting business in downtown Monrovia, Liberia
EPA
In pictures: Ebola virus Ebola virus A Liberian health worker sprays disinfectant on a drivers boots to stop the spread of the deadly Ebola virus at the Christian charity Samaritan Purse head offices in Monrovia, Liberia. Over 660 people have died of Ebola in West Africa in 2014 making it the world's deadliest outbreak to date according to statistics from the World Health Organisation
EPA
In pictures: Ebola virus Ebola virus A Liberian taxi driver wears protective gloves as a precaution to prevent infection with the deadly Ebola virus whilst driving in downtown Monrovia, Liberia. Many Liberians have taken to wearing gloves and washing hands after every interaction in an attempt to curb the spread of the deadly virus
EPA
In pictures: Ebola virus Ebola virus A Liberian money exchanger wears protective gloves as a precaution to prevent infection with the deadly Ebola virus while transacting business with customers in downtown Monrovia, Liberia
EPA
In pictures: Ebola virus Ebola virus A woman from Liberia takes food to a sick relative in the Ebola isolation unit at the ELWA Hospital where US doctor Kent Bradley is being quarantined having contracted the Ebola virus. Over 660 people have died of Ebola in West Africa in 2014 making it the world's deadliest outbreak to date according to statistics from the World Health Organisation
EPA
In pictures: Ebola virus Ebola virus The disease has now spread to Liberia and, for the first time, Sierra Leone and Nigeria, killing at least 672 people in 1,201 cases, according to the World Health Organisation’s latest figures
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In pictures: Ebola virus Ebola virus Health specialists prepare for work in an isolation ward for patients at the Medecins Sans Frontieres facility in southern Guinea
AFP/Getty Images
In pictures: Ebola virus Ebola virus A Liberian street vendor wears protective gloves as a precaution to prevent infection with the deadly Ebola virus while transacting business with customers in downtown Monrovia, Liberia
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In pictures: Ebola virus Ebola virus A nurse from Liberia sprays preventives to disinfect the waiting area for visitors at the ELWA Hospital where a US doctor Kent Bradley is being quarantined in the hospitals isolation unit having contracted the Ebola virus, Monrovia, Liberia
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In pictures: Ebola virus Ebola virus Staff of the 'Doctors without Borders' ('Medecin sans frontieres') medical aid organisation carry the body of a person killed by the virus
In pictures: Ebola virus Ebola virus A Liberia man (right) talks to a nurse (left) about the health of his relative who is in the isolation unit of the ELWA Hospital where a US doctor Kent Bradley is being quarantined having contracted the Ebola virus, Monrovia, Liberia
EPA
In pictures: Ebola virus Ebola virus A nurse from Liberia walks to spray preventives to disinfect the waiting area for visitors at the ELWA Hospital where a US doctor Kent Bradley is being quarantined in the hospitals isolation unit having contracted the Ebola virus
EPA
In pictures: Ebola virus Ebola virus Staff of the Christian charity Samaritan's Purse put on protective gear in the ELWA hospital in the Liberian capital Monrovia
AFP
In pictures: Ebola virus Ebola virus Lagos State Health Commissioner Jide Idris, speaks, during a news conference in Lagos, Nigeria. No one knows for sure just how many people Patrick Sawyer came into contact with the day he boarded a flight in Liberia, had a stopover in Ghana, changed planes in Togo, and then arrived in Nigeria, where authorities say he died days later from Ebola
AP Photo/Sunday Alamba
In pictures: Ebola virus Ebola virus Staff of the Christian charity Samaritan's Purse put on protective gear in the ELWA hospital in the Liberian capital Monrovia. An American doctor battling West Africa's Ebola epidemic has himself fallen sick with the disease in Liberia, Samaritan's Purse said
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In pictures: Ebola virus Ebola virus Protective gear including boots, gloves, masks and suits, drying after being used in a treatment room in the ELWA hospital in the Liberian capital Monrovia
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In pictures: Ebola virus Ebola virus A Liberian man holding a Civet being sold on a roadside as bush meat in Lofa County. Bush meat is one of the major carriers of the Ebola virus. The Liberian government and International partners have warned people to not eat it. The World Health Organisation (WHO) reported that a total of 888 Ebola cases including 539 deaths have been recorded in West Africa since February
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In pictures: Ebola virus Ebola virus People unload protection and healthcare material at Conakry's airport, to help fight the spread of the Ebola virus and treat people who have been already infected
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In pictures: Ebola virus Ebola virus Body of evidence: health workers transport a casket of a nun whose death resulted from an Ebola infection in Zaire in 1995
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In pictures: Ebola virus Ebola virus Peter Piot in Yambuku, northern Congo (then Zaire), in 1976, where he was part of the original team to discover the Ebola virus
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In pictures: Ebola virus Ebola virus A member of Doctors Without Borders helps to unload protection and healthcare materials in Guinea
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In pictures: Ebola virus Ebola virus Doctors in protective gear work inside the Medecins Sans Frontieres isolation ward as Guinea faced the worst ever outbreak of the Ebola virus
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Tarik Jasarevic, a spokesman for the WHO, told The Independent it was not possible to estimate how many unrecorded Ebola cases and deaths had been caused. “It is not just being underestimated in terms of figures, but also in terms of the social, economic and security impact,” he said. “It is a health issue, with much wider consequences... Next week we will present an Ebola road map, based on what we have learnt so far and what it will take to put in place everything we need.”
Sierra Leone’s economy has deflated by 30 per cent, while Liberia and Guinea, where the outbreak began about six months ago, are expected to see economic growth slowed. In Nigeria, the fourth and by far the most populous country to record Ebola cases, fears of wider spread were raised today after two new cases were confirmed – the first who had not come into contact with an infected traveller who flew into Lagos from Liberia last month.
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