MSF. Pushed to the Limit and Beyond


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 The slow international response to the West Africa Ebola outbreak created an avoidable tragedy that cost thousands of lives, a leading medical charity said on the one year anniversary of the first confirmed case.

The world’s worst Ebola epidemic has killed over 10,200 people in the three most affected countries of Guinea, Liberia and Sierra Leone since March 2014 when it was first confirmed in the forest region of Guinea.

Médecins Sans Frontières (MSF), which first raised the alarm over Ebola, said in a report that everyone from national governments to the World Health Organization (WHO) had created bottlenecks that prevented the epidemic being quickly snuffed out.

“The Ebola outbreak has often been described as a perfect storm: a cross-border epidemic in countries with weak public health systems that had never seen Ebola before,” Christopher Stokes, MSF’s general director, said in the report.

“Yet this is too convenient an explanation. For the Ebola outbreak to spiral this far out of control required many institutions to fail. And they did, with tragic and avoidable consequences.”

In a scathing report titled “Pushed to the limit and beyond”, MSF said its warnings in June that the epidemic was out of control and that it could not respond on its own were dismissed as alarmist.

Guinea and Sierra Leone downplayed the epidemic and accused MSF of spreading fear and panic. In June, the Sierra Leone government told the WHO to report only lab-confirmed deaths – falsely reducing the death toll, the report said.

Kenema hospital in the southeast, where some of the first cases were reported in Sierra Leone, also withheld crucial epidemiological data preventing MSF from identifying affected villages and responding, the report said.

“The Ministry of Health and the partners of Kenema hospital refused to share data or lists of contacts with us, so we were working in the dark while cases kept coming in,” MSF’s emergency coordinator in Sierra Leone, Anja Wolz, said in the report.

The governments of Guinea and Sierra Leone were contacted about the report by the Thomson Reuters Foundation, but did not comment.

Liberia was transparent and asked for help almost on a daily basis. MSF, which reported this to the WHO in June, said the outbreak could have been halted if immediate action was taken, but these warnings were again ignored.

Crying Wolf

Isabelle Nuttall, director of the WHO’s Global Alert and Responses Network told the Thomson Reuters Foundation at the height of the outbreak in September the WHO had been accused of crying wolf in the past.

In 2009, the WHO declared swine flu (H1N1) as a public health emergency of international concern (PHEIC), prompting governments to stock up on swine flu vaccines. The pandemic was not as severe as predicted and cost governments hundreds of millions of dollars in unused medicine.

Margaret Harris, WHO’s Ebola spokesperson in Geneva said that only after infected Liberian Patrick Sawyer travelled by air to Nigeria in late July could the WHO consider Ebola as a PHEIC. The announcement came on Aug. 8, prompting a global response.

However, by then the pandemic had spiralled out of control, MSF said. The agency branded the response a “global coalition for inaction” and said by the end of August, it had to turn away patients in Liberia leaving many to die in their homes or on the streets.

“We had to make horrendous decisions about who we could let into the centre,” said MSF coordinator Rosa Crestani, who worked at the organization’s Ebola centre in Monrovia, which could only be opened for 30 minutes a day because of the demand for beds.

“We could only offer very basic palliative care and there were so many patients and so few staff that the staff had on average only one minute per patient. It was an indescribable horror.”

Internal differences also prevented MSF from working together and deploying faster, resulting in just one of MSF’s five operation units taking on the bulk of the response, Brice de la Vigne, head of operations for MSF Belgium, said in a telephone interview.

The number of Ebola cases dropped dramatically between November and January in Sierra Leone, Liberia and Guinea. The presidents of all three countries announced a target to reach zero Ebola by mid-April.

However, Guinea recently reported a doubling of cases in a month, Sierra Leone has a whole neighbourhood under quarantine and Liberia announced on Friday its first new case 16 days after its last Ebola patient was released.

The Ebola outbreak is not over until there are zero cases in the region for 42 days, said MSF.

Misha Hussain, Emma Batha
Thomson Reuters Foundation