Medical NGO MSF says response by foreign countries is ill-adapted to tackling the spread of Ebola in west Africa, warning the outbreak is far from over
The medical NGO Médecins sans Frontières (MSF) has launched a scathing attack on the international community for its slow and patchy response to the effort to stamp out Ebola in west Africa.
It says the response risks creating “a double failure” because ill-equipped locals inSierra Leone, Liberia and Guinea have been left to run hospitals and treatment centres.
Three months after MSF called for international intervention, its international president, Dr Joanne Liu, said it was “extremely disappointing that states with biological-disaster response capacities have chosen not to deploy them”. She said people “are still dying horrible deaths in an outbreak that has already killed thousands” and urged the world not to be complacent. “We can’t let our guard down and allow this to become a ‘double failure’: a response that is slow to begin with, and then is ill-adapted in the end.”
MSF compiled its briefing three months after calling for countries to get involved in the Ebola response. Liu criticised the concentration of international efforts on the construction of Ebola treatment centres without also providing staff and training, transport and laboratories.
In rural areas of Liberia, where hopes had been raised that the Ebola infection rate had plateaued, there were still “active chains of transmission” and no transport facilities to test the patients. In Sierra Leone, the national Ebola response team was struggling, with callers to the emergency 117 helpline being told to isolate themselves at home.
“How is it that the international community has left the response to Ebola – now a transnational threat – up to doctors, nurses and charity workers?” said Liu.
MSF’s briefing paper on the three countries hardest hit by the disease comes a day after the World Health Organisation (WHO) declared it was optimistic about the region despite rising numbers of reported cases.
Bruce Aylward, assistant director general in charge of emergencies at the WHO, said “there has been a real slowdown in the spread of new cases” in Sierra Leone, where the disease is on the rise, and that “across west Africa we are no longer seeing exponential growth and in some areas a steady decline”.
MSF said the situation was “far from under control” in Sierra Leone, that the “situation is alarming” in Guinea and, while progress was being made in Liberia, there was no room for complacency. “The outbreak is far from over, as a single case can start a localised epidemic,” it said, reporting infection chains starting in remote rural areas with no access to treatment centres or testing facilities.
MSF said case numbers had dropped in the Liberian capital, Monrovia, where there was now surplus bed capacity, but added that many international agencies “seem unable to adapt to the rapidly changing situation” with outbreaks in Bong, Margibi, Gbarpolu, Grand Cape Mount and River Cess counties. In some areas, such as River Cess, patients must travel for up to 12 hours by road to reach a functioning laboratory and a community care centre, it said.
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Guinea, where the outbreak started, was “long overlooked by international efforts”, according to MSF, which said the response was “painfully slow”. It said Guinea’s taskforce for dealing with Ebola was improving but that the caseload in November, month on month, was up 25%. It added: “New areas are reporting infections and 17 of Guinea’s 33 prefectures have reported cases in the past three weeks.
“Like in Sierra Leone and Liberia, the absence of implementing partners willing and able to manage case management centres and a lack of trained staff have been a bottleneck and the source of large delays.”
Infection is increasing “alarmingly” in Sierra Leone, said the report, and local healthcare workers were carrying the burden. The latest number of confirmed cases in the country is 5,978.
It said the UK’s contribution in Sierra Leone has yet to have an impact two months after its aid programme was announced. The UK and China have sent teams to build Ebola centres in locations including Port Loko, Freetown and Makeni, the worst-affected of the country’s 14 districts.
MSF said the UK’s promise to build and provide resources for an additional 700 beds had yet to be fulfilled. “As of 27 November, only 11 of these beds were operational, and only 28 patients had been treated. While the remaining centres are under construction and scheduled to open soon, they will not be running at full capacity until well into the new year,” it said.
Since the UK government’s announced plans for six hospitals, only one has opened, in Kerrytown, an hour’s drive from Freetown. About 50% of the available beds were government-run or run by the armed forces, with another 40% run by MSF, it said.
The Department for International Development (DfID) said UK aid was helping to fund many more beds than accounted for in the new hospitals announced three months ago: “UK funding means that right now 686 UK-funded treatment and isolation beds are operational to diagnose and treat people who have Ebola.”
DfID added that it had trained 4,000 healthcare workers who are all in Africa, mostly in Sierra Leone, that teams in Freetown were burying 100% of corpses in the city within 24 hours and that three new labs funded by British aid were now up and running.
“In the absence of adequate facilities to isolate, diagnose and manage Ebola cases, Sierra Leonean healthcare workers are struggling,” MSF said. “[We are] deeply concerned about contamination of uninfected patients and healthcare workers where staff are not necessarily trained to manage Ebola patients and where infection control measures cannot be assured.”
Lack of education about Ebola in all three countries is still a major issue and will prevent the containment of the virus. “MSF teams are still finding that misconceptions about Ebola are widespread and stigma is intense, leading some to avoid seeking treatment or report cases,” it said of Liberia. In a recent example it found that people who had been in contact with the sick were fleeing into the bush so as not to be traced, fearful of what would happen if they were.
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