Many foreign aid workers in the ongoing Ebola epidemic have a safeguard that their West African counterparts are denied: emergency air evacuation should they become dangerously ill.



Since June, air ambulances have rescued at least 10 foreign health workers who came into contact with the Ebola virus. Those cases include a Doctors Without Borders staffer sent home to France, a British man sent to the U.K., two Dutch doctors airlifted to the Netherlands and four infected Americans flown to U.S. hospitals to receive experimental serums, according to the Associated Press. All survived except for two Spanish priests who were flown back to Spain for treatment. So far 373 health workers from Guinea, Liberia, Nigeria and Sierra Leone have contracted the virus, according to the World Health Organization, and 208 have died.



In two cases the Sierra Leone government sought aid from the World Health Organization to evacuate infected physicians. Both requests were denied.



Four Sierra Leone physicians were among the caretaker casualties, according to news reports. The latest loss was Dr. Olivet Buck, who caught the virus on Tuesday, September 9. Following the diagnosis, President Ernest Bai Koroma of Sierra Leone sent an urgent letter to the WHO seeking aid in organizing her evacuation for Friday, September 12, to Hamburg, Germany. The president felt that his country, which already has a shortage of health workers, could not lose another doctor.



The WHO replied on September 13 that it could not comply with Koroma’s request to organize Buck’s medical air transport. Instead it pledged to provide Buck with medical care, such as experimental drugs, back in Sierra Leone. But her home country’s hospitals were already overwhelmed with patients. Later that night Buck died. Her death and those of her compatriots, including the physicians Sheik Humarr Khan, Modupe Cole and Sahr Rogers, is a significant blow to the country’s health care service.



Following Buck’s death, officials from Sierra Leone criticized the WHO for its “sluggish” response, which came a day after the expected evacuation date, according to the AP. Khan also died while the Sierra Leone government was still negotiating potential evacuation plans with the WHO. Sierra Leone’s president has said that he was ready to approve the $70,000 Buck’s evacuation to Germany would have cost and that the hospital in Hamburg was ready to take Buck.



“We’re not in a position to evacuate every health worker,” says WHO spokesperson Tarik Jasarevic. “We evacuate the people we employ, and have done so twice.” Evacuations are the responsibility of a health worker’s employer, Jasarevic says. Only one West African was flown to a hospital abroad: a Senegalese epidemiologist and WHO staffer. If the WHO had planned to evacuate all infected West African health care staff, at $70,000 apiece the airlifts would have come to $26.1 million—too expensive for the agency’s budget. The WHO’s 2014–2015 expenditure on infectious disease is $841 million, after suffering a $72-million cut from the previous year.



Ethicists agree that the WHO could not evacuate every West African doctor to better facilities outside of the hot zone, but disagree on the specific cases of Buck and Khan.



“For the single request at that time, it’s hard to understand why the WHO explained it away, especially when those doctors can serve as heroes and inspirations to other doctors,” says Arthur Caplan, a bioethicist from New York University. Caplan says that in these two cases the WHO had the resources to evacuate the doctors. “[The WHO] haven’t opened up the flood gates, they are just saying ‘how about these two?’”



Nancy Kass, a bioethicist from Johns Hopkins University, agrees that the WHO should commit first-rate treatment for West African caretakers, but believes that air evacuations are not the best use of the WHO’s deeply underfunded budget. “The [WHO’s] response does not seem inappropriate to me at all,” she says. “It’s easy to say ‘It’s just one person,’ but it’s never just one person.”



The best way to treat the infected local health workers, the WHO says, is for the international community to send more aid workers to provide care and assistance. Kass suggests that an NGO should undertake the task of airlifting West African doctors for treatment abroad. The U.S., rather than considering airlifting physicians out of their home countries, should expedite making experimental treatments available there, she says. “It absolutely seems that someone should be taking care of the heroes in West Africa who are giving themselves up to take care of people,” she says. “But that’s not what WHO does. They can’t afford it.”

