Doctors Without Borders appeals for help as Ebola crisis escalates

The NGO Médecins Sans Frontières or Doctors Without Borders this week denounced international inaction in Ebola-stricken African countries, saying developed states must deploy specialized medical assets without delay if the situation is to be brought under control. Doctors Without Borders Czech Republic sent an open letter to Prime Minister Bohuslav Sobotka outlining several priority areas. I spoke to the organization’s director Pavel Gruber about what is needed.

Health workers, attend to patients that contracted the Ebola virus, at a clinic in Monrovia, Liberia, photo: CTK

“Actually we launched this appeal not only towards the Czech government but towards the governments of most developed countries where Doctors Without Borders have offices. Basically, we are calling for a massive reaction because now the scale of the epidemic is so huge that it is not possible to handle it in the classical set up of the NGO and UN. We are calling for isolation units, mobile laboratories and air-bridges because it is very difficult to get to some of these locations. We are asking for a help network for infected health workers –doctors and nurses –and last but not least for an evacuation model for those fighting Ebola directly in the epicenter of the epidemic. We are facing an enormous, unprecedented epidemic and that is why, for the first time, we are appealing to national states to deploy their civil and military capacities because otherwise we will not be able to cope.”

How many physicians has Doctors Without Borders got now in the stricken areas and how many more specialists do you need?

“Now we have about 200 international workers –doctors, nurses, logistics workers, water and sanitation specialists as well as about 2,000 local employees working in different positions. It is difficult to say how many people we need, but as an example – we are now running one isolation unit in Liberia where we now have 160 beds and are scaling it up to 200 beds but the minimum need, in Liberia alone, is 500 additional beds.”

What kind of aid are you expecting from the Czech government at this point? What are you hoping for?

Pavel Gruber, photo: Czech Television

“Actually we do not want to put ourselves in a position where we would tell the government to do one thing or another. That is why we have listed three, four, five different measures which can be taken and if we look at the level of the Czech health care system and our bio-hazard units it is obvious that we can deploy any of these. So I really would leave it up to the government to decide what they consider to be most appropriate. What is important is quick action. If we spend two, three or four weeks negotiating what response would be best the number of infected people could double in the meantime.”

So now the death toll is a thousand and there are roughly double that number infected?

“Yes, those are the figures approximately. Doctors Without Borders are registering some two thousand patients. Of those, 1300 have confirmed Ebola and 240 have been successfully cured. We have treated about two thirds of all infected patients.”

Are you saying that there are specialists in the Czech Republic who could be sent out, that the military should help?

“Yes, but we would leave that to the government whether they decide to opt for military or civil teams. Of course we know the Czech military has specialized bio-hazard units so this might be the perfect answer. What I want to stress is that we are calling for military medical capacities not military intervention in terms of securing quarantines or such measures. ”

The worst situation is said to be in Liberia –how can it best be tackled? I understand the population is very mobile – what is your biggest problem in tackling the epidemic?

Medical supplies bound for West Africa to combat Ebola are prepared for shipment inside the warehouse of Project C.U.R.E., Centennial, Colorado, photo: CTK

“You are right in that Liberia is key to winning this battle. It is tricky to say what is needed, because everything is needed. The Liberian health system has collapsed. There was a situation where five major hospitals in Monrovia were closed. Among the side effects of the Ebola epidemic is the general collapse of the society, people have no access to health care, a lot of health care providers are infected with Ebola, a lot of health care providers have fled the country, so it is not just about the Ebola crisis but about the collapse of the health care system in Liberia.”

Do you feel that the developed countries have not done enough – and have merely focused on protecting their own territory?

“That is what we are saying. Of course it is perfectly legitimate to protect your own territory but it is not enough. I think that most of the developed countries have done this in an adequate manner and that is why we are saying –it is good to have taken these measures, but now please support these stricken countries. Both Liberia and Sierra Leone are countries that have been racked by civil war for years and have a very low level of health care as such–I think there is one doctor per 200,000 inhabitants so even without an Ebola epidemic these countries are very weak and we certainly cannot expect them to cope with such a disaster.”

Why is there no cure yet or no vaccine against Ebola?

“We –Doctors Without Borders -have been saying this and calling for action for more than ten years. Ebola is in a group of what we call neglected diseases such as the sleeping sickness and others. These diseases affect millions of people in the poorest countries of the world. These countries are not an interesting market for the pharmaceutical industry. We criticize the fact that there is not enough investment into research in order to eradicate these illnesses.”

If these measures that you are calling for are not taken – it there is not a more active approach to fighting the Ebola epidemic – what is the worst-case scenario as you see it?

Local health workers in Sierra Leona, photo: CTK

“Well, what we are seeing and fear in Liberia and Sierra Leone is a collapse of the state and society and it is hard to say what would follow. One possibly optimistic thing is that we do not have that many cases in Freetown, the capital of Sierra Leone, if that were to change then we would have two capitals with infected populations. We sometimes forget this –but we are talking about thousands of dead people who leave behind families, children, siblings and so on. From the human point of view it is a huge disaster.”

Do you feel that the World Health Organization has seriously underestimated this problem and has not been active enough?

“Well, yes, we are criticizing the WHO for this, but they themselves have admitted that they underestimated the situation. When we first released a statement saying that the epidemic was spiraling out of control at the end of April the reaction of the WHO was Doctors Without Borders are creating panic. In August they admitted that they underestimated the situation and now we are in the same boat, so we are calling on the WHO to take the lead. Because, really Doctors Without Borders should not be in the lead position here and we should not be the ones providing an answer to a major epidemic –that is not our role.”

Under ideal circumstances – how soon can this epidemic be brought under control?

“Well, as our president Dr. Joanne Liu said, if we are very optimistic and all the measures are taken in time and on an appropriate scale, then we can talk about six months.”