Letters

Role of the Red Cross movement in Uganda’s Ebola outbreak

Editor – With reference to the news item in the December 2000 Bulletin (pp.1476–1477) on the outbreak of Ebola haemorrhagic fever in Uganda in October–November 2000, I agree with the main conclusions about what seems to make a difference in the management of such outbreaks.

Ray Arthur’s comments on the correlation between a more vigorous intravenous fluid replacement therapy and the higher survival rate compared with other outbreaks are reasonable. My own thought is that we were probably also dealing with different strains of the virus, some of them more virulent and lethal than others. Additional factors contributing to a better survival rate appear to be the early detection of cases and the tracing of contacts. One particular feature of this latest outbreak is the difficulty of reintegrating survivors into their own communities: they have suddenly become outcasts — expelled from home, their clothes burnt, and with no possibility of finding work.

Your news item mentioned a number of WHO partners as contributors to the relative success of the intervention. The International Committee of the Red Cross (ICRC) is mentioned, but not the International Federation of Red Cross and Red Crescent Societies or the Ugandan Red Cross. Many people do not realize the existence of three different components of the Red Cross movement; the work of national societies and the Federation is very often ignored, albeit unintentionally, so I should like to clarify who does what.

ICRC provides services and health care in conflict zones, while the Federation is the umbrella organization for 176 national societies, representing and supporting them. Such support includes the provision of guidance and standards and coordination of efforts. In emergencies, we support the national societies to do the actual work — and if the task is too big we also provide the necessary resources, as was the case in the Ebola outbreak.

There is one National Society per country, running support programmes that target the most vulnerable people in the population, both under normal circumstances and during emergencies. In this epidemic, the Ugandan Red Cross and the Federation trained scores of volunteers to do much of the house-to-house health information and education campaigning as well as case detection and, when cases were found, to make sure the patients presented for check-up and treatment. From my perspective, based on our previous experience in Gabon and the Democratic Republic of the Congo, this support was crucial and made a major contribution to the better outcome.

The problem with the discharged patients was detected quite early, so the same volunteers, plus additional ones, were trained to provide psychosocial support. This is an ongoing activity and we do not know as yet how effective it is — we are still learning. This is a complex issue, as there are many misconceptions, taboos and traditional belief-related factors to deal with. Once we have analysed the operation, the Federation and the Ugandan Red Cross plan to publish jointly an evaluation of the lessons we have learned.

Håkan Sandbladh
Health in Emergencies
International Federation of Red Cross
and Red Crescent Societies
1211 Geneva 19, Switzerland
email: sandblad@ifrc.org