wanna do is find out what's happening, so they can tell people... >> governments around the world all united to condemn this... >> as you can see, it's still a very much volatile situation... >> the government is prepared to carry out mass array... >> if you want free press in the new democracy, let the journalists live. >> people have suffered and died from ebola for years. it's a devastating disease. what takes thi makes this latest west african outbreak the deadliest ever? ebola is the "inside story."

>> hello, i'm ray suarez. ebola is a disease caused by a virus. it's very easily spread from person to person. up to nine out of ten people who contract the disease die of it. people who have been incubating ebola shed bodily fluids through vomiting, diarrhea and bleeding, and contact with bodily fluids is how the disease is spread. there is no cure. there is no vaccine. with cases now reported in four west african countries the world faces a frightening prospect of a wider outbreak. today's ebola outbreak in west africa is the worst in history, and in a globalized air-traveled, savvy world there

is a race to control it. since march the "world health organization" has confirmed 670 people have died liberia, sierra sierra leone and guinea. now a cause for concern, patrick sawyer, he died from ebola after flying on more than one plane. he got sick in liberia, then it's believed he got had a stop in ghana. now sawyer's case is sending local and international officials scrambling. >> the "world health organization" is sending two teams to both nigeria and togo to undertake contact tracing to try to trace the people who this gentleman may have been in touch with during his flight.

we will insure that the virus does not escape. >> reporter: it's a disease that starts with flu-like symptoms and can end with victims bleeding from their eyes, mouth and ears. the "world health organization" said that once someone gets ebola the death rate can be as high as 90%. >> before the epidemic started people did not know what ebola was. now the situation is difficult. it is a crisis. >> reporter: ebola is not airborne and can only be caught through bodily fluids like saliva, sweat and blood. those who are diagnosed with it are immediately quarantined putting medical professionals at the front line of contagions. >> my family tell me every day not to work here because my life is at risk. my colleagues, when they work here every day they die. two of my colleagues i know are

in the hospital. they were diagnosed positive with ebola yesterday. >> reporter: the center for disease control said the likelihood of ebola spreading to the u.s. is very low, but in an age where a deadly disease could be only one plane ride away the cdc has cautioned healthcare providers to be extra vigilant of patients returning to the united states from west africa. >> ebola and the other diseases that have come roaring out of the tropics, can you stop a disease in its tracks before the virus infects larger and larger numbers, in countries where they are already heavily burdened. here to talk about this disease, dr. anthon

my guests. dr. quigley, is there any intelligence coming out of the west africa that gives an idea why there was this sudden spike in a number of cases? >> well certainly the media has propagated a lot of the information that's available locally. i think the fact that as your report indicated some americans have been contaminated has heightened the awareness, and it's difficult to sort out fact from fiction for some of these circumstances, and it's hard to get to the bottom of your question. >> doctor, there are ebola cases going on in an on going basis in west africa. what set of circumstances conspires to have a sudden jump like this.

not necessarily in the case of ebola, a any disease like this. >> ebola is a good example of a number of disease that is come from animals and infect our species and infect people. middle east syndrome is one. bird flu is another, but ebola is the one on everyone's mind today. and in general ebola will have come from one or more animal species, bat s, animals, gorilla and infect people eating bush meat or even other exposure to animals and it can be transmitted person to person with close contact with bodily fluids where they come in contact with the virus, not through the air. >> what makes one year worse than another? one of the circumstances--now here's a very, very high mortality disease.

normally the outbreaks are contained in part by that. most everybody who gets it dies and that puts a roadblock in the way of continued spread. but now we're seeing people in urban areas. now we're seeing people coming into hospitals with the early symptoms. how does something like this break out? >> yes, it's a very important question. it's not easily answered. but in this particular instance the largest outbreak ever since the first one in 1976 of ebola virus disease, it seems that the fact that people have come into cities has contributed to the spread and the difficulty in controlling the virus. but secondly the virus has spread rurally to many sites in the three countries in west africa, which has not been the case in the past, in uganda , zaire or sudan or elsewhere, so it's very hard to control

through isolated people who are ill and quarantining people who are exposed for up to 21 days they have to stay in quarantine. >> drdoctor, the two big institutions, the cdc and the nih outside of washington, d.c. have as a primary responsibility looking after people in the united states. when there is a spike like this overseas is there an alarm that goes off stateside? >> you want to be vigilant because with you know a person can get on a plane as that person who went to nigeria , the cdc with the health mechanism that we have here in the united states and globally will stay alert for the possibility that we might get a person here. the question that you just asked my colleagues on the line is that what we have here in the united states would be a system

that would make it highly unlikely there would be the kind of explosive spread if we did happen to by accident get someone who flew over here when they were relatively well but got infected in the west african country, then came here and got ill and got infected where they would be really very sick. so you need the type of very careful protocol for person protective equipment to prevent that kind of spread. the other aspect going on there, and you mentioned the idea of people dying. one of the problems with ebola is that it can still be spread by diarrhea, vomit, blood even after a person dies. we're seeing a spread of infection when families don't bring the patient to the hospital, and they take care of them at home and die at home and

