In the face of the rapid spread of Ebola in three West African countries, the U.N.’s World Health Organization mismanaged its response and delayed declaring it an international emergency, according to an investigation by the Associated Press.
Documents and emails obtained by the AP charge that the WHO made critical mistakes that may have cost lives. Calls by WHO officials on the ground in Kenema, Sierra Leone, to do more went unheeded by higher ups. And mid-level bureaucratic dysfunction forced the WHO leader to step in to allocate money for basics like protective rubber boots. These represent just two examples of many in which the organization failed, the AP report found.
“I expect all our colleagues … to facilitate experts and staff to do their field work and not to post barriers because business as usual does not work during crisis,” said an email from WHO Secretary-General Margaret Chan.
Kenema was one of the hot spots for the Ebola outbreak. Hospitals there were suddenly inundated with cases and struggled to keep up. The scene in the town was described by senior U.S. health official Austin Demby:
When I go Kenema, you know, just the shock of my life. You know, I walk inside the main ward, you know, close to about six dead bodies then (sic) they inside body bags, you know, just laying all over the place, you know? About seven nurses they (sic) admit inside the hospital, inside the care center. I think (inaudible) I see a complete breakdown of systems. You know, I think the WHO, I’m not for blaming anybody for anything but WHO could really spend a little more time on Kenema.
The WHO provided support to local hospitals and for the Red Cross response, but struggled immensely. For example, WHO sent chlorine that was either expired or missing documentation to Kenema Government Hospital.
“I was deeply shocked about discovering that the chlorine we received was totally inefficient, up to the point we could hardly detect any active component in it,” according to an email from WHO logistics official Jérôme Souquet. “This chlorine is the cornerstone of all our activities, especially desinfection (sic).”
The hospital asked the Red Cross to build a separate facility for Ebola patients. But the WHO and the Ministry of Health for Sierra Leone didn’t provide information needed to determine a site for the clinic. The epidemic peaked before the site was found and the clinic completed.
Some people interviewed by the AP cite the examples of chlorine and the inability to quickly build the Red Cross clinic as evidence that more lives could have been saved. Medical historian Mark Honigsbaum told reporters that it is possible that Kenema could have avoided Ebola entirely if the international and local response were better organized.
These logistical problems with the WHO response were not detailed in a WHO report appraising its response to the Ebola crisis. The critical report, published in April, brought forward the problems with leadership and organization as major gaffes committed by the organization. This new information shows that problems existed on nearly every level of the WHO response. Health workers lacked adequate transportation, power supply at the hospital lab was inconsistent and the supply of body bags ran out during the peak of the outbreak.
But the blame does not solely rest on the WHO. Health ministries in the three affected countries struggled to respond. Health workers were and still are grossly underpaid and overworked. Supplies did not always make it to where they were needed. And the biggest push by the international community came months after the outbreak took off.
“The world simply did not respond to the disaster in West Africa last summer,” said Joseph Fair, a U.S. disease expert advising the Sierra Leonean government, to the AP. “It truly was like fighting a forest fire with a spray bottle.”
More than 11,000 people died from Ebola in West Africa and the outbreak continues. Cases are dramatically lower than they were even a few months ago, yet new cases emerge just when it appears to have ended.