Five things to remember a decade after the Ebola outbreak in West Africa – Médecins Sans Frontières (MSF) International

Learn about our mission, our charter and principles, and who we are.
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Médecins Sans Frontières brings medical humanitarian assistance to victims of conflict, natural disasters, epidemics or healthcare exclusion.
Learn about how, why, and where MSF teams respond to different diseases around the world, and the challenges we face in providing treatment.
Learn about the different contexts and situations in which MSF teams respond to provide care, including war and natural disaster settings, and how and why we adapt our activities to each.
Learn about our response and our work in depth on specific themes and events.
In more than 70 countries, Médecins Sans Frontières provides medical humanitarian assistance to save lives and ease the suffering of people in crisis situations.
Our staff “own” and manage MSF, making sure that we stay true to our mission and principles, through the MSF Associations.
We set up the MSF Access Campaign in 1999 to push for access to, and the development of, life-saving and life-prolonging medicines, diagnostic tests and vaccines for people in our programmes and beyond.
Read stories from our staff as they carry out their work around the world.
Hear directly from the inspirational people we help as they talk about their experiences dealing with often neglected, life-threatening diseases.
Based in Paris, CRASH conducts and directs studies and analysis of MSF actions. They participate in internal training sessions and assessment missions in the field.
Based in Geneva, UREPH (or Research Unit) aims to improve the way MSF projects are implemented in the field and to participate in critical thinking on humanitarian and medical action.
Based in Barcelona, ARHP documents and reflects on the operational challenges and dilemmas faced by the MSF field teams.
Based in Brussels, MSF Analysis intends to stimulate reflection and debate on humanitarian topics organised around the themes of migration, refugees, aid access, health policy and the environment in which aid operates.
This logistical and supply centre in Brussels provides storage of and delivers medical equipment, logistics and drugs for international purchases for MSF missions.
This supply and logistics centre in Bordeaux, France, provides warehousing and delivery of medical equipment, logistics and drugs for international purchases for MSF missions.
This logistical centre in Amsterdam purchases, tests, and stores equipment including vehicles, communications material, power supplies, water-processing facilities and nutritional supplements.
SAMU provides strategic, clinical and implementation support to various MSF projects with medical activities related to HIV and TB. This medical unit is based in Cape Town, South Africa.
Regional logistic centre for the whole East Africa region
BRAMU specialises in neglected tropical diseases, such as dengue and Chagas, and other infectious diseases. This medical unit is based in Rio de Janeiro, Brazil.
Our medical guidelines are based on scientific data collected from MSF’s experiences, the World Health Organization (WHO), other renowned international medical institutions, and medical and scientific journals.
Find important research based on our field experience on our dedicated Field Research website.
The Manson Unit is a London, UK-based team of medical specialists who provide medical and technical support, and conduct research for MSF.
Providing epidemiological expertise to underpin our operations, conducting research and training to support our goal of providing medical aid in areas where people are affected by conflict, epidemics, disasters, or excluded from health care.
Evaluation Units have been established in Vienna, Stockholm, and Paris, assessing the potential and limitations of medical humanitarian action, thereby enhancing the effectiveness of our medical humanitarian work.
MSF works with LGBTQI+ populations in many settings over the last 25-30 years. LGBTQI+ people face healthcare disparities with limited access to care and higher disease rates than the general population.
The Luxembourg Operational Research (LuxOR) unit coordinates field research projects and operational research training, and provides support for documentation activities and routine data collection.
The Intersectional Benchmarking Unit collects and analyses data about local labour markets in all locations where MSF employs people.
To upskill and provide training to locally-hired MSF staff in several countries, MSF has created the MSF Academy for Healthcare.
This Guide explains the terms, concepts, and rules of humanitarian law in accessible and reader-friendly alphabetical entries.
The MSF Paediatric Days is an event for paediatric field staff, policy makers and academia to exchange ideas, align efforts, inspire and share frontline research to advance urgent paediatric issues of direct concern for the humanitarian field.
The MSF Foundation aims to create a fertile arena for logistics and medical knowledge-sharing to meet the needs of MSF and the humanitarian sector as a whole.
A collaborative, patients’ needs-driven, non-profit drug research and development organisation that is developing new treatments for neglected diseases, founded in 2003 by seven organisations from around the world.
