The Ebola crisis has brutally exposed the “age-old failures” of the humanitarian aid system with the World Health Organisation and governments repeating the mistakes of past public health emergencies, the medical charity Médecins Sans Frontières (MSF) has said.

In a highly critical report on Monday, marking the first anniversary of the official outbreak in west Africa, the charity said the governments of Guinea and Sierra Leone obstructed the early response and contributed to the loss of life.

“The Ebola outbreak has often been described as a perfect storm: a cross-border epidemic in countries with weak public health systems that had never seen Ebola before,” said MSF general director Christopher Stokes.

“Yet this is too convenient an explanation. For the Ebola outbreak to spiral this far out of control required many institutions to fail. And they did, with tragic and avoidable consequences.”



Many institutions failed, with tragic and avoidable consequences Christopher Stokes, MSF general director

The lessons learned by the WHO from the last international pubic health crisis, the cholera outbreak in Haiti that began in 2010 – were simply ignored and not put in place, says the report.

The WHO should have been fighting the virus by stepping into the obvious leadership vacuum, but instead stood on the sidelines and limited its role to advisory support.

MSF said its early warnings of an “unprecedented” situation in March last year were dismissed as “alarmist”, with the WHO calling into question its declaration that this outbreak was different to those before in places such as the Democratic Republic of the Congo.

The WHO’s “willingness to assume responsibility to respond robustly” was not present, says MSF.

The charity warned that the number of cases “have not significantly declined since late January” and numbers are “still higher than in any previous outbreak”.

As of 18 March, the death toll from Ebola in west Africa was 10,251, with one new case on Friday in Liberia breaking the country’s 42-day countdown to Ebola-free status.



“We have learned a lot, but it does not mean anything if you do not have the political will to change,” said MSF operations director Brice de le Vingne. He fears a similar outbreak in another country with weak health systems could result in the same inaction.

The report recalls the “indescribable horror” the charity faced when Ebola first struck last March. It had to turn away patients because it could not cope and no other organisations were on the frontline.

It says efforts to contain the spread were thwarted by “political blockages”.

The Guinean government complained MSF was spreading panic to help raise funds, for example.

The Sierra Leone ministry of health refused to share data in the early outbreak and instructed the WHO to report only lab-confirmed deaths, thereby excluding the “probable” and “suspect” cases that could not be tested because of the lack of testing facilities.

MSF set up a hospital in Kailahan, but the hospital in neighbouring Kenema was not sharing information and by the time it did, the disease had “mushroomed”.

By contrast, it said, the Liberian authorities were transparent about the spread of cases from the outset.

“This contributed to an epidemic of fear”, which had the positive effect of making the public quickly grasp the importance of isolation and safe burial, says De le Vingne.

De le Vingne also blamed the change in direction of many of the world’s charities for exacerbating the problem, adding that too often MSF is the first to respond to emergencies around the world.

“Many NGOs have taken the path of lobbying and advocacy, which is a good thing, but they have abandoned emergencies. Oxfam 10 years ago had a huge water and sanitation capacity. That’s not the case now,” he said.

The report says 2014 was a very demanding year in which MSF was stretched way beyond its limits.



It only had 40 experts in infectious diseases to call upon, but because of WHO’s inaction, MSF was left to set up and run operations, as well as train 1,300 international staff and 5,000 local staff.

“The flexibility and agility for a fast, hands-on emergency response still does not sufficiently exist in the global health and aid systems,” says Joanne Liu, president of MSF.



“Lessons that should have been learned in the mass cholera epidemic in Haiti four years ago were not,” she added.

MSF said restoring healthcare systems in the region will not be enough. Systems must be put in place involving labs and effective emergency responses in each of the countries at risk of future outbreaks.

The knowledge of the world’s health communities has been shared, but it risks being useless if not immediately deployed the next time.

“Political will is crucial to put this knowledge into practice,” MSF said. The charity called for a global strategy to help push the need for emergency aid up the agenda to create world-readiness for the next public health crisis.

On Monday, the head of the UN Ebola mission, Ismail Ould Cheikh Ahmed, told the BBC the epidemic would be over by August.

He admitted that when the virus first struck “there was probably a lack of knowledge and there was a certain degree of arrogance”, but he said he believed lessons were being learned.