1976. In previous outbreaks, ebola has been confined to rural areas in which there was little contact outside the villages of which it appeared. Unfortunately, this outbreak now an epidemic spread from village to an International Center for regional trade, and spread into urban areas in guinea, sierra leone and liberia, that are crowded with limited medical services, and limited Resident Trust much government. The unprecedented west african ebola epidemic has not only killed more than 5,000 people, with more than 14,000 others known to be affected. This situation has skewed the planning for how to deal with the outbreak. In our two previous hearings on the ebola epidemic, an emergency hearing we held on august 7th, and then a followup on september 17th, we heard about the worsening rates of infection and challenges in responding to this forum from Government Agencies such as usaid and cdc and samaritans person. Todays hearing is intended to take testimony from nongovernmental organizations, providing services on the ground currently, in the affected countries, especially liberia, so we can better determine how proposed actions are being implemented. In its early stages ebola fan fests the same symptoms as less immediately deadly diseases such as malaria, which means initial Health Care Workers have been unprepared for the deadly nature of the disease that they have been asked to treat. This meant that too many Health Care Workers, national and international, have been at risk in treating patients who themselves may not know they have ebola. Hundreds of Health Care Workers have been infected, and many have died, including some of the top medical personnel in the three affected countries. What we found quite quickly was that the Health Care Systems in these countries, despite heavy investment by the United States and other donors, remain weak, as it happens there are these are three countries either coming out of very divisive civil conflict, or experiencing serious political divisions. Consequently, citizens have not been widely prepared to accept recommendations from their own governments. For quite some time, many people in all three countries would not accept that the ebola epidemic was real. Even now it is believed that despite the prevalence of burial teams throughout liberia, for example, some families are reluctant to identify their sufferings and dead loved ones for safe burials. Which places the family members and their neighbors at heightened risk of contracting this often fatal disease when patients are most contagious. The porous borders of these three countries have allowed people to cross between countries at will. This may facilitate commerce, which is a good thing, but it also allows for diseases to be transmitted regionally. As a result, the prevalence of ebola in these three countries has ebbed and flowed with the migration of people from one country to the other. Liberia remains the hardesthit of the three countries with more than 6500 ebola cases officially recorded. Probably a significant understatement. The number of infected and dead from ebola could be as much as three times, however, than official figure due to underreporting. Organizations operating on the ground have told us over the past five months that despite the increasing reach of international and National Efforts to contact those affected with ebola there remains many remote areas where it is still difficult to find residents or gain sufficient trust to obtain their cooperation. Consequently, the ebb and flow in infections continues. Even when it looks like the battle is being won in one place, it increases in a neighboring country, a region, and then reignites in the area that look to be successes. The United States is focusing on liberia. The uk is focusing on sierra leone, and france and the European Union are supposed to be focusing on guinea. In both sierra leone and guinea the antiebola efforts are behind the pace of those in liberia. This epidemic must be brought under control in all three if our efforts are to be successful. Last week, i along with congresswoman karen bass, and congressman mark meadows of this subcommittee introduced hr5710 the ebola Emergency Response act. This bill lays out steps that are needed for the u. S. Government to effectively help fight the west african ebola epidemic, especially in liberia. The worsthit of the throw countries. This krus recruiting and Training Health care personnel, establishing fully functional treatment centers, conducting education campaigns among populations in affected countries, and developing diagnostics, treatments and vaccines. Hr5710 confirms u. S. Policy in the antiebola fight, and provides necessary authorities for the administration to continue or expand anticipated actions in this regard. The bill encourages u. S. Collaboration with other donors. Mitigate the risk of economic collapse and civil unrest in the three affected countries. Furthermore the legislation authorizes funding of the International Disaster assistance account at the higher fy2014 level to effectively support these antiebola efforts. Id like to now turn to my friend and colleague miss bass. As always, thank you chairman smith for your leadership, and also for taking the lead on the legislation that we hope