Catastrophic Ebola outbreak not a perfect storm but systems failure: MSF

West Africa's ongoing Ebola outbreak reached its catastrophic scale because of the failure of a variety of international agencies and the lack of global health rapid response capacity, a new report says

Medecins Sans Frontieres, which is also known as Doctors Without Borders, released the report to coincide with the year anniversary of the recognition that Ebola had broken out in Guinea, a part of Africa that had never before dealt with the disease.

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The report notes that many observers have suggested the scale of the outbreak was due to a perfect storm-like confluence of factors. The disease appeared at the juncture of three countries with porous borders and fragile health-care systems. And it ravaged people with no prior experience with Ebola and no understanding of how it spreads.

But the report says that analysis 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," says Christopher Stokes, general director of the doctors' group.

The report says the World Health Organization displayed a lack of leadership, downplaying the threat the outbreak posed when MSF officials were desperately trying to get the world to realize how dangerous the situation in West Africa had become.

"Meetings happened. Action didnt, says Marie-Christine Ferir, MSF's emergency co-ordinator.

The Associated Press reported last week that the idea of declaring the outbreak a global health emergency was floated in early June, but the Geneva-based agency held off taking that step until early August. Emails obtained by the AP suggest the WHO worried the move would anger the affected countries, might restrict travel of Muslims to the annual pilgrimage to Mecca and might have economic consequences.

WHO recognizes all organizations "did not have the huge, robust response that was really needed to get on top of this," spokesperson Margaret Harris said Monday from Geneva.

"The MSF report is a painful read because you can hear the pain of all the people who worked so hard knowing they could do very little for the people in their clinical care because there was such large numbers," Harris said.

But the MSF report says the WHO is not the only agency that bears blame. "It would be a mistake to attribute full responsibility for the dysfunctional response to just one agency. Instead, the age-old failures of the humanitarian aid system have also been laid bare for the world to see, rather than buried in under-reported crises like those in Central African Republic and South Sudan," the report says.

Wake-up call

MSF has taken a lead role in Ebola outbreaks for years, setting up and staffing treatment units. But as case numbers exploded across Guinea, Sierra Leone and Liberia, the organization virtually begged other non-governmental organizations to help, eventually even asking countries to send military hospitals. It was months before the world began to respond in significant ways.

"In the end, we did not know what words to use that would make the world wake up and realize how out of control the outbreak had truly become," says Dr. Bart Janssens, director of operations for MSF.

The organization also criticized its own response. Though MSF had helped contain numerous Ebola outbreaks over the past 20 years, its hemorrhagic fevers team was small, comprising about 40 "Ebola veterans." Others in the operation were initially reluctant to divert more of MSF's people to the Ebola fight, and MSF says it should have been faster to mobilize the full capacity of the organization.

The MSF report also questions if it might have been able to do more to improve communications in Guinea earlier in the outbreak. Deep distrust of the foreign aid responders persists in some Guinean villages to this day and still hampers containment efforts.

MSF says the outbreak has produced a number of tragic firsts for it, including:

• It was the first outbreak in which MSF lost so many patients, 2,547 at the time the report was written.
• It was also the first time MSF staff became infected with Ebola. So far 28 have been infected and 14 have died.
• For the first time ever, MSF was forced to turn patients away from Ebola treatment units. At one point, a major treatment centre in Monrovia, Liberia opened its gates for 30 minutes a day just long enough to fill the beds emptied by the previous night's deaths.

Nearly 25,000 people have been infected since this outbreak began and more than 10,000 of them have died.

Harris said case numbers have come down from 1,000 a week to about 100 to 150 per week now but need to decline more quickly.

WHO's expert committee review into what could have been better duringthe outbreak is expected in May.