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In the first days of the Ebola outbreak in West Africa, as aid workers and health authorities battled to contain the deadly virus, Mariano Lugli asