UN health agency acknowledged ‘nearly everyone involved in the response failed to see some fairly plain writing on the wall’

The World Health Organisation has admitted mishandling the early stages of the Ebola outbreak in west Africa, saying it failed to recognise the risks of the disease in the fragile states of Guinea, Liberia and Sierra Leone.

“Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall,” says a draft internal document obtained by the Associated Press. Experts should have realised that the conventional way of containing an Ebola outbreak would not work in a region with porous borders and broken health systems.



WHO’s appointment system in Africa is also criticised in the document. Heads of WHO country offices in Africa are “politically motivated appointments” made by the WHO regional director for Africa, Dr Luis Sambo, who does not answer to the agency’s chief in Geneva, Dr Margaret Chan, it said. As Peter Piot, director of the London School of Hygiene and Tropical Medicine told the Guardian last week: “What should be [the] WHO’s strongest regional office because of the enormity of the health challenges, is actually the weakest technically, and full of political appointees.”



Medecins Sans Frontieres, whose volunteer doctors had begun to treat Ebola cases as soon as the outbreak was officially diagnosed in March – three months after the first case – had warned WHO in strong terms that this outbreak was different from previous ones.



“First of all it was the first time we had a case in a big city like Conakry [capital of Guinea]. It is something very different from the remote Congo jungle,” MSF’s Brice de le Vingne, director of operations in Brussels, told the Guardian. The cases were also in a triangle where three countries met. “We knew we were going to have a problem with dealing with three different administrations.” No country was going to want to declare an Ebola epidemic, because of the economic implications.



On 3 April, MSF first warned WHO, who responded by saying the numbers were still small. A dispute then broke out on social media between MSF and the WHO’s spokesman, who insisted it was all under control.

The leaked document reveals that a teleconference in late April that included WHO, MSF and the US Centers for Disease Control and Prevention heard that some WHO experts were not bothering to send reports of Ebola cases to head office in Geneva.



WHO said it was “particularly alarming” that the head of its Guinea office refused to help get visas for an expert Ebola team to come in and $500,000 in aid was blocked by administrative hurdles.

At a meeting of WHO’s network of outbreak experts in June, Dr Bruce Aylward, normally in charge of polio eradication, alerted Chan about the serious concerns being raised about WHO’s leadership in west Africa. He wrote an email that some of the agency’s partners including national health agencies and charities believed the agency was “compromising rather than aiding” the response to Ebola and that “none of the news about WHO’s performance is good”.



Five days later, Chan received a six-page letter from the agency’s network of experts, spelling out what they saw as severe shortcomings in WHO’s response to the deadly virus.



“This [was] the first news of this sort to reach her,” WHO said in the draft document. “She is shocked.”

