This presentation about Ebola crisis in 2014 and the global response failure to it.

1. Ebola Crisis
The global response failure
Amal Almughthim

2. What is Ebola?
Ebola is a deadly disease caused by a virus. After entering the body, it kills cells,
making some of them explode. It wrecks the immune system, causes heavy bleeding
inside the body, and damages almost every organ.
• Symptoms:
Early on, Ebola can feel like the flu or other illnesses. Symptoms show up 2 to 21 days after
infection and usually include:
 High fever.
 Headache.
 Joint and muscle aches
 Sore throat.
 Weakness.
 Stomach pain.
 Lack of appetite.
As the disease gets worse, it causes bleeding inside the body, as well as from the eyes, ears, and
nose. Some people will vomit or cough up blood, have bloody diarrhea, and get a rash.

3. Ebola Transmission:

4. Year Country Ebola virus species Cases Deaths Case fatality
2012 Democratic Republic of Congo Bundibugyo 57 29 51%
2012 Uganda Sudan 7 4 57%
2012 Uganda Sudan 24 17 71%
2011 Uganda Sudan 1 1 100%
2008 Democratic Republic of Congo Zaire 32 14 44%
2007 Uganda Bundibugyo 149 37 25%
2007 Democratic Republic of Congo Zaire 264 187 71%
2005 Congo Zaire 12 10 83%
2004 Sudan Sudan 17 7 41%
2003 (Nov-Dec) Congo Zaire 35 29 83%
2003 (Jan-Apr) Congo Zaire 143 128 90%
2001-2002 Congo Zaire 59 44 75%
2001-2002 Gabon Zaire 65 53 82%
2000 Uganda Sudan 425 224 53%
1996 South Africa (ex-Gabon) Zaire 1 1 100%
1996 (Jul-Dec) Gabon Zaire 60 45 75%
1996 (Jan-Apr) Gabon Zaire 31 21 68%
1995 Democratic Republic of Congo Zaire 315 254 81%
1994 Cote d'Ivoire Taï Forest 1 0 0%
1994 Gabon Zaire 52 31 60%
1979 Sudan Sudan 34 22 65%
1977 Democratic Republic of Congo Zaire 1 1 100%
1976 Sudan Sudan 284 151 53%
1976 Democratic Republic of Congo Zaire 318 280 88%
HistoryofEbola

5. Ebola Outbreak 2014
Epidemic killed FIVE times more
than all other known Ebola outbreaks combined.

6. Etienne Ouamouno holds photographs of his wife Sia and two children Emile and
Philomene, the first known victims of this Ebola outbreak

7. Patient Zero:
• Emile was just two years old and living in the remote Guinean village of when he
began suffering from a fever, headache and bloody diarrhea.
• In December 2013, the young boy died - followed within days by his three-year-
old sister Philomene and their pregnant mother Sia.
• Ebola infected village health workers before spreading to nearby districts.
• Early on, health workers and doctors believed they were dealing with cholera or
Lassa fever, and of the first 15 deaths documented four were health staff.

8. How the outbreak start?

9. Outbreak Timeline:
• In March 2014, hospital staff alerted Guinea's Ministry of Health and
then medical charity Medecins Sans Frontieres (MSF). They reported a
mysterious disease in the south-eastern regions of Guniea. It caused
fever, diarrhoea and vomiting. It also had a high death rate. Of the first
86 cases, 59 people died. The WHO confirmed the disease as Ebola.
• By the end of March, Ebola had crossed the border into Liberia.
• In May, It was confirmed in Sierra Leone.
• In June, MSF described the Ebola outbreak as out of control.
• in July, Nigeria had its first case of the disease.

10. In August 2014, the United Nations health
agency declared an
"International Public Health Emergency"

11. Outbreak Timeline:
• on 29 August, Senegal reported its first case of Ebola. A young man from
Guinea had travelled to Senegal despite having been infected with the
virus, officials said.
• By September, WHO director general Margaret Chan said the number
of patients was "moving far faster than the capacity to manage them".
• in October, Director of CDC in the US, said that the Ebola outbreak in
West Africa was unlike anything since the emergence of HIV/Aids.
• On 25 October, Authorities in Mali confirmed the death of the country's
first Ebola patient, a two-year-old girl.

12. How the virus spread?

16. Ebola outside West Africa
• Infection outside Africa has been restricted to health workers in Madrid and in
Dallas except for three cases.
 The first case of the deadly virus diagnosed on US soil was announced on October. He
contracted the virus in Liberia. Two medical workers in Dallas, Texas, who treated
patient tested positive for Ebola since his death but have both recovered.
 The second death on US soil was surgeon, from Sierra Leone. He was flown back to
the US in November and treated for Ebola at a hospital in Nebraska but he died a
short time later.
• Germany, Norway, France, Italy, Switzerland and the UK have all treated
patients who contracted the virus in West Africa.

