The World Health Organisation dragged its feet for two months over declaring the Ebola outbreak a global emergency for fear of damaging the economy of Guinea and other afflicted countries, leaked documents show. The internal documents obtained by the Associated Press in Geneva reveal that WHO’s Geneva headquarters was receiving emails by mid-April 2014 from staffers on the ground in Guinea calling for help with an epidemic that had already killed 100 people but was recognised to be largely hidden and spreading.

One of the emails was from an experienced Ebola expert with WHO’s Africa office, who wrote to a Geneva official saying the situation had taken a critical turn because many health workers at the Donka hospital in Guinea’s capital, Conakry, had been exposed to the virus. “What we see is the tip of an iceberg,” wrote Jean-Bosco Ndihokubwayo. The scientist requested the help of half a dozen veteran outbreak responders, writing in all capitals in the email’s subject line: “WE NEED SUPPORT.”

WHO official Stella Chungong said she was very worried, warning in an email that terrified health workers might abandon Donka Hospital and that new Ebola cases were coming out of nowhere. “We need a drastic ... change [of] course if we hope to control this outbreak,” she said.

WHO sent a top Ebola expert, Pierre Formenty, to the region. But many of the other managers sent to Conakry “had no idea how to manage an Ebola epidemic,” according to Marc Poncin, who was mission chief in Guinea for Médecins Sans Frontières, the volunteer doctors who bore the brunt of the epidemic until after WHO declared a global public health emergency in early August. That, together with the publicity around the infection of two American health workers who were repatriated for treatment, brought the US, UK and other countries together in the fight against the disease.

But in early April, WHO was downplaying concerns. Spokesman Gregory Hartl told reporters that “this outbreak isn’t different from previous outbreaks”. In a Twitter message sent by Hartl and preserved by ITV News, he is shown asking: “You want to disrupt the economic life of a country, a region, [because] of 130 suspect and confirmed cases?”

The news worsened throughout April. Formenty said teams in Conakry had seen patients pop up all over the city with no known links to other cases. “This means there is one part of the epidemic that is hidden,” he later wrote in an internal report. “The Ebola outbreak could restart at any time.”

In early June, there were discussions at WHO over whether to call a global health emergency. An internal document says such a declaration “ramps up political pressure in the countries affected” and “mobilises foreign aid and action.”

But one director viewed it as a “last resort”. WHO was having to contend with other outbreaks, including polio, which has a high political priority. There were also issues with the government of Guinea, which, according to WHO documents, was reporting only confirmed Ebola cases and not those suspected or probable, in a bid to downplay the dangers and avoid alarming foreigners working in the mining industry.

Dr Sylvie Briand, head of the pandemic and epidemic diseases department at WHO, acknowledged that her agency made wrong decisions, but said postponing the alert made sense at the time because it could have had catastrophic economic consequences. “What I’ve seen in general is that for developing countries, it’s sort of a death warrant you’re signing,” she told AP.

On 10 June, Briand, her boss, Dr Keiji Fukuda, and others sent a memo to WHO chief Dr Margaret Chan, noting that cases might soon pop up in Mali, Ivory Coast and Guinea-Bissau. But the memo went on to say that declaring an international emergency or even convening an emergency committee to discuss the issue “could be seen as a hostile act”.

But others argue that although declaring an international emergency is no guarantee of ending an outbreak, it functions as a kind of a global distress call.

“It’s important because it gives a clear signal that nobody can ignore the epidemic any more,” said Dr Joanne Liu, MSF’s international president.

In a meeting at WHO headquarters on 30 July, Liu said she told Chan: “You have the legitimacy and the authority to label it an emergency ... You need to step up to the plate.”

After WHO declared an international emergency on 8 August, Barack Obama sent 3,000 troops to west Africa and promised to build more than a dozen 100-bed field hospitals. Britain and France also pledged to build Ebola clinics, China sent a 59-person lab team, and Cuba sent more than 400 health workers.

Dr Bruce Aylward, WHO’s top Ebola official, maintains however that labelling the Ebola outbreak a global emergency would have been no magic bullet. “What you would expect is the whole world wakes up and goes: ‘Oh my gosh, this is a terrible problem, we have to deploy additional people and send money,’” he said. “Instead what happened is people thought: ‘Oh my goodness, there’s something really dangerous happening there and we need to restrict travel and the movement of people.’”