they either touch the body or don't take the proper precautions and it's spread through family members. it's understandable because it's traditional behavior, but nonetheless it's totally counter pro oh ducktive when it comes to trying to contain an epidemic particularly in western africa countries it has gotten in the cities, and the density of the cities compound the situation more when people become sick, and it's oftentimes the people who are taking care of them that it spreads as physician and healthcare workers as you mentioned. >> what are the rules for people working in sierra leone, liberia, not only that they don't pass it but they don't fall victim to it themselves. >> it's extremely ironic and the doctor alluded to personal

petition equipment, which is mandatory, but one has to know how to use that's ppe. that means they need to be properly educated prior to deployment, and they need to ongoing their education throughout the course of their work while they're providing services for this highly contagious disease. as the doctor alluded to it's a disease that can be spread after death. so for that reason the vigilance has to be maintained from soup to nuts. from the moment they enter the hospital to the moment they break and there cannot an break in that hygienic practice, which is critical. >> is that hard to do in places in the developing world where unlike western medical care everything is not oriented around december posal everything. in an american hospital they throw almost everything away after one use. but in places that are poor, that can't necessarily buy everything over and over again, that must be harder to do. >> indeed it's a challenge. but there are many healthcare

providers who are willing to take those risks and hopefully are adhering to the protocols that we have both alluded to. there are ways of overcoming disposal equipment. there are practices one can pursue to maintain hygienic precautions that preclude the transmission of the disease over and above just disposing of the clothing you're wearing. >> how would that look different from a normal patient? are you gowned, masked in an advicel visibly different way? >> it's not just how these people are housed, we call it quarantined facilities it is more difficult in these emerging marketplaces to get the resources to create the appropriate environment and have all the appropriate equipment,

but we can only do our best under the circumstances that are there. >> we're going to take a short break. when we come back we'll talk about how diseases like this spread from animals to humans, and what it means for the future of healthcare when a world like this up has no boundaries when it comes to viruses. this is "inside story." stay with us.

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>> welcome back to "inside story" on aljazeera america, i'm ray soares. the outbreak of ebola in west africa this time on the program, relatively large numbers of ebola have been infected in sierraly own and guinea and what people need to know as they wrestle with this and other viruses. in the last seg, dr. lucey, from animals to people, is that something that happens over and over again, whether you're dealing with different strains of the disease, or once it's established in humans, it doesn't matter where it comes from anymore. it's a human disease? >> it depends on the virus, and there are some that can come from people.

but we're talking about viruses, ebola in africa, and mers in the middle east. and a variety of bird flu vires, the most recent in china, h7 and 9, but the one that we have most recently heard of, in india and elsewhere. there are different strains, to use that term, and all of these rna viruses that mutate a lot. ebola specifically has at least five, and now probably the strain that's in west africa, this is a new strain, related to the first one from zair. so there are probably close to six strains now. and it's important to know how people get infected with each of these outbreaks. because that can help us understand how to control. >> is that how it got

established in the population? >> that's right, ray. hiv is an example of the question that you just asked. does the disease keep coming back and hitting humans from the animal? the prototype of that was ebola. ebola was first recognized in 1976 in the democratic of the congo, and there of been a couple of outbreaks, this being the most important. important of the outbreaks, but it continued to go from an animal reservoir to a human, not really fully being established in a human, whereas hiv made that zoonotic jump from the animal to the human. and now when you make the contrast from ebola to hiv, you

see an example of each of the contrasts that you're asking about. >> so as professor lucey mentioned, rna, does a disease like ebola change over time? if we come up with some defenses and silver bullets in the next couple of years, will we be developing new ones if the virus continues to change? >> well, first of all, we need to have a disease that we're working on given the urgency of the situation. but you're right, you can have mutations that interfere, quite frankly, and our functionally relevant mutations, you don't get a mutation that will completely negate the interventions that you have. you can get mutations of an rna virus that have the capability

of mutating correctly by a mechanism, and you can get mutations that would get away from a drug that you would use, that would not being effective against the virus. we see that in mutations of the influenza virus, with the anti-influenza drugs, and then as they go through voit and the populations, they develop mutations. so the answer to your question, ray, certainly that can happen. but right now, we're focusing on getting some intervention for ebb ol a. either through vaccine or therapy. >> i don't want to veer away from the brave people on the front lines. i want to remind people about them. just in the last day, sierra leon just lost it's anti-ebola doctor, one week after he's infected, he's dead.

and that would be a anywhere in the world, but for a country as hungry for trained doctors as sierra leon, i'm guessing it's a compounded tragedy. >> it is, it's compounded in so many ways, ray, and this is a sating tragic outcome for somebody who has committed himself to this unselfish gesture. and all i can say, it's important that we, those of us in a position to do so, dr. fauci and his organizations continue to work round-the-clock to develop at least treatment regimens and vaccines that would be effective, because there are going to be tragedies because of the nature of this disease and how contagious it is. >> when you got an emergency like this, how does the international sos respond? getting the necessary equipment and people like firemen coming to the rescue?