18. At 13 January 2016, WHO declared the last of the
countries affected, Liberia, to be Ebola-free.
28,616
Ebola cases have
been reported in
Guinea, Liberia
and Sierra Leone
11,310
deaths.
10,000
survivors of
Ebola virus
disease.
4,809 Liberia
3,955 Sierra Leone
2,536 Guinea
8 Nigeria

19. Countries Effected Situations

20. Liberia
• Ravaged by a 14-year violent civil conflict,
that ended in 2003, Liberia's health
services struggled to deliver basic services
long before the Ebola outbreak.
• The first case across the border was
confirmed in March, throughout September,
the county was reporting more than 200
new cases each week.
• With only around 60 Liberian doctors
before the Ebola outbreak, the death of a
number of its high profile and most
competent medical professionals left the
country's health staff decimated and
demoralized.

21. Sierra Leone
• It was one unsafe burial that ended up leading
directly to Sierra Leone's explosion of Ebola
cases in the summer with 365 Ebola deaths.
• The healer had treated Ebola patients flocking
to seek her care across the border from Guinea,
before dying herself.
• Health teams working in the region identified a
further 13 women who caught the virus
attending the same burial, starting a chain
reaction of infections, deaths and more
funerals.
• From there Ebola spread to Sierra Leone's
capital Freetown where overcrowded living
conditions and fluid population movements
helped it to spiral further out of control.

23. Nigeria: A success story
• A country home to 170 million, Nigeria has
almost seven times the combined population of
Guinea, Liberia and Sierra Leone.
• A rapid response and effective tracing of almost
1,000 individuals who may have been exposed to
the virus meant the number of Ebola deaths in
Nigeria was limited to eight.
• At the heart of the fight against Ebola in Nigeria
was Dr.Ameyo Stella Adadevoh.
• Dr.Adadevoh diagnosed American-Liberian
Patrick Sawyer with Ebola when he was
hospitalized in Lagos.
• The doctor and her staff physically intervened
when Mr Sawyer tried to leave the treatment
center. This action cost Dr Adadevoh and three
medical staff their lives when they too contracted
the disease.

24. The global response failure, who’s
to blame?
IMF
Local
Governments
WHO

25. “global response has ‘failed miserably’ in its response to the Ebola virus. We
should have done so many things. Healthcare systems should have been built.
There should have been monitoring when the first cases were reported. There
should have been an organized response.”
Jim Kim
The president of the World Bank

26. “The world, including WHO, was too slow to see what was unfolding
before us.“
Margaret Chan
WHO director-general
January 2015

27. IMF policies & Ebola spread in West
Africa:
• International Monetary Fund (IMF) may have contributed to
the rapid spread of Ebola in three West African states, because
of under-funded, insufficiently staffed, and poorly prepared
health systems in Sierra Leone, Liberia and Guinea.
• Conditions on IMF loans to Guinea, Sierra Leona and Liberia
over the past two decades prioritized debt repayments and
building foreign exchange reserves over healthcare spending.
Heavily indebted to foreign lenders after emerging from
conflicts, the three countries rely partially on loans to run
government services, including health centers. (Gulland 2014)

28. Local Governments:
• The three poor West African states are heavily dependent on donor
funding. Conflict in Liberia and Sierra Leone in the 1990s also
contributed to the destruction of their health systems.
• Within this mix the governments of West Africa must accept some
responsibility for not calling for assistance earlier. Indeed, the fact
that Liberia’s president attracted criticism from the leaders of Guinea
and Sierra Leone even after it had become apparent that the virus
was wreaking widespread havoc is a damning critique of the political
leadership throughout this crisis.
• Other countries in the region, including Nigeria and Senegal – who
also faced cases of Ebola – had stronger healthcare systems, which
were able to stop mass contagion of the epidemic.

29. WHO:
• Ebola was most definitely not expected in Liberia, Guinea or Sierra Leone. The virus had
never been seen in West Africa before. So when the first cases were reported in March there
was no big WHO machine ready to roll. As it turns out, West Africa's Ebola outbreak
actually began in Guinea last December and seems to have gone almost unnoticed for three
months.
"Nobody knew that this disease called Ebola would be possible in such parts of Africa," said
Dr Isabelle Nuttall, the WHO's Director of Global Capacities, Alert and Response.
• But even if the WHO did not expect Ebola in West Africa, it did receive information, and
warnings, from medical experts on the ground. Medical charity Medicines Sans Frontiers
(MSF) said on 31 March that Guinea was facing "an epidemic of a magnitude never before
seen in terms of the distribution of cases in the country". But on 1 April, the WHO's senior
communications officer, Gregory Hartl, suggested that MSF was scaremongering.

