On August 27, 2014, Medecins Sans Frontieres published “Ebola: the failures of the international outbreak response” in France’s Le Temps magazine. The article questioned why the international community is relying on the fragile health systems of the affected countries to manage an international health crisis of this scope. Considering the poor response to the epidemic and the progressive collapse of existing systems, the question is pertinent.
Precious time was wasted before the global health community understood the magnitude of the Ebola outbreak—it took WHO five months after the first case appeared in West Africa to declare the epidemic an international health emergency. Yet even after this realization the response is limited and overloading the fragile systems in these countries, instead of complementing their services with the interventions, from triage of potential Ebola patients to management of the confirmed cases, that are urgently needed.
Health systems in West Africa were built to prevent death from everyday diseases and conditions like malaria, diarrhea, and lack of skilled birth attendants—not to respond to epidemics. International organizations, public health agencies, and donors have been working with national and regional governments over the years to enhance their capacity to offer primary health care. These services are provided by dedicated health care professionals who are supported by community health workers, some of whom are volunteers with minimal if any medical background.
The tremendous stress on these weak systems and their health care providers is provoking serious disruptions in usual services. Health care workers in these countries give oral rehydration salts to children and administer vaccines. But they cannot diagnose Ebola cases, trace contacts, quarantine suspicious cases, or treat confirmed ones. If we force these fragile health systems to focus on Ebola, other patients will not be able to attend clinics, mothers will not be able to deliver at health facilities, and supplies of malarial and other drugs will be interrupted.
The health systems in Ebola-affected countries are improving the health of citizens but cannot respond to an epidemic, not now nor in the near future. They must first learn to detect epidemics, develop alert systems, and manage public health crisis. Meanwhile, it is the global health community’s responsibility to provide financial, scientific, and human resources until the epidemic has been squelched. Until then, Medecins Sans Frontieres’ question will remain unanswered.