Five months have passed since the Ebola virus was first confirmed in West Africa — but according to a top aid official, the emergency response is still leaderless and suffering from a kind of “Ebola psychosis” that has made the global community reluctant to join the front-line fight.

The unprecedented Ebola epidemic has now caused 2,473 reported cases and 1,350 deaths across four West African countries, but medical charity Médecins Sans Frontières is still one of the few international organizations with boots on the ground, said president Dr. Joanne Liu.

The Canadian physician, who recently returned from a 10-day tour of the worst-hit countries, said there is a “vacuum” of leadership in the outbreak response, which still lacks a co-ordinated plan at the top.

“This is the biggest Ebola epidemic of modern times … (but) no one has somehow gained control,” said Liu in a phone interview from Montreal. “The ministries of health and governments of each country have a responsibility, but the other thing is that somehow the WHO needs to step up.

“They keep telling me, ‘We’re not an emergency response organization.’ I’m sorry but you’re the World Health Organization; you need to step up to that role because you have the legitimacy and the authority to do that.”

Liu’s comments echo a recent New York Times editorial, which criticized the WHO for being “shamefully slow” in supporting Guinea, Liberia and Sierra Leone, the three countries that have been hardest hit by the outbreak and which are “among the poorest and most war-racked in the world.”

A spokesperson for the WHO declined to respond to specific allegations but said the UN health agency currently has 150 people on the ground. He noted it also recently deployed a team of top experts — including Dr. Keiji Fukuda, assistant director general for health security — to West Africa, where they will soon meet with government officials in Liberia and Sierra Leone to “adapt and operationalize a response plan.”

But for Liu, the most urgent need is for “people who will roll up their sleeves and do some legwork in the field” — everyone from doctors and nurses to “social mobilization” teams who can help spread education and awareness.

“People need to go and walk around and talk to the elders, talk to the villagers, and explain to them what’s going on,” she said. “If we don’t act rapidly … fear will be changed into panic and then irrational behaviour. We need to stop that vicious cycle.”

MSF, which is also responding to crises in Syria, South Sudan, Gaza and Iraq, is now reaching a breaking point in West Africa, with many staffers serving on their third or even fourth Ebola mission. The organization just opened its largest-ever isolation ward in Liberia with 120 beds, which have already been filled, Liu said.

The health crisis also extends beyond Ebola and the affected countries are now experiencing “emergencies within an emergency,” Liu said. With health workers either dead from Ebola or too scared to work, no one is receiving health care for anything, she said. In Liberia, for example, six babies recently died after their pregnant mothers walked for hours looking for a place to deliver.

“Right now, a child with malaria has nowhere to go for treatment,” she said. “At the end of this, we may have more secondary deaths from lack of access to health care than from Ebola.”

Liu said many aid agencies that typically work alongside MSF during humanitarian crises simply aren’t present in West Africa. “We are calling them, having meetings with them, but they are not there.”

One reason for this is how Ebola has been portrayed, she said. “People think the only way to make a difference in an Ebola crisis is to come with a cosmonaut outfit and work in an isolation centre.”

Another factor has been the pervasive fear, which Liu herself has experienced. She said her family was terrified when they heard she was going to West Africa — a reaction she didn’t even encounter when she went to Syria. And now that she’s home, her friends won’t invite her to dinner, she said.

“I think right now there is an Ebola psychosis,” she said. “The reality is people are scared.”

Even within MSF, recruiting for Ebola has been difficult. It doesn’t help that MSF has been unable to secure guarantees from governments that they will fly their own citizens home for treatment if they get infected while responding to the outbreak. Airlifting an Ebola patient requires permission not only from the receiving government, but from every single country the airplane flies over, Liu added.

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“We’re all facing some dramatic administrative blockages right now,” she said. “It’s really hard to ask someone, ‘Go and put your life in danger — but if you ever get sick, we can’t guarantee we can bring you home for help.’”

No MSF worker has ever died while responding to an Ebola outbreak and Liu credits the organization’s rigorous procedures for keeping her people safe. But she admits to being worried, given how hard her staffers are working and the exhaustion permeating the organization’s ranks.

Liu says rich countries around the world have to help — not by closing borders but by strengthening capacity on the ground. “If people don’t understand that, then we’re going to be facing something much bigger than what we’re facing right now.”