EXCLUSIVE: As United Nations coordinators are claiming success in getting a handle on the Ebola crisis in West Africa, the medical organization that first sounded an alarm about the epidemic warns that the response is ragged, many areas are not getting help, and U.N. coordinating efforts are not having much impact.
“We have little concrete evidence of UNMEER’s work making a tangible difference,” an official of Doctors Without Borders, the front-line medical emergency organization, told Fox News.
He was referring to the United Nations Emergency Mission for Ebola Response, the first-ever U.N. emergency health mission, mounted with much fanfare by Secretary General Ban Ki-moon in September. It involves more than 280 U.N. coordinating personnel and a $50 million budget to support them through the end of this year alone.
UNMEER was formed with the mandate to coordinate the billion-dollar local and international effort aimed primarily at stopping Ebola’s spread in Liberia, Guinea, Sierra Leone and neighboring countries, and, on December 1, its top leaders publicly claimed a dramatic measure of success.
But according to Doctors Without Borders, neither the coordination nor the success -- at least, at the level required -- is yet happening.
In a “briefing paper” published the day after top U.N. officials made their optimistic claims, the volunteer organization declared that while there have been “positive steps forward,” the response to the “rapidly-changing epidemic has so far been inadequate.”
Rather than the “well-coordinated, comprehensive and expertly-staffed intervention” Doctors Without Borders (DWB) had called for months earlier, “actual efforts have been sluggish and patchy, falling dangerously short of expectations.”
Among the problems:
- continuing shortages of personnel to train local health care staff in handling Ebola cases safely, a problem that will take “some weeks” to address;
- a ponderous misallocation of facilities to diagnose, isolate and care for infected patients;
- lengthy construction delays for new facilities;
- lack of segregation of Ebola victims from other sick people, leading to closures of many health care facilities; and
- continuing ignorance about the disease, especially in rural areas.
The situation in Guinea, the report said, was “alarming,” while in Sierra Leone the fight against the virus “is being outpaced by the increasing number of infections.”
In Liberia, the worst-hit country, Ebola cases in the capital of Monrovia have been dropping, but others are sprouting in the countryside, and “many international actors seem unable to adapt to the rapidly-changing situation.” The result: “resources are being allocated to activities that are no longer appropriate to the situation.”
As one example, the report cited China’s construction of a 100-bed “case management center” for Ebola victims in Monrovia, where there were already 580 CMC beds, and where two more 100-bed centers are planned for the same neighborhood as the Chinese facility. Meantime, “there are only 178 operational beds in CMCs in the rest of the country.”
“There are still active chains of transmission in almost every part of the country,” DWB related. On one rural exploratory mission, members of the group discovered that “people who had been in contact with the sick were fleeing into the bush so as not to be traced as a contact or taken to a case management facility, fearful of what may happen.”
Moreover, local government workers who were supposed to be spreading across the countryside offering laboratory diagnosis services, safe burials, ambulance services and tracing of contacts between Ebola victims and the uninfected “sometimes lack the basic equipment to do it and are not paid for their work.” Those supposed to find new cases sometimes had neither vehicles nor SIM cards to activate their mobile phones.
As of Monday, UNMEER was reporting that there were 17,517 cases of the highly contagious virus in the three West African countries, and 6,187 reported deaths. WHO also declared that the number of cases was “stable or declining” in Liberia, “slightly increasing” in Guinea, and “may still be increasing” in Sierra Leone.
Those numbers are in many ways no more than guestimates, as affected populations in hard-to-access areas of the three hardest-hit countries are not included.
Nonetheless, on December 1, Anthony Banbury, head of UNMEER, told a press conference in Freetown, Sierra Leone, that the “global response has successfully turned this crisis around, in I think a remarkable way.”
He cited worst-case projections in September that estimated as many as 10,000 new cases per week by the beginning of December, and said current totals were “less than one-tenth of that.”
At the center of Banbury’s claims of success were what UNMEER calls its “70-70-60” targets for the three most affected countries. Translation: safe burial of 70 percent of Ebola fatalities, and isolation of 70 percent of newly infected patients, all within 60 days of UNMEER’s inception.