to have marked up soon. I also want to thank todays distinguished witnesses, and prominent ngo organizations. Providing critical medical, nutritional, and developmental assistance in the most adversely affected nations in west africa. I look forward to hearing your updates on how your respectively organizations continue to combat this deadly outbreak, what trends youre seeing both positive and negative, and what Additional Support is needed as you coordinate with the government the governments of the impacted countries and the international community. I appreciate your efforts and outreach to help Keep Congress informed of this evolving crisis. The current crisis, as has been stated, has been the largest and most widespread outbreak of the disease in history, creating a particular burden on the countries that are involved. Since the beginning of the outbreak, u. S. Based ngos have made a significant and sustained effort to support the three countries as they fought the disease. The United States has committed nearly 1 billion to build treatment centers, train Health Care Workers, and burial teams, supply hospitals with protective gear, and ensure the safety and humanitarian support. I would, in particular, like to hear from the witnesses what you think about the assistance that has been provided. And then i have a particular interest in your thoughts around when we are past this crisis what the u. S. Can leave in place. And your thoughts on how we move forward. So we know that the reason why this hit so badly is because of the Weak Health Infrastructure in these three countries. So out of this terrible crisis, is there a way for us to begin to think longterm about the future, how do we support the infrastructure of countries . And your thoughts on that would be appreciated. Ed administration has asked congress for over 6 billion in emergency funds in order to sustain the progress that has been made and to ensure an end to the crisis. This request will expand assistance to contain the epidemic, safeguard the American Public from further spread of the disease, and support the development of treatments. Sustained u. S. Financial support and involvement is essential to support the stable governance of these nations which is jeopardized by the current crisis. I also dont think that we have given much time to much time and attention to the fact that were dealing with countries that could actually be moved quite a bit backward, especially countries that have recently, you know, gotten past civil wars. So i look forward to your testimonies, and im interested in hearing from you about what we can do to assist your efforts. Thank you. Thank you. Id like to now welcome our three very distinguished witnesses who are extraordinaryly effective and informed and will provide this subcommittee i think a real insight as to what has been happening and what needs to be done. Beginning with mr. Rabih torbay, who is a Senior Vice President for the International Operations and oversees International Medical corps, Global Programs in 31 countries and four continents. And its staff and the staff volunteers numbering well over 8,000 people. He has personally supervised the expansion of imcs humanitarian and Development Programs into some of the Worlds Toughest working environments, including sierra lie yoen, iraq, darfur, liberia, lebanon, pakistan, afghanistan, haiti, libya and most recently syria. As the organizations senior representative in washington, d. C. , he serves as imcs liaison with the United States government. Well then hear from mr. Brett sedgewick who is a technical adviser for Food Security and livelihoods for global communities. He previously served as Vice President for the nascom foundation for whom he built stakeholder relations with government entities, donors and ngos and oversaw business development. Prior to that he served as liberias country director for chf international where he oversaw programs designed, implementation and monitoring for a range of donors. He also served as technical adviser to on a similar basis. Well then hear from dr. Darius mans who is the president of africare where he is responsible for the leadership and growth of that organization. Previously he fulfilled a number of roles at the Millennium Challenge Corporation, including acting chief executive officer and Vice President of implementation and managing director for africa. In these positions dr. Mans was responsible for vast and Diverse Program portfolios in mcc, exact countries. He also has experience managing 45 country programs around the world, as director of the world bank institute, working as an economist, teaching economics, and serving as a consultant on Infrastructure Projects in latin america. Were joined by mr. Weber, vice chairman of the committee. Thank you for being here. Lets go. Thank you. Thank you i turn to mr. Torbay. Chairman smith, Ranking Member bass, and distinguished members of the subcommittee, on behalf of International Medical corps, i would like to thank you for inviting me to testify today to describe the ongoing fight against the ebola Virus Outbreak from the ground level. I have already submitted a lengthy written testimony to the subcommittee. My remarks this morning will highlight key observations, and offer ten