IN= =TERNATIONAL

How the Ebola Outbreak in Africa Could Become a Threat

to Europe - Gateway to Hell By Katrin Elger, Veronika Hackenbroch, Horand
Knaup, Gordon Repinski and Samiha Shaf

With Ebola spreading rapidly in Nigeria and other parts of West Africa,
international organizations fear the number of infections could exceed
20,000. Experts are calling for the industrialized world to do more to
help stop the virus.

Kalashnikovs cost as little as $100 in Port Harcourt, says Helmut Lux, an

orthopedist and trauma surgeon from Germany. The machine gun is said to be
the favorite weapon of gangs in the Nigerian city. Lux came to the port city in
oil-rich southern Nigeria two years ago and worked for the aid organization
Doctors without Borders. He quickly learned that an AK-47 can rip large holes in
a person's body. Lux conducted operations day and night until overuse resulted
in an inflamed tendon in his hand.

'An Extremely Filthy and Broken City'

Despite having worked in Port-au-Prince after a devastating earthquake
destroyed the Haitian capital in 2010, Lux was shocked by what he saw in
Nigeria. "Port Harcourt is an extremely filthy and broken city," he says. "It's the
gateway to hell." Now, the situation has become even worse. The city is
threatened by Ebola.

Even though the Nigerian authorities have responded correctly, it's in no way
certain that they will succeed in halting the outbreak. "Everything will depend on
whether all the contacts of the sick come out," says Oyewale Tomori, the
rapporteur for the World Health Organization's Ebola Emergency Committee. All
the ingredients for a catastrophe are in place. Disease control experts are united
in their fears that if the virus spreads to Lagos, a metropolis with millions of
inhabitants and mass slums, the number of deaths in Nigeria could quickly
eclipse the victim total in all of West Africa thus far.

"That would be a disaster for the people -- they wouldn't stand a chance," says
Lux. If someone gets sick with Ebola, he explains, there's a high likelihood that
person will be cast out by their family and that they will run away rather than
report themselves to the authorities.

The World Health Organization has deployed 15 technical experts to Port

Harcourt, and an Ebola emergency operations center and an isolation facility
with 26 beds that can be expanded have been set up. WHO officials have warned
that the security situation in the city is a serious problem and aid workers are
only able to move around with a military escort.

Dashed Hopes for Containment

This most recent outbreak got its start with a breathtaking act of negligence,
one which destroyed hopes that the deadly epidemic could quickly be controlled
in Africa's most populace country. An advisor to the Liberian Finance Ministry
brought Ebola to Lagos and officials quickly identified and quarantined the
people with whom he had contact. But one of them, the diplomat Olu-Ibukun
Koye, managed to escape quarantine.

At the beginning of August, he secretly went to Port Harcourt, where he found a

doctor willing to provide him with discreet treatment in a hotel. Koye survived
and after he started feeling better a few days later, he returned to Lagos. By
then, however, the doctor who had been treating him, Iyke Enemuo, had
contracted the virus.

The doctor continued providing treatment to patients at his private clinic and
also celebrated the birth of his new child at home with friends and family.
Eventually he grew so sick he had to be taken to the hospital. He didn't tell the
staff that he had provided treatment to a patient with Ebola. He also allowed
members of his church to place their hands on him during a healing ritual.

Enemuo died on August 22, but not before infecting his wife, his younger sister
and an elderly patient at the hospital where he had been treated. The patient
has also since died.

Are Official Ebola Estimates too Low?

The situation is already bad enough in the other countries that have been hit by
the disease, including Sierra Leone, Liberia and Guinea. Now WHO officials have
conceded that the official count of 4,000 Ebola cases and 2,100 deaths is likely
far too low.

DER SPIEGEL
Graphic: Ebola Cases in West Africa

In an action plan presented by the organization in August, officials estimate

there will be 20,000 infections before the current epidemic ends. Officials at
Doctors without Borders are even more pessimistic. "If something doesn't
happen quickly," says Joanne Liu, the international president of the organization,
"the number of infected could grow tenfold in the next three months, whereas
the WHO stated that it would take until November before the first vaccine or
medicines for treating Ebola can be delivered.

"Six months into the worst Ebola epidemic in history, the world is losing the
battle to contain it," said Ban Ki-moon adding also that it was an "international
rescue call" for the global community.
A Closing Window of Opportunity
Virtually all disease control experts agree that the only thing that can be done is
for industrialized nations to intervene directly to halt the spread. "There is a
window of opportunity to tamp this down, but that window is closing," says Tom
Frieden the director of the Centers for Disease Control in the United States. "We
know how to stop Ebola. The challenge is to scale up to the massive levels
needed to stop this outbreak."
Most needed are experts familiar with biohazards who don't need basic training
in such simple matters as how to use protective clothing. People are also needed
who can quickly set up makeshift hospitals using basic materials. Supplies and
logistical support are also required.

Doctors without Borders' Liu notes that many countries have invested heavily in
biological threat response. "I'm downright begging them for support, but it's
almost as if I am starving and the only thing being offered to me is a small
appetizer," she says.

Additional aid did come from the European Union, which increased its relief from
12 to 144 million. Still, money is no substitute for highly trained aid workers
and logistical support - immediate on-site relief in Africa is a must.

"Why isn't a country like Germany doing more," asks Lui. "Why, for example,
isn't there a functioning airlift?" From an operational perspective, however, Ebola
is a significant concern for the German military, which has had troops active in
several African countries for months now. The Bundeswehr's training mission in
Mali has provided considerable cause for concern given that the country shares
its borders with nations already hit by the epidemic, including Guinea.

The Bundeswehr has since developed an emergency plan for its areas of
deployment that includes five levels of action describing medical measures and
stipulating what soldiers should do in the event of infections. Experts from
Germany could also be flown in to provide support.

The swift spread of Ebola in Nigeria has left many wondering if the disease might
ultimately find its way to Germany or other parts of the world by way of air
travel. And given the situation in Nigeria, that eventuality can no longer be ruled
out. With the latest cases in Nigeria, "the situation has clearly been aggravated
again," says Florian Steiner, an Ebola expert at Berlin's Charit university
hospital. He notes that the densely populated country has a major international
airport. "There's considerable poverty, but also a very rich upper class," he says.
He adds that people are more educated and more mobile than those in Sierre
Leone or Guinea and that they can afford airfare.

"That means that the risk of someone flying in who has been infected has
increased considerably," Steiner says. "We are very well equipped in Germany,
but at the same time we don't have unlimited capacity."

Joanne Lui is convinced that the best way to protect Germany and Europe from
Ebola is to halt the disease in its current location. She's also trying to convince
other countries around the world of the same. "To put out this fire, we must run
into the burning building."