Doctors Without Borders Slams Slow International Response to Ebola

Reluctance to declare an outbreak combined with a lack of expertise paved the way for Ebola to kill thousands, the nonprofit says. Misha Hussain/Reuters

A failure to heed early warnings combined with a lack of expertise paralyzed the response to a deadly outbreak of the Ebola virus which began one year ago, international medical nonprofit Doctors Without Borders said in a new report published Monday.

Doctors Without Borders said a "global coalition of inaction" crippled attempts to halt the spread of the disease, which has killed more than 10,200 people and infected almost 25,000 in West Africa.

An atmosphere of fear, mistrust and misinformation also hampered efforts to control the outbreak, and persists in the three three worst-affected countries, Sierra Leone, Guinea and Liberia, the nonprofit said.

"The Ebola outbreak has been often described as a perfect storm: a cross-border epidemic in countries with weak public health systems that had never seen Ebola before," Christopher Stokes, general director of Doctors Without Borders, says in the report,Pushed to the Limit and Beyond.

"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," said Doctors Without Borders.

On the same day as the report's publication, Ismail Ould Cheikh Ahmed, the head of the United Nations's Ebola mission, told the BBC the U.N. acted "arrogantly" in its early handling of the disease.

At the outset of the virus, "there was probably a lack of knowledge and there was a certain degree of arrogance, but I think we are learning lessons," Ahmed told the BBC.

Ahmed said he expects the outbreak will be over by August. "We have been running away from giving any specific date, but I am pretty sure myself that it will be gone by the summer," he said.

Last week, the Associated Press obtained emails from the World Health Organization that showed it delayed declaring Ebola an outbreak for two months after it was initially suggested by staff. The emails revealed WHO's fears that declaring the outbreak would harm the economies of the virus-stricken African countries and interrupt Muslim pilgrimage to Mecca.

On Monday, WHO spokeswoman Margaret Harris said the organization was prevented from working to contain Ebola because it was not involved in early investigations into the disease when cases first started appearing in December 2013. "It would have been much easier to control this outbreak had we known in January [2014] or December when the very first case occurred or the first cluster," Harris said on BBC Radio 4. "That was investigated by a group that unfortunately did not involve WHO, and you can ask my colleague at [Doctors Without Borders] a little more about that," she said.

Doctors Without Borders criticized WHO in its report for a "vacuum of leadership," accusing it of limiting its role in the early days of the outbreak to advising governments of the affected countries when it should have deployed staff to care for patients on the ground. The nonprofit also accused WHO and other governments and organizations of calling it alarmist when it began to warn of the severity of the outbreak.

The nonprofit also criticized the Guinean and Sierra Leonean governments for failing to recognize the danger and seriousness of the disease.

A lack of global expertise about Ebola and a shortage of staff with experience in treating Ebola also contributed to the disease's spread, Doctors Without Borders said.

At the start of the outbreak, Doctors Without Borders had only 40 people considered 'veterans' of the treating and dealing with the disease. Over the past year, the group has deployed 1,300 international staff and more than 4,000 national staff to treat Ebola patients. Fourteen of its staff members have died treating Ebola. At the height of the outbreak, Doctors Without Borders's ELWA 3 treatment center in Liberia could only be open for 30 minutes a day due the the huge crowds wanting to get in and receive treatment. Many died outside the center.

The relatively unknown nature of Ebola may also have prompted a slow and stagnated response from aid agencies more used to dealing with the humanitarian aftermath of widespread environmental damage, Doctors Without Borders says.

"Natural disasters like floods and earthquakes usually prompt a generous outpouring of resources and direct intervention from aid organizations and concerned states, but fear of the unknown and lack of expertise in Ebola paralyzed most aid agencies and donors," the report says.

Liberia, which has seen 4,264 deaths and 9,526 cases of Ebola, has witnessed a decline in Ebola transmission, but the disease still lingers in the region. Sierra Leone has seen a recent resurgence and transmission in Guinea remains widespread, with the country seeing 95 new confirmed cases last week, the highest number this year, according to WHO.

The consequences of the outbreak will be felt long after it is declared over: It has decimated the health care infrastructure of the three worst-affected countries, leading to a drop in vaccinations, HIV treatment and a lack of safe places for pregnant women to give birth. Communities remain suspicious and fearful of health care workers who were unable to stop their neighbors from dying.

The outbreak has also seriously harmed the economies of Sierra Leone, Guinea and Liberia, which together will lose $1.6 billion in projected economic growth this year, according to the World Bank.

"The world is more interconnected today than ever before and world leaders cannot turn their backs on health crises in the hope that they remain confined to poor countries far away," the report says. "It is to everyone's benefit that lessons be learned from this outbreak, from the weakness of health systems in developing countries, to the paralysis and sluggishness of international aid."