recommendations for our Ebola Response experience. International medical corps is a global humanitarian Nonprofit Organization dedicated to saving lives, and relieving suffering through Health Care Training and relief and Development Programs. We work in 31 countries around the world, and weve been working in west africa since 1999. Our response to the Ebola Outbreak has been robust in both liberia, and sierra leone. More than two thirds of all ebola cases and over three quarters of all ebola related deaths have come from these two countries. By the end of this month, we anticipate having a total about 800 staff in those two countries, and by years end, we expect this number to exceed 1,000 working in four ebola treatment units, two in liberia and two in sierra leone. I would like to take this opportunity to acknowledge dedicated and Courageous International and African National staff working in our treatment centers. They are from liberia and sierra leone as well as many parts of the United States, europe and other states. Our staff is compromised of doctors, nurses, technicians, specialists in water sanitation and hygiene, logisticians, Mental Health professionals, custodial workers, and burial teams. In addition to the treatment units, we have established several services for groups just now arriving to combat the outbreak. One example is a Training Center on the ground in liberia. It will teach and train staff from all organizations engaged in the fight to contain ebola, and show them how to treat patients and stay safe in a potentially dangerous workplace. We are also responding to the upsurge of ebola cases in mali. We will be setting up an ebola treatment unit and developing Health WorkerTraining Program to help the country fight the outbreak. Our robust response to the Ebola Outbreak has one overriding objective. Contain the current outbreak at its source in west africa. To succeed several key factors must be in place. One of these is building and safely operating ebola treatment units, staffed by welltrained health professionals. Another key factor is using Training Programs to transfer into local hands the skills and knowledge necessary to respond effectively to the Ebola Outbreaks. We must also assure effective coordination among all actors involved in the fight to contain the virus, including the u. N. , international and national governments, and ngos. To turn the tide of this epidemic we must all Work Together to maximize the strength of all involved. Finally we need to conduct expansive Data Collection and rigorous Data Analysis to build an accurate picture of ebola containment, and spot any need for new responses. Once we succeed to contain the current outbreak, we must remain vigilant to assure that theres no resurgence of this epidemic. The fight to contain ebola and future and prevent future outbreaks will require substantial investment. I would like to thank the u. S. Agency for international development, particularly its office of foreign Disaster Assistance for the funding it has provided to International Medical corps for our Ebola Response, as well as the support of the u. S. Military, particularly in setting up a laboratory near our ebola treatment unit in bonn county. We welcome the president s emergency request to congress to combat ebola in west africa. And based on our ontheground experience in fighting this epidemic, we would recommend that the 1. 4 billion allocated for International Disaster assistance be increased by an additional 200 million to a total of 1. 6 billion. And we recommend that an additional 48 million be added to the Economic Support Fund for a total of 260 million. Mr. Chairman, i conclude my tell by offering ten recommendations for effective treatment and eradication of ebola virus. One, ensure the availability of adequate number of welltrained, well protected Health Workers. One of the most critical Lessons Learned from this response has been the importance of having sufficient Human Resources prepared to address an outbreak of Infectious Disease. Two, ensure that construction of new ebola treatment units fit the local loads. The work must be well coordinated and well trained staff ready to work in each facility. We need to remain flexible and nimble and adapt quickly to changing remand to response of breaks in rural areas. Three, ensure the necessary quantity and quality of personal protective equipment that is available. Four, improve Data Collection. Surveillance that will help individuals receive treatment faster. Five, ensure that fear and understand the lines of communications and divisions of responsibilities are established understood and maintained among coordinating bodies operating in the region. A smart and efficient coordination system at the National Level is critical for an effective response. Six, we welcome the advances made over the past few weeks in establishing procedures to evacuate and treat expatriate Health Workers who might contract ebola. We recommend that the systems be put in place now, be institutionalized and made part of the global preparedness planning future for future epidemics. Seven, we recommend that commercial air space over ebola countries remain open that personnel and resources can move quickly. Eight, accelerate and support the production