Despite the massive push to bring the number of new Ebola cases down to zero as quickly as possible, there will inevitably be “flare-ups” that could reverse the overall downward trend and prove difficult to contain, the UN’s response co-ordinator has warned.

Dr David Nabarro, the UN’s special envoy for Ebola, said the huge medical, administrative and logistical operation to fight the disease could still be set back by individuals ignoring official advice.

“There will be flare-ups, there will be disappointments; there will be people who evade quarantine – because nobody likes being told to stay put – there will be people who choose not to declare that they’ve got a relative ill, there will be people who get ill and just misdiagnose themselves,” he said.

“I’m afraid there will be difficulties and we are, to a degree now, steeled for that.”



If people “ducked under the radar” – as recently happened in one case in northern Sierra Leone – and if they are not quickly located and treated, said Nabarro, they could cause a spike in the infection rate.

“[That case] was dealt with, but if we didn’t have the capacity, both national and international, to do this work – and to do it in a really coordinated way – then these flare-ups occur and, frankly, before you can blink, we could be back to a situation where it starts climbing up again,” he said.

If the infection rate began to rise once more, Nabarro explained, it would be hard to get it down again, “just because people are really tired”.

“You need the cooperation of the local communities all the time – it can’t be done by outsiders on their own.”

The challenge now, said Nabarro, was to avoid stigmatising individuals while keeping communities motivated for the final push, which he likened to the “last five kilometres of a marathon”.

The Ebola outbreak in west Africa has so far killed more than 10,300 people in Liberia, Sierra Leone and Guinea.

According to the most recent figures from the World Health Organisation (WHO), a total of 79 new cases of Ebola were reported in the week to 22 March – the lowest weekly total of 2015.

In Guinea, which was reporting almost 300 cases a week during the peak of the crisis, there were 45 new cases. Sierra Leone reported 33 new cases, down from a peak of 500 a week.

Liberia, which had reported no cases for three consecutive weeks, confirmed a new case on 20 March, breaking the country’s 42-day countdown to Ebola-free status. In August and September last year, the country was reporting 300 cases a week.

While the numbers are heading in the right direction, Nabarro cautioned that the scale of the task facing those trying to get them down to zero should not be underestimated.

He said more than 700 WHO staff were working in 63 different local administrations across Liberia, Sierra Leone and Guinea trying to coordinate the final push.

In each local government area, said Nabarro, national and international workers were trying to maintain surveillance of the population, identify those with the disease, trace contacts, identify the chains of transmission and keep entire communities engaged.

“These are all big demands of communities and responders and it’s very intrusive and difficult stuff,” he said.

As well as running a huge community mobilisation programme using radio, door-to-door work and cooperation with local religious leaders – not to mention ensuring the “logistical backbone” of helicopters, boats and other vehicles was working effectively – there was also the question of data, said Nabarro.

“It’s [about] getting the full geographical coverage and linking everyone together with the most excellent data systems so the databases are comparable and we don’t end up with a mess because different people can’t talk to each other,” he explained.



Nabarro reacted cautiously to this week’s scathing report from the medical charity Médecins Sans Frontières (MSF). The report said the Ebola crisis had laid bare the “age-old failures” of the humanitarian aid system, and accused the WHO of repeating the mistakes of previous public health emergencies. It also argued that the governments of Guinea and Sierra Leone had obstructed the early response and contributed to the loss of life.

“As always in a major health crisis, there will be different perspectives on what went on and why particular problems occurred, so let’s wait and see what the others have got to say through their own exercises before final conclusions are reached,” said Nabarro.



He did, however, fully agree with MSF’s plea for lessons to be learned from the crisis: “This time our memories must stay very long and we must remain very mindful of the enormity of the suffering, so we can be ready to apply the lessons even a year or two afterwards, even if this calls for quite a lot of investment in different ways of working or in resources.”

Earlier this week, the head of the UN Ebola mission, Ismail Ould Cheikh Ahmed, told the BBC the epidemic would be over by August earlier this week. Nabarro, however, refused to be drawn on dates.

“We are all working to see this come to zero as quickly as possible,” he said. “We know it’s going to be difficult but we all want to sustain the effort to try to get it to zero in all three countries as quickly as possible.”