The burial target, Banbury said, had been “exceeded” in all three countries, while the isolation goal had been “exceeded” in Liberia and Guinea, and “exceeded in many places” in Sierra Leone.
At the same press conference, Banbury’s top-level confrere, David Nabarro, Senior U.N. System Coordinator for Ebola Virus Disease, warned on the other hand that the number of newly infected cases “still greatly varies each week,” and “the distribution changes from week to week.” The situation, he added, “can worsen unexpectedly.”
In fact, according to Doctors Without Borders, it may be doing so, due in part to haphazard coordinating efforts that are still not getting resources and training programs to the places where they are most badly needed, with not enough signs yet that those requirements are going to be properly met.
“It’s true that in the last few months new efforts have been made to better coordinate the Ebola response in the affected countries, both on the national and regional levels,” the Doctors Without Borders official told Fox News.
“But new layers of management aren’t alone going to solve the problem on the ground -- hands-on, well-coordinated and flexible efforts in the places they are needed will.”
Doctors Without Borders (DWB) also known by its French name of Medicins Sans Frontieres (MSF), is in a good position to know what it is talking about. More than 3,400 of DWB’s international and local staff are fighting the disease in West Africa, and 13 have died as a result.
It operates six Ebola case management centers, and has admitted around 3,800 confirmed victims of the virus; nearly 1,600 of them have survived.
(DWB’s hoped-for budget for 2014-2015 for the Ebola effort is about $138 million. So far, the organization reports on its website, it has raised almost $90 million, but bulk from private donors.)
Moreover, DWB has already had experience with too-rosy U.N. thinking. The organization began warning about the explosive nature of the current Ebola outbreak -- the worst ever seen -- last February. But its concerns were initially downplayed by WHO.
WHO’s executive director, Margaret Chan, admitted to TIME magazine in October that she really got an idea of the problem’s magnitude in June, and that “cases of Ebola were spreading in a hidden manner.”
Still, WHO only declared the outbreak a problem of international concern in August, and it took the rest of that month to roll out an elaborate “road map” for fighting the disease.
By that time, criticism of WHO’s role, and deep concerns about the potential international spread of the disease -- as well as the death toll -- were dramatically mounting. The head of WHO’s Africa unit has stepped down; the U.N. organization says it will conduct a full inquiry into the much-criticized initial response -- but only after the Ebola crisis is over.
Now, huge amounts of money are involved. A mammoth campaign has raised more than $1 billion for the Ebola response effort, against needs that are estimated to reach $1.5 billion by February 2015. The U.S. contribution so far is more than $233 million for anti-Ebola efforts, and nearly $600 million in overall humanitarian relief.
(A congressional spending bill unveiled Tuesday night also includes some $5.4 billion that the Obama administration wants to use for domestic and international anti-Ebola programs and other forms of spending tied to the crisis.)
But DWB’s point is that big and bureaucratic efforts are not what is needed: effective effort -- a “well-coordinated, comprehensive and expertly-staffed intervention”-- is still desperately required.
Asked to comment on the substance of DBW’s “briefing paper,” a spokesman for Secretary General Ban pointed to Banbury’s and Navarro’s declarations, “which outlined the progress that has been made and the challenges that still lie ahead.”
“The U.N. is implementing a clear strategy in support of the affected governments and communities,” the spokesman told Fox News in an email. “Where the Ebola response strategy is comprehensively implemented, transmission slows dramatically. The Ebola outbreak is evolving unevenly. As the outbreak evolves, so must our response.”
Much of the spokesman’s reply emphasized the need for more money. Only $1 billion of the U.N.’s estimated $1.5 billion in financing needs for the crisis has been raised so far, along with pledges of $121 million for the trust fund that supports UNMEER into the future.
“In addition,” he added, “we will need significant funding to support longer term recovery. It is essential that we provide sustained support to the affected countries after the end of the outbreak.”
When that hoped-for moment will arrive seems even less clear after the DWB report.