Cumulative worldwide cases of Ebola*
[The following text appears within a diagram. Please see your hard copy for actual diagram.]
Outbreak becomes the biggest in the history of Ebola
Before the arrival of international aid, Liberia had 50 doctors and a population of 4.4 million
The U.N. says 19,000 doctors are still needed
DEC. 2013– MARCH 2014:
Ebola is not recognized for many months as the cause of a small hemorrhagic fever outbreak that began in Guinea in December 2013. This is the first Ebola outbreak outside a rural area in the disease’s decades-long history.
Ebola is confirmed as the cause of the outbreak. Doctors Without Borders/Médecins Sans Frontières (MSF) sets up its first clinics in Guéckédou, Guinea.
WHO dismisses warnings from MSF that the outbreak is becoming a global emergency.
Guinea falsely thinks its outbreak is under control as cases are going unreported or are being hidden. Health officials fail to recognize this, and soon the outbreak will swiftly grow.
Scientists’ warnings are ignored. American virologist Robert Garry, for instance, returns from Sierra Leone to meet with U.S. State Department and Health and Human Services Department officials to raise concerns. “The response was cordial, but nothing happened,” he tells TIME.
MSF releases a statement saying “Ebola is out of control” and asks for aid. The organization says it alone cannot keep up with the spread.
The President of Sierra Leone declares a national emergency but faces criticism because it took the government 15 weeks to sound the alarm. (By comparison, Nigeria declared a public emergency when that country had one patient.)
A plan is announced to cordon off parts of Guinea, Liberia and Sierra Leone. But the perimeter encompasses only 70% of the affected areas.
WHO declares Ebola a global public-health emergency, five months after Ebola was confirmed in Guinea and after nearly 1,000 deaths.
MSF says the response to the Ebola outbreak is “dangerously inadequate” and begs WHO and states to deliver a massive deployment of aid.
MSF criticizes WHO’s first road map of the Ebola outbreak, saying, “None of the organizations in the most affected countries–the U.N., WHO, local governments, NGOs (including MSF)–currently have the proper setup to respond at the scale necessary to make a serious impact on the spread of the outbreak.”
Some Liberians call for the resignation of President Ellen Johnson Sirleaf, arguing that her government failed to establish a health care system capable of handling the Ebola outbreak.
The White House commits $500 million and 3,000 troops to West Africa to build 17 treatment centers. Critics contend this is months too late, and a later report in the journal Lancet says the commitment is not enough to turn around the outbreak in Liberia, which has the most cases.
MSF and the International Red Cross say world powers need to develop a “global health defense” of deployable doctors.
There is still a general lack of leadership. MSF president Dr. Joanne Liu tells TIME, “I find it absolutely ridiculous and unreasonable to ask a private international organization like MSF to become the leader of the response. Hopefully this will change in the next few weeks and we will become a smaller player, but I have my doubts.”
There’s still no leadership, and supplies are taking too long to be delivered. Aid for Sierra Leone–hospital linens, 100 cases of protective suits, 80 cases of face masks and over $140,000 in medical supplies–continues to sit in a shipping container that arrived Aug. 9. Government tensions hold up delivery.
About 750 U.S. government personnel are deployed. The Defense Department’s first three Ebola treatment centers are not expected to be completed until mid-November.
*EXCLUDING THE STRAIN IN DEMOCRATIC REPUBLIC OF CONGO
SOURCES: WHO; MSF; NEW ENGLAND JOURNAL OF MEDICINE
This appears in the November 10, 2014 issue of TIME.