By Ann Marie Foley - 25 March, 2015
The Ebola outbreak got out of control because many institutions failed to respond and the result was both devastating and avoidable.
This is according to the international medical humanitarian organisation Médecins Sans Frontières (Doctors Without Borders) which has highlighted the shortcomings of the global response to the Ebola crisis one year on.
“The Ebola epidemic proved to be an exceptional event that exposed the reality of how inefficient and slow health and aid systems are to respond to emergencies,” said Dr Joanne Liu, international president, Médecins Sans Frontières (MSF).
A new report by MSF, ‘Pushed to the Limit and Beyond’, describes its early warnings one year ago about cases of Ebola spreading in Guinea.
There was an initial denial by governments of affected countries, and with such global inaction the outbreak spread into neighbouring states.
The report is based on interviews with dozens of MSF staff involved in the organisation’s Ebola intervention during the last year.
There were more than 1,300 MSF international staff and 4,000 local staff deployed in west Africa, where they cared for nearly 5,000 confirmed Ebola patients.
By the end of August, MSF’s ELWA3 centre in Monrovia was way beyond full capacity. Staff had to turn away visibly ill people from the front gate, knowing that they could return to their communities and infect others.
“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,” said Christopher Stokes, general director of MSF.
“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.”
The report also looks at MSF own challenges over the past year and the difficult choices made with its lack of sufficient resources.
MSF states that while its own Ebola experience is limited to a relatively small group of experts, it should have mobilised more resources earlier.
Facing an exceptionally aggressive epidemic and a weak international response, MSF teams focused on damage control. Unable to do everything, compromises had to be made between the competing priorities of patient care, surveillance, safe burials and outreach activities, amongst others.
“At the most severe periods of the outbreak, MSF teams were unable to admit more patients or provide the best possible care,” says Dr Liu. “This was extremely painful for an organisation of volunteer medics, leading to heated exchanges and tensions within MSF.”
MSF’s process of assessment is underway to identify issues and learn lessons that can be applied to future outbreaks. It is also documenting and analysing patient data to have a better understanding of all the multiple factors that can contribute to Ebola mortality.
MSF stated that a global strategy must be prepared, that will support research and development for Ebola vaccines, treatments and diagnostic tools that are needed.
The huge challenge now and in the coming months is to ensure that every single person in contact with someone infected with Ebola must be identified before an end to the outbreak can be declared.
MSF said that there is no room for mistakes or complacency; the number of cases weekly is still higher than in any previous outbreak, and overall cases have not significantly declined since late January.
“The trauma of Ebola has left people distrustful of health facilities, has left health workers demoralised and fearful of resuming services, and has left communities bereaved, impoverished and suspicious,” the report says.
“Global failures have been brutally exposed in this epidemic and thousands of people have paid for it with their lives. 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.”
In the three worst affected countries, nearly 500 health workers have lost their lives in the past year, a disastrous blow to an already serious shortfall of staff before the Ebola crisis hit.
MSF stated it is urgent that access to health services is restored as a first step towards rebuilding functional health systems in the region.