Help in the time of Ebola

“WE ARE exhausted, we are angry, we are desperate,” said Sophie Delaunay, the American director of Médecins Sans Frontières (MSF) last week, frustrated at the tardy international response to the deadly Ebola virus in west Africa. Within days of these words, the outside world was at last waking up to the danger of Ebola haemorrhagic fever—a viral disease that threatens tens of thousands of lives, health systems, economic growth and even political stability in parts of west Africa.

On September 16th Barack Obama, the American president, said he would dispatch 3,000 troops and spend more than $750m to contain the epidemic. “We can’t dawdle on this one,” he declared. His move follows earlier, more modest, commitments from countries such as Cuba and China (each is sending about 170 people) and Britain, which will build a 62-bed hospital. Commitments from other countries look even more paltry. Germany will provide a few million dollars, the European Union is giving $15.5m (though it is giving 12 times that amount in general humanitarian aid) and three laboratories*. As The Economist went to press, the UN was due to debate a motion calling for more help.

This is the largest outbreak of Ebola in history and the first in west Africa. The disease is transmitted by body fluids, and may have originated in bats. Official figures suggest that almost 5,000 people have been infected and more than 2,400 have died, mainly in Liberia, Sierra Leone and Guinea. These figures underestimate the problem, given that many patients are thought to be unaccounted for. Roughly half of those who become infected go on to die.

Across the continent, Ebola barely rates among big killers, with far more deaths attributable to malaria or even diarrhoea. But the exponential spread of infections means that, unchecked, it could quickly grow extremely large. The World Health Organisation (WHO) last month said it hoped to control the outbreak within nine months and at 20,000 cases, but other experts think it may take 12 to 18 months—and infect hundreds of thousands of people—before it is brought under control.

More significantly, the disease has devastated the weak health-care systems of already fragile countries, some of which are recovering from civil wars. The collapse is sometimes called an “emergency within the emergency”. Many of the 144 health-care workers who have died from Ebola (an unprecedented number) were not working in infection-control facilities but rather in general hospitals that lacked any protective gear.

Liberia has fewer than 200 doctors serving some 4m people. Since the outbreak, all of its main public hospitals have shut (some private ones are still working). Death, illness and fear mean that just 50 doctors are continuing to work in the domestic health system. Across the region, cases of malaria, typhoid and cholera are going untreated. Even where hospitals do remain open, patients may be too frightened of catching Ebola to attend.

What is most needed are people and kit to isolate and care for patients, trace their contacts and bury the dead. America’s first military deployment to combat a disease should make a difference, but will be focused on Liberia, a country founded by freed American slaves.

The American joint command will be based in the capital, Monrovia, where it will co-ordinate relief efforts and train up to 500 health-care providers every week. Households across the country will also be offered protection kits—which include gloves, masks and disinfectant. America wants to build 17 treatment facilities, each containing 100 beds.

Troops will not treat patients but will offer logistical and other support. American help will allow services to be restored at ten non-Ebola hospitals. It will also offer air transport in the region, where many commercial airlines have ceased flying to Ebola-stricken countries.

Will this be enough? Brice de le Vingne, the director of operations at MSF, thinks the American response may just be enough to halt the disease in Liberia. The number of cases there is doubling every two weeks, says Jeremy Farrar, infectious-disease specialist and director of the Wellcome Trust, a British health-care charity. Yet the spread of the disease is not far behind in Sierra Leone, which is receiving far less support.

The assistance is coming late. In March MSF warned that with cases scattered over Guinea—and uncontained in remote locations, as during previous outbreaks—the world was facing an unprecedented urban epidemic of Ebola. By 23rd June the virus had spread to more than 60 places across west Africa. At this point MSF, not to mention local health authorities, were at the limits of what they could cope with. The epidemic was out of control, warned MSF. Yet the WHO did not declare the situation an international public-health emergency until August.

The long-term economic effects on these countries is likely to be grave. The World Bank says that unless the epidemic is contained it could cause Liberia’s economy to contract by 4.9% and slash growth in Sierra Leone from 11% to about 2%. Trade across many African borders has slowed over fears of the disease; tourism has suffered. The World Bank recently released $105m of $250m it had offered to support the immediate response and to rebuild damaged heath systems. And the $181m promised by the European Union is largely aimed in this direction. Although long-term thinking is laudable, the immediate issue in Liberia is national stability. The defence minister, Brownie Samukai, told the UN Security Council that Ebola is a threat to his country’s existence.

There is already much distrust and fear towards authorities in the country. Angry locals ransacked one Ebola treatment facility in August, causing patients to flee. Liberia has been roundly criticised for coercive measures that hinder disease surveillance and harm economic activity. These include border closures, a night-time curfew and quarantines—one of which sparked a deadly riot in Monrovia.

Sierra Leone is to repeat this failed experiment. It was due to impose a three-day lockdown on the country from September 18th. Experts at MSF and elsewhere have warned that such draconian measures could be counterproductive, by driving people to conceal the illness and by destroying trust in the authorities.

^{* This figure was updated on September 23rd. The original version said the EU had provided one laboratory.}