23 Mar 15 07 Jun 19

Pushed to the Limit and Beyond: MSF on the global Ebola response one year into the deadliest outbreak in history

Dr. Joanne Liu
Présidente internationale de MSF
« Lorsqu’Ebola est devenu une menace pour la sécurité internationale et non plus une crise humanitaire affectant une poignée de pays pauvres d’Afrique de l’Ouest, le monde a enfin commencé à se réveiller. »

One year ago today, an outbreak of Ebola in the West African country of Guinea was announced. Since then, nearly 10,000 people have died of the disease, and it has not yet been defeated. Médecins Sans Frontières/Doctors Without Borders (MSF) today released a critical analysis of the Ebola epidemic over the past year, revealing the shortcomings of the global response to the crisis and warning that the outbreak, despite an overall decline in cases, is not yet over. 

The report, Pushed to the Limit and Beyond, is based on interviews with dozens of MSF staff involved in the organization’s Ebola intervention. It describes MSF’s early warnings one year ago about cases of Ebola spreading in Guinea, the initial denial by governments of the affected countries, and the unprecedented steps that MSF was forced to take in the face of global inaction as the outbreak engulfed neighbouring states. Over the past year, more than 1,300 MSF international staff and 4,000 local staff have been deployed in West Africa, where they cared for nearly 5,000 confirmed Ebola patients.

Exposing inefficiencies in aid and health systems

“Today we share our initial reflections and take a critical look at both MSF’s response and the wider global response to the deadliest Ebola outbreak in history,” says Dr. Joanne Liu, MSF international president. “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.”

The report details the effects of the several months-long “global coalition of inaction,” during which the virus spread wildly, leading MSF to issue a rare call for the mobilization of international civilian and military medical assets with biohazard capacity. By the end of August, MSF’s ELWA3 centre in Monrovia was overwhelmed with patients. Staff were forced to turn away visibly ill people from the front gate, in the full knowledge that they would likely 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,” says Christopher Stokes, MSF’s general director. “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 trauma of Ebola has left people distrustful of health facilities, has left health workers demoralized and fearful of resuming services, and has left communities bereaved, impoverished and suspicious

MSF looks to its own challenges

The report also lays out the challenges MSF faced over the past year and the difficult choices made in the absence of available treatment and sufficient resources. While MSF’s Ebola experience is limited to a relatively small group of experts, it should have mobilized 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, among 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 organization of volunteer medics, leading to heated exchanges and tensions within MSF.”

MSF’s process of reflection is underway, as it seeks to learn lessons that can be applied to future outbreaks, while documenting and analyzing its patient data to examine the multiple factors that can contribute to Ebola mortality. Crucially, a global strategy to sustain research and development for Ebola vaccines, treatments and diagnostic tools must be developed. 

A significant challenge remains ahead. To declare an end to the outbreak, every single person in contact with someone infected with Ebola must be identified. 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.

'Global failures have been brutally exposed'

In Guinea, patient numbers are again rising. In Sierra Leone, many people are presenting with the virus who were not previously on lists of known Ebola contacts. Liberia is currently on the countdown to zero cases, but remains at risk while the virus lives on in neighbouring countries.

“The trauma of Ebola has left people distrustful of health facilities, has left health workers demoralized and fearful of resuming services, and has left communities bereaved, impoverished and suspicious,” the report says.

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. It is urgent that access to health services is restored as a first step towards rebuilding functional health systems in the region.  

“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,” the report concludes.  


Pushed to the Limit and Beyond. A year into the largest Ebola outbreak.


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