>> well, it's a very complex issue. first and form most, in the ideal world, we would want to upgrade the level of care that the infected individual is receiving, and as simple as that is to state, it's not as simple to institute. for example, if we wanted to upgrade the care from somebody infected in one of these west african countries like is he early on and we wanted to move that patient from an ambulance to somewhere on the other side of the world, we would have to have permission from the local health authorities in the country, and a receiving country, and a destination center that is willing to take such an individual, who may not be in that destination country. we would have to have permission to fly over and do fuel stops. so the logistics are very complicated. furthermore, we have to be able

to put our own transport teams in harm's way, so we have to have vehicles to transport the patients, and the patients fit to fly. so we have to have special biological containment units, and those are not as easy it come by as one thinks. the disease has manifested at some point in time with secretions such as diarrhea and documenting, and to try to contain that is a challenge, and you run the risk of contaminating those professionals trying to remove this patient, assuming that you need to move them in the first place. so a few are sending in personnel to assist on-site. which seems to be our first line of defense. but we're working with all of those organizations to try to figure out ways that we may be able to transport these patients to upgrade their care. >> we're going to take a break, and when we come back, we'll talk about neighboring nations

and whether the widening world have to be worried about 24 outbreak of ebola. this is "inside story." >> an american tonight investigative report >> i never would have thought this would happen to us >> athletes going for the gold >> i've had a lot of people ask me... why didn't you scream?... why didn't you yell?...kick... why didn't you go tell your mom? >> betrayed by those they believed in the most >> there's bad people out there in youth sports >> could this happen to your child? >> my sole purpose in coming forward, is to help change the culture of sports >> an america tonight investigative report only on al jazeera america

>> we're here in the vortex. only on al jazeera america. >> you're watching "inside story" on aljazeera america, i'm ray soares. four countries in west africa are fighting an outbreak of ebola virus. it's highly contagious and deadly. and the countries with the largest number of cases, beginy, liberia and sierra leone, including conflict zones in poor countries. and could even the heroic volunteer staff make up for the lack of spending on health in this part of the world? still with us, dr. robert quigley, regional director for international sos, dr. anthony fauci, director of the national

substitute of allergies and infectious diseases, and dr. daniel lucey at georgetown medical center. dr. fauci, already suspended flights to the infected countries, and the contact tracing team is in west africa trying to put together a timeline for this patient in nigeria. just how worried should the rest of west africa and the world be about a wider outbreak? >> well, rather than use the word, worry, ray, i would say be alert. certainly, the possibility more so in the countries surrounding the three or four countries that you mentioned because the borders are rather porus there. and when people come in, one thing that you have to make sure. if they come in with symptoms of ebola, it feels like a serious

flu. they are aching and they have a headache, and then they start in the symptoms of vomiting and diarrhea. so you have to be aware of people traveling in porus borders. if you're talking about the united states or canada or european countries, you have to be careful when people fly in from those areas, and you might in an emergency room have someone come in with an illness, it's very important for physicians and healthcare providers to do a very quick travel history. i did all of my training in medicine in the middle of new york city, and we learned right from the getgo because of the people coming into the city from all over the worlds o'world, if someone comes in with an illness, the first thing that you and is, do you have recent travel? and that's what we need to ask in the united states, the possibility that someone might have flown in from a country and

gotten infected if that country and flown in here. so it's a head up game. and you have to deal with the protective equipment and protocols that we have been talking about on the show. >> but does that mean, professor lucey, pulling people off of passenger planes at airports and doing something voluntary if there's a possible sufferer? where are the lines here. >> i think that doing tests on people who don't agree to them being performed is crossing the line, so you want to be reasonable at all times. i think that a heightened alertness or vigilance is certainly indicated at this point. but how do you communicate your concern, and increased vigilance, and the behaviors that go along with that is very very important. you have to gain and maintain a trust of the people that you're

trying to help. >> and professor, dr. quigley, quickly before we go, is the world responding quickly and thoroughly enough from this flair coming up from west africa? >> i think that two organizations such as your own, this is an educational forum, and we're educating the public at large, which i think is appropriate. and whether or not we're responding enough will remain to be seen, but from what i've seen today, everybody is committed to battling this unfortunate illness, and time will tell what the outcome will be. >> that briggs u brings us to tf this edition of "inside story." thank you for being with me and in washington, i'm ray soares.

>> israel's prime minister insists the campaign will go on until calm is restored. but there is tension in jerusalem after two attacks that police are link to go palestinians. we're live with the latest. also coming up in the program. baghdad order counter attacks on the islamic state group. and