BRUSSELS — The international response to the Ebola crisis in West Africa has been slow and uneven leaving local people, national governments and non-governmental organizations (NGOs) to do most of the practical, hands-on work, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today, warning that the international community risks failing to adapt to the outbreak after initially failing to respond quickly enough.
Three months after MSF called for states with biological-disaster response capacity to urgently dispatch human and material resources to West Africa, all three of the worst-hit countries have received some form of assistance from the international community. But foreign governments have focused primarily on financing or building Ebola case management structures, leaving staffing of the facilities to national authorities, local health care staff, and NGOs lacking required expertise. National authorities in the affected countries have taken the lead on the response with whatever means available.
"People are still dying horrible deaths in an outbreak that has already killed thousands," said Dr. Joanne Liu, MSF international president. "We can't let our guard down and allow this to become double failure, a response that was slow to begin with and is ill-adapted in the end."
Training NGOs and local health care workers to safely operate case management facilities can take weeks. While MSF and other organizations have been offering training, the bottleneck has created significant delays.
"It is extremely disappointing that states with biological-disaster response capacities have chosen not to utilize them," Dr. Liu said. "How is it that the international community has left the response to Ebola—now a transnational threat—to doctors, nurses and charity workers?"
Across the region, there remains a lack of adequate facilities for isolating and diagnosing patients where they are needed most. In rural areas of Liberia with active chains of transmission, there are no transport facilities for laboratory samples. In Sierra Leone, scores of callers reporting suspected cases to the national Ebola hotline are told to isolate people at home.
Meanwhile, other elements essential to an Ebola response—such as awareness-raising and community acceptance, safe burials, contact tracing, alert and surveillance—are still lacking in parts of West Africa.
In Guinea, for example, where the epidemic continues to spread, awareness-raising and sensitization remain very weak, especially for an intervention that began eight months ago. But some international actors seem unable to adapt quickly enough to a fluid situation and to shift focus to other required activities.
"Controlling an Ebola outbreak goes beyond isolation and patient care," said Dr. Liu. "Wherever there are new cases, the full package of activities must be in place. Everyone involved in the response must take a flexible approach and allocate resources to the most pressing needs at any given time and place across the region," she said.
MSF began its Ebola intervention in West Africa in March 2014 and is now operating in Guinea, Liberia, Sierra Leone, and Mali. The organization runs six Ebola case management centers with a total capacity of more than 600 beds. Since March, MSF has admitted more than 6,000 people, of whom approximately 3,800 tested positive for Ebola and 1,600 have recovered. MSF has 270 international staff in the region and employs 3,100 nationally hired personnel.