Gert van der Hoek
In Memoriam - Editor, Senior Moderator
EBOLA RESPONSE: WHERE ARE WE NOW?
MSF BRIEFING PAPER
DECEMBER 2014
INTRODUCTION
In early September 2014, MSF urged states with biological disaster response capacity to intervene in
West Africa, where an outbreak of Ebola has already taken more than 5,900 lives. Without the help of
foreign governments, the organisation said, nongovernmental groups and the United Nations had no
hope of effectively implementing WHO Global Roadmap against Ebola.
In particular, MSF called forstates to urgently intervene in Guinea, Sierra Leone and Liberia to
dispatch trained personnel in their numbers, to create mobile laboratories to improve diagnostics and
to set up Ebola case management facilities. The organisation also called for these states to establish
dedicated air bridges with which to move personnel and equipment to and within West Africa; to
create a regional network of field hospitals to treat medical personnel; and to address the collapse of
state infrastructure, which has left people in many parts of West Africa without access to basic
healthcare.
Three months later, the Ebola response is rolling out in the worst-affected countries, and local people
and authorities, international NGOs and foreign governments are now involved to varying degrees.
There have been positive steps forward: for example, a number of bodies have been established to
improve coordination at the national and regional levels; a handful of field hospitals for healthcare
workers have been set up in the region; and governments – with some support from the international
community – are now leading on efforts against Ebola in all three countries.
On the whole, however, the response to this rapidly-changing epidemic has so far been inadequate.
Instead of the well-coordinated, comprehensive and expertly-staffed intervention MSF called for
ninety days ago, actual efforts have been sluggish and patchy, falling dangerously short of
expectations. In particular:
• The international response to Ebola in West Africa has been slow, encumbered by serious
bottlenecks in terms of staffing. Though all three of the worst-hit countries have received
some assistance from foreign governments, these actors have focused primarily on financing
and/or building Ebola case management facilities, leaving staffing them up to NGOs and local
healthcare staff who do not have the expertise to do so. Training people to safely operate
Ebola case management facilities and carry out other necessary activities takes weeks of
theoretical and hands-on training. Though a number of organisationsincluding MSF have
been offering training, this bottleneck has created major delays.
• In all three of the worst-affected countries, there are still not adequate facilities in which to
diagnose and care for patients, and there are major gaps in all other elements of the
response
. In Liberia, most of the operational beds are concentrated in the capital Monrovia,
while remote rural areas are benefitting from little international support. In Sierra Leone, there
are still not enough additional case management facilitiesfor the increasing number of
infections across the country: most patients currently in MSF’s case management centres
in Bo and Kailahun come from other districts. In Guinea, there are only a handful of
CMCs open and running, eight months after the epidemic was declared. Across the region,
there are major gaps in all other elements of the response. Only a small number of
international actors are carrying out these activities and not all of the affected areas are
covered.
• We must avoid a “double failure” situation whereby the response is slow in the first
instance and ill-adapted later on. Many international actors seem unable to adapt quickly
enough to a rapidly-changing situation. The result of this is that resources are being allocated
to activities that are no longer appropriate to the situation. In Monrovia, Liberia, for example,
more case management facilities are being built despite adequate isolation capacities and a
drop in cases in the capital. All actors involved in the response – MSF included – must take a
flexible approach and allocate resources according to the most pressing needs at any given
time and place.
Today, Guinea, Sierra Leone, Liberia and now Mali are all in different phases of the outbreak and the
hotspots are constantly moving. Across West Africa, MSF is providing assistance in all six of the
essential elements of an Ebola response: isolation and supportive medical care for cases; safe burials;
awareness-raising; alert and surveillance in the community; contact tracing; and the provision of
general healthcare. More flexible support is urgently required in all of these areas until the outbreak is
over – in other words, until the very last contact has been followed up and is found to be Ebola-free.
MSF
More :
MSF Ebola Briefing, dec 2014 : The outbreak is far from over in Liberia
MSF Ebola Briefing, dec 2014 : the situation is far from under control in Sierra Leone
MSF Ebola Briefing, dec 2014 : The situation in Guinea is alarming
.