Ten years ago, on 23 March 2014, Guinea declared an outbreak of Ebola. Beforehand, Ebola outbreaks were known to be dangerous, but small. Not this time, though: it would take two years and more than 11,000 deaths, before the epidemic was over. Dr Michel Van Herp, a renown Ebola expert even before 2014, looks back at the biggest Ebola outbreak ever, and answers five key questions.
“When we read the reports of people dying of an unknown disease in Guinea, early in 2014, we thought this was probably an outbreak of Ebola, even if that disease was extremely rare in West Africa. We sent our Ebola teams on the ground.
At that time, Médecins Sans Frontières (MSF) was one of the very few organisations with experience in Ebola outbreaks. But it became clear that this outbreak had been slumbering for months and was already present in more places than anybody was used to dealing with.
The outbreak happened in a place in the world where no one expected Ebola, in an area that didn’t interest the authorities, and no one was ready to deal with it. It took governments, UN agencies and aid organisations a very, very long time to take the outbreak seriously. MSF frantically rang the alarm bell, multiple times, but nobody seemed to listen.”
“Never had Ebola outbreaks happened in so many countries at the same time. The virus spread in Guinea, Sierra Leone and Liberia, but there were also cases in Senegal, Mali and Nigeria. It was also the first time that Western countries, like Italy, Spain, the UK, and the US., had cases of Ebola. 
The scale of this epidemic was absolutely unheard of. When it was finally over, in March 2016, more than 28,000 people had been reported to be infected, of whom 11,000 died. Before this epidemic, the largest Ebola outbreak had infected 425 people. Everybody, including our staff, was completely overwhelmed by this outbreak.”
“For almost six months, the world tried to ignore this outbreak. Only by the end of the summer of 2014, did governments and aid organisations finally start to help.
At the time, there were no treatments for Ebola. Patients would be admitted in an Ebola clinic, mainly to avoid them infecting other people. In earlier outbreaks, a family member could accompany the patient. But in 2014, to admit the huge number of patients, very big structures had to be built. The safety procedures had to be extremely strict, and it was impossible to allow family members. This large-scale approach scared patients and their families.
By the end of 2014, dozens of aid organisations, most of whom had been unexperienced with Ebola, were involved in different aspects of the response. The coordination of all those organisations, in multiple places in multiple countries, was extremely challenging. Some governments turned to authoritarian tactics to force patients and their families into compliance. That scared them even more.
The focus on the patients and their families, which had been so key to containing previous outbreaks, was completely lost in the enormous machine that the Ebola response had become.”
“Many of the things that we consider as ‘lessons learned’ are things we knew before 2014, but that were forgotten. But we have also learned new things. We learned how we could take a simple, oral swab of dead people, to test whether they had died of Ebola. This allowed us to better understand the dynamics of the epidemic.
We also organised clinical studies and discovered a good vaccine against the Zaire strain of Ebola. And we learned from organising the clinical studies, so we were faster during the 2018 outbreak in the Democratic Republic of Congo (DRC). In DRC, we found treatments with antibodies for the Zaire strain of Ebola.”
“There are very concrete things we can improve. We should again allow a family member to accompany a patient to the Ebola clinic. We can protect them better now, with vaccination and drugs for pre-exposure prophylaxis. 
Very sick patients should receive an antibody treatment much faster. Antibodies can be real lifesavers and the sooner a patient receives them, the better they work. We must adapt our models to make the best use of this option. And we need to continue looking for other treatments. The Ebola virus can provoke an inflammatory response that is so strong that it can kill the patient. If we had a drug to calm down that inflammatory response, we would save more Ebola patients.
We also must improve the follow-up of patients after their recovery. The virus can linger in the brain, the eyes, and the testes of survivors. Another type of drug, antivirals, can clean up the virus from these places. And six months after their full recovery, Ebola survivors should get a shot of the vaccine, to give their immune system another boost.
In the last 10 years, we have certainly made errors when we responded to Ebola outbreaks. Some errors were forced, some were unforced. But in general, we clearly have made progress, and there are good options for even more progress. The odds for a patient with Ebola in the next outbreak will be much better than they were 10 years ago.”
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