A man suspected of being infected with Ebola arrives at the Evandor Chagas National Institute of Infectious Diseases in Rio de Janeiro October 10, 2014. REUTERS/Mauro dos Santos

By Carolyn Cohn

LONDON (Reuters) - Leading companies offering medical evacuation services are balking at flying Ebola patients out of West Africa for treatment abroad as the cost and the complexities of the deadly epidemic grow.

Several airlines have cut flights to the region and there are reports of countries not allowing air ambulances to make refueling stops, further complicating the so-called medevac option many companies provide for staffers in risky regions.

The world's worst Ebola epidemic since the disease was identified in 1976 has killed more than 4,000 people, mainly in West Africa. The virus, spread by contact with bodily fluids, causes fevers and potentially fatal bleeding.

Several foreign health workers have been repatriated for treatment after contracting Ebola in West Africa.

Two leading companies in the field - medical assistance company International SOS and insurance firm Allianz Worldwide Care - both recently said they would not provide medevac services for all patients with Ebola symptoms.

An International SOS spokesman clarified the company's position on Saturday to say that did not mean their services were not available under any circumstances, and pointed to a new statement on its website.

"International evacuation for patients with active clinical symptoms of Ebola is extremely limited and may not be achievable if patients have any uncontrolled body fluids, such as vomiting, diarrhoea or bleeding," the statement read on Saturday.

An earlier statement said that "evacuation should not be considered as feasible" for patients with active clinical symptoms of Ebola.

The medical insurance firm Allianz Worldwide Care ruled out such services in an online statement updated on Wednesday, saying: "Our air ambulance partners are currently not evacuating patients with suspected or confirmed Ebola infection out of affected regions due to the highly complex nature of evacuations when Ebola or other viral haemorrhagic fevers are involved.

"In the case of suspected or confirmed Ebola cases, we would liaise closely with our clients and brokers to see whether there is any possibility of military medical evacuation via support from the patient’s local embassy and home government."

MEDEVAC AND EPIDEMICS

An Allianz spokeswoman said no insurers or air ambulances were able to evacuate people with symptoms of Ebola.

Other insurance and assistance firms contacted by Reuters declined to comment, did not respond to requests for comment or said they had not dealt with Ebola cases.

Insurance companies often provide medical evacuation as a routine part of international health insurance policies, but the evacuation option may not apply in the case of an epidemic.

Reductions in the cover provided by insurance or assistance companies may make the job of non-governmental organisations harder, as they battle to fight the virus.

Save the Children will be managing an Ebola treatment centre in Sierra Leone, which will involve employing "scores of people" in the country, a Save the Children spokesman said.

He said the charity's workers were covered by medical insurance. "What we cannot say is that we can absolutely cover evacuation, I do not think anybody possibly can, because of availability of aircraft," he said.

"All options of evacuation would be assessed on a case by case basis," he added.

Insurance specialists estimate medical evacuation from West Africa could cost at least 45-65,000 pounds ($72-104,000) per person.

International SOS provides services such as clinics and emergency assistance for member companies around the world.

Evacuation only makes up 2-3 percent of its work, the spokesman said, including the evacuation of healthy workers who can travel on regular or specially chartered flights.

The cost of medical evacuation, however, would be met by the member companies themselves or by their insurance companies, he added.

Another complication is that Ebola patients may simply not be well enough to be moved. Those symptoms would involve the secretion of bodily fluids, the International SOS spokesman said.

(1 US dollar = 0.6238 British pound)

(Reporting by Carolyn Cohn; Editing by Tom Heneghan and Sonya Hepinstall)