30. WHO:
• An outbreak of Ebola was officially declared in Guinea on 23 March 2014 and WHO
secretariat mobilized a response team via the Global Outbreak Alert and Response
Network (GOARN) to deploy to Guinea to assist local health authorities.
• Throughout April 2014, the organization continued to mobilize technical support and
resources to assist the affected countries. As a result, by 7 May 2014 some 113
technical experts had been deployed to assist the health authorities in Guinea, Liberia,
Sierra Leone and AFRO.
• As of May 7, 2014 the number of confirmed Ebola cases in Guinea was 235.

31. WHO:
• Till 10 June 2014, a total of 440 suspected or confirmed Ebola cases.
• The rise in cases so alarmed some officials in AFRO that they contacted the secretariat
in Geneva recommending a PHEIC be declared, but the response they received
discouraged invoking the IHR 2005, suggesting a declaration of that nature would only
damage relations with the affected countries.
The term PHEIC is defined in the IHR (2005) as “an extraordinary event which is
determined, as provided in these Regulations:
 to constitute a public health risk to other States through the international spread of
disease; and
 to potentially require a coordinated international response”.
This definition implies a situation that: is serious, unusual or unexpected;
carries implications for public health beyond the affected State’s national
border; and may require immediate international action.

32. WHO:
• The WHO's regional headquarters in Africa issued irregular online statements as to
new cases and death tolls, which were often not confirmed by WHO headquarters in
Geneva for several days.
• By 17 June, number of cases had risen again, to 528 suspected or confirmed cases.
• Only in June did the WHO call a meeting of its Global Outbreak Alert committee,
and only then, it seems, did WHO Director General Margaret Chan take a long hard
look at the situation.
• The IHR emergency committee met for the first time over two days on 7–8 August
2014 and conveyed to the director-general their assessment that the declaration of a
PHEIC was justified.

33. It took 1,000 Ebola deaths
in Africa and the spread of
the disease to Nigeria for
WHO to proclaim a global
emergency.

34. WHO:
Budget cuts
• An embarrassing internal WHO document, leaked to the Associated Press (October
2014) indicates senior WHO officials know mistakes have been made, suggesting
"nearly everyone involved in the outbreak response failed to see some fairly plain
writing on the wall".
• Some suggest the financial cutbacks that the WHO, like all United Nations agencies, is
facing, may be part of the problem.However, others argue that money shortages should
not cause a failure to listen to clear warnings and should not have caused months of
delay in recognizing the extent of the Ebola epidemic.
• What is clear is that the organization's structure, will need a major re-examination
and there will be calls for more flexibility and transparency when facing the next
sudden health crisis.

35. WHO's response to the Ebola had 3
phases:
• Phase 1 focused on rapid scale-up of the response;
• phase 2 focused on increasing capacities,
• phase 3 focused on interrupting all remaining chains of
Ebola transmission, and responding to the consequences
of residual risks.

36. WHO Response

39. WHO Strategy for the prevention and control
of Ebola epidemics:

40. Ebola Hero's:
• Local volunteers going house-to-house to explain the virus, or
tirelessly burying bodies in the safest possible way, were crucial to
stop the spread.
• Communities accepting the realities of the virus and changing their
everyday lives, and families allowing their loved ones to be taken to
isolated treatment centers all played a strong role.
• Weak health systems were bolstered but an influx of local volunteers
and international teams helped.

41. Other outbreaks are likely but the hope is
the world will be better prepared and have
learnt to pay greater attention, should Ebola,
or another disease like it, strike again.

42. References:
1. WHO. Ebola outbreak 2014-2015. Retrieved from:
http://www.who.int/csr/disease/ebola/en/
2. Baize, S., et al. (2014). "Emergence of Zaire Ebola Virus Disease in Guinea."
New England Journal of Medicine 371(15): 1418-1425.
3. Gulland, A. (2014). "IMF policy is blamed for contributing to Ebola epidemic."
BMJ : British Medical Journal 349.
4. Kamradt-Scott, A. (2016). "WHO’s to blame? The World Health Organization
and the 2014 Ebola outbreak in West Africa." Third World Quarterly 37(3): 401-
418.
5. McInnes, C. (2016). "Crisis! What crisis? Global health and the 2014–15 West
African Ebola outbreak." Third World Quarterly 37(3): 380-400.
6. Nunes, J. (2016). "Ebola and the production of neglect in global health." Third
World Quarterly 37(3): 542-556.
7. Crook, B., et al. (2016). "Content Analysis of a Live CDC Twitter Chat During
the 2014 Ebola Outbreak." Communication Research Reports 33(4): 349-355.

43. Thank You