MSF BRIEFING PAPER
DECEMBER 2014
INTRODUCTION
In early September 2014, MSF urged states with biological disaster response capacity to intervene in
West Africa, where an outbreak of Ebola has already taken more than 5,900 lives. Without the help of
foreign governments, the organisation said, nongovernmental groups and the United Nations had no
hope of effectively implementing WHO Global Roadmap against Ebola.
In particular, MSF called forstates to urgently intervene in Guinea, Sierra Leone and Liberia to
dispatch trained personnel in their numbers, to create mobile laboratories to improve diagnostics and
to set up Ebola case management facilities. The organisation also called for these states to establish
dedicated air bridges with which to move personnel and equipment to and within West Africa; to
create a regional network of field hospitals to treat medical personnel; and to address the collapse of
state infrastructure, which has left people in many parts of West Africa without access to basic
healthcare.
Three months later, the Ebola response is rolling out in the worst-affected countries, and local people
and authorities, international NGOs and foreign governments are now involved to varying degrees.
There have been positive steps forward: for example, a number of bodies have been established to
improve coordination at the national and regional levels; a handful of field hospitals for healthcare
workers have been set up in the region; and governments – with some support from the international
community – are now leading on efforts against Ebola in all three countries.
On the whole, however, the response to this rapidly-changing epidemic has so far been inadequate.
Instead of the well-coordinated, comprehensive and expertly-staffed intervention MSF called for
ninety days ago, actual efforts have been sluggish and patchy, falling dangerously short of
expectations. In particular:
• The international response to Ebola in West Africa has been slow, encumbered by serious
bottlenecks in terms of staffing. Though all three of the worst-hit countries have received
some assistance from foreign governments, these actors have focused primarily on financing
and/or building Ebola case management facilities, leaving staffing them up to NGOs and local
healthcare staff who do not have the expertise to do so. Training people to safely operate
Ebola case management facilities and carry out other necessary activities takes weeks of
theoretical and hands-on training. Though a number of organisationsincluding MSF have
been offering training, this bottleneck has created major delays.
• In all three of the worst-affected countries, there are still not adequate facilities in which to
diagnose and care for patients, and there are major gaps in all other elements of the
response
. In Liberia, most of the operational beds are concentrated in the capital Monrovia,
while remote rural areas are benefitting from little international support. In Sierra Leone, there
are still not enough additional case management facilitiesfor the increasing number of
infections across the country: most patients currently in MSF’s case management centres
in Bo and Kailahun come from other districts. In Guinea, there are only a handful of
CMCs open and running, eight months after the epidemic was declared. Across the region,
there are major gaps in all other elements of the response. Only a small number of
international actors are carrying out these activities and not all of the affected areas are
covered.
• We must avoid a “double failure” situation whereby the response is slow in the first
instance and ill-adapted later on. Many international actors seem unable to adapt quickly
enough to a rapidly-changing situation. The result of this is that resources are being allocated
to activities that are no longer appropriate to the situation. In Monrovia, Liberia, for example,
more case management facilities are being built despite adequate isolation capacities and a
drop in cases in the capital. All actors involved in the response – MSF included – must take a
flexible approach and allocate resources according to the most pressing needs at any given
time and place.
Today, Guinea, Sierra Leone, Liberia and now Mali are all in different phases of the outbreak and the
hotspots are constantly moving. Across West Africa, MSF is providing assistance in all six of the
essential elements of an Ebola response: isolation and supportive medical care for cases; safe burials;
awareness-raising; alert and surveillance in the community; contact tracing; and the provision of
general healthcare. More flexible support is urgently required in all of these areas until the outbreak is
over – in other words, until the very last contact has been followed up and is found to be Ebola-free.
MSF
More :
MSF Ebola Briefing, dec 2014 : The outbreak is far from over in Liberia
MSF Ebola Briefing, dec 2014 : the situation is far from under control in Sierra Leone
MSF Ebola Briefing, dec 2014 : The situation in Guinea is alarming
.