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Ebola Outbreak: Advice for Humanitarian Aid Workers

This content is also available in French.

Purpose

These CDC recommendations help prepare humanitarian aid workers to safely work in a country with an Ebola outbreak. They will help prepare workers to take necessary steps before traveling, while working overseas, and upon returning to the United States.

 

 

Key points

Pre-travel
  • Take care of your health; learn about Ebola and where to get medical care if you get sick or injured overseas. Visit a travel clinic before you go.
  • If you will be working in a healthcare setting, make sure you are trained to work in non-US healthcare settings, are trained on proper use of personal protective equipment (PPE), and bring an adequate supply of PPE.
  • Stay informed about the outbreak. Check CDC's Ebola Outbreak in West Africa page regularly for the latest outbreak information.
During your travel
  • Follow recommendations for preventing exposure to Ebola.
  • Use PPE if working in healthcare settings.
  • Seek medical care immediately if you develop fever or other possible Ebola symptoms.
Returning to the United States
  • Be prepared to go through exit screening in the country you are leaving and entry screening when you arrive in the United States or other countries.
  • When arriving in the United States, tell Customs and Border Protection officers you were in a country with an Ebola outbreak.

Recommendations for humanitarian aid workers

Humanitarian aid workers play an essential role in controlling Ebola at its source in West Africa. All aid workers should be affiliated with a recognized humanitarian aid organization. CDC appreciates your work and wants to support your health and safety.

Before you leave

Caring for Your Emotional Wellbeing

It may be stressful to work or study in a country with an Ebola outbreak. There are practical steps you can take to help reduce stress.

Before Travel
  • Learn about Ebola and the destination country to prepare for differences in culture and environment. If you can, talk to someone who’s been there so you know what to expect.
  • Find out about any psychological or social support offered by your school and how to connect with those resources while overseas.
During Travel
  • Pay attention to your body’s signs of stress-- like feeling scared, anxious or sad, or having nightmares or problems sleeping.
  • To reduce and manage stress:
    • Keep a regular sleep schedule, and find time to relax when you can.
    • Eat a healthy diet, and exercise when you can.
    • Manage your workload as best you can by setting realistic tasks and priorities.
    • Keep in touch with friends or loved ones back home.
After Travel
  • Take time off to rest, spend time with those you love, and return to your daily routine.
  • If you feel sad or anxious after returning home, you may wish to seek counseling.
Be well informed and prepared
  • Learn about Ebola on CDC's Ebola website. Refer to the health recommendations and travel notice for your destination.
  • Learn more about recommended PPE and other infection control procedures on CDC’s Ebola in Non-US Healthcare Settings webpage. The World Health Organizations (WHO) also has Infection prevention and control guidance.
  • Learn more how to stay healthy and safe by going to the Humanitarian Aid Workers page or the “Stay Healthy and Safe” section that is visible on the Destination page after you select the country where you are traveling. If you can, talk to someone who has been there so you know what to expect. Print these materials to take with you.
  • Learn about screening requirements and restrictions that might affect your travel home. Countries with Ebola outbreaks are screening travelers leaving the country, and the United States and other countries are screening travelers arriving from countries with Ebola outbreaks.
  • Register with the US embassy in your destination country through the US Department of State’s Smart Traveler Enrollment Program (STEP).
  • Discuss with your employer plans for returning back to work and teleworking options while being monitored, and how they can address stigmatization concerns.
See a travel medicine provider

Schedule a visit with a travel medicine provider, ideally 4 to 6 weeks before you leave, for a pre-travel health screening. Even if you are leaving sooner, a visit to a travel medicine doctor is still helpful to:

  • Discuss specific health recommendations based on your health history and travel plans.
  • Discuss working in challenging settings and its impact on your physical and mental health.
  • Check if you are up-to-date on routine vaccines, as well as any other vaccines, and medicine (such as anti-malaria pills), and provide specific health information for your destination.
Packing tips
  • Travel health kit: Put together a travel health kit with items such as over-the-counter medications, a thermometer, alcohol-based hand sanitizer, anti-malaria pills, and basic first aid items.
  • Personal Protective Equipment (PPE): If you will be working in a healthcare setting or in situations where you will have close contact with people who are sick with Ebola, ensure that your organization provides you with PPE such as face shields or goggles, medical masks, gloves, gowns, aprons, and waterproof boots. If your organization does not provide PPE, it is important to pack these items and bring them with you. PPE is in short supply in countries with Ebola outbreaks.
Check in-country medical resources and medical evacuation plans
  • In-country medical services: Healthcare resources in countries with Ebola outbreaks may be limited or not available. Before you leave, identify places you can get healthcare during your trip. The US embassy in the country where you are going can help you locate medical services.
  • Medical care and evacuation: Check your health insurance plan and any insurance benefits offered by your organization to ensure you are covered for healthcare abroad if you get sick (with Ebola or another illness) or injured. Ask your organization about their medical evacuation plans. CDC recommends purchasing travel health insurance and medical evacuation insurance if you are not fully covered by your personal health insurance or organization-issued plans.
    • Information about medical evacuation services can be found on the US Department of State’s Insurance Providers for Overseas Coverage page.
      • Some insurance providers are excluding medical evacuation coverage for people who have Ebola. Check with providers to ensure you have the coverage you need.
      • Be sure to check the coverage limits for evacuation insurance. Also check to see if the policy covers evacuation to the United States or to the nearest location where adequate medical care is offered.
  • Emergency exposure plan: Work with your organization to ensure a plan is in place to bring you back to the United States if you have a high risk of exposure to Ebola.
    • As part of exit screening in countries with Ebola outbreaks, travel restrictions have been established that may affect whether you are allowed to travel on commercial flights if you have been exposed to Ebola—even if you are not sick.
    • If you had a high risk of exposure to Ebola, you may not be allowed to travel on commercial flights to the United States and potentially to other countries. You will either have to arrange a charter flight home or stay in the country until 21 days after your last exposure and authorities ensure it is safe for you to travel.

How can I be exposed to Ebola?

You can be exposed to the Ebola virus if you have contact with blood or body fluids (such as urine, saliva, sweat, feces, vomit, breast milk, and semen) without wearing the right protective clothing and equipment. You may also be exposed through direct contact with semen from a man who has recovered from Ebola (for example, contact during oral, vaginal, or anal sex).

For healthcare workers, this includes wearing a face shield or goggles, a medical mask, double gloves, a waterproof gown or coveralls, an apron, and waterproof boots.

This kind of exposure can happen if you —

  • Are stuck with a needle or splashed in the eye, nose, or mouth with blood or body fluids of someone sick with Ebola.
  • Handle blood or body fluids of a sick Ebola patient.
  • Touch a person who is sick with Ebola.
  • Touch the body of someone who died from Ebola.
  • Care for or live with a person who is sick with Ebola.
  • Spend a long amount of time within 3 feet (1 meter) of a person who is sick with Ebola.

During your trip

Become familiar with Ebola symptoms, prevention recommendations, and what to do if you become sick.

Ebola symptoms

Fever (100.4°F / 38°C or above) or other symptoms such as

  • severe headache
  • fatigue (feeling very tired)
  • muscle pain
  • vomiting
  • diarrhea
  • stomach pain
  • unexplained bleeding or bruising

Ebola is a serious disease that causes death. There is no approved vaccine or specific treatment for Ebola, so prevention is important.

Prevention recommendation
  • Practice careful hygiene. Wash your hands often with soap and water or use an alcohol-based hand sanitizer.
  • Avoid contact with blood and body fluids or objects that may have come in contact with a sick person's body fluids.
  • Avoid contact with dead bodies, including participating in funeral and burial rituals.
  • Avoid contact with semen from a man who has recovered from Ebola (for example, by having oral, vaginal, or anal sex).
  • Avoid contact with animals (such as monkeys or bats) or with raw or undercooked meat.
  • Don’t eat or handle bushmeat (wild animals hunted for food).
  • Avoid health facilities in West Africa where patients with Ebola are being treated if you are not working in a healthcare setting.
  • Until more information is known about sexual transmission, avoid contact with the semen of a man who has recovered from Ebola (for example, during oral, vaginal, or anal sex). If you do have sex, use a condom the right way every time. Consider bringing your own supply of condoms.
  • Report any potential unprotected Ebola exposure or illness promptly, following your organization's reporting procedures.
If working in healthcare settings

If you will be working in healthcare settings, be prepared to care for patients in a region where resources are scarce and the healthcare system is strained.

If you may be exposed to people with Ebola, follow these steps:

When you return to the United States, public health workers will assess your health and your Ebola risk level. You will be classified as being in the "some risk" category and monitored at that level if you have done the following in the previous 21 days:

  • Provided care to Ebola patients or entered the patient-care area of an Ebola Treatment Unit or Ebola Holding Unit for any reason while wearing the recommended PPE
  • Provided direct care to patients in any healthcare setting
If you become sick during your trip
  • Notify your organization and public health authorities.
  • Seek medical care immediately if you develop fever or other possible Ebola symptoms.
  • Avoid exposing others.
  • Avoid public transportation.

Returning to the United States

See CDC’s Screening and Monitoring Travelers to Prevent the Spread of Ebola fact sheet for information about screening of travelers leaving West African countries with Ebola outbreaks and screening of travelers entering other countries, including the United States.

You can also learn more about how you will be connected with a health department after you arrive in the United States to monitor your health for Ebola symptoms.

  • A public health worker will assess your health and Ebola risk level to decide how best to monitor you for symptoms and what other restrictions may be needed. Based on your level of possible exposure to Ebola, your travel and public activities may be limited.
  • The public health worker will also tell you what to do if you have a fever (100.4°F/38°C or above) or other symptoms.
    • Follow the directions from the public health worker. But if you cannot reach someone right away, you can contact your state health department or call CDC at 1-800-232-4636.
    • If you have a medical emergency, call 911. If you call 911, tell the operator that you have recently returned from a country with an Ebola outbreak and your symptoms. Doing this will help emergency responders know how to provide the best medical care and protect themselves and others.
    • It is very important that you get medical care right away.

See CDC’s fact sheet and questions and answers about the Monitoring Symptoms and Controlling Movement Guidelines to learn more.

Going back to work

Public health officials will advise when you can go back to work depending on your level of exposure.

If you need to limit contact with others, talk to your employer about options for teleworking while being monitored. Also discuss how to address stigmatization concerns with your colleagues. Remind them that people

  • who recently traveled to West Africa don’t put others at risk if they don’t show Ebola symptoms.
  • being actively monitored may have had some risk of exposure and are being watched for symptoms. It doesn’t mean they are contagious.
  • who have no symptoms after 21 days don’t have Ebola so are no risk to others.

Resources

Ebola Information

Ebola Travel Information
Mental Health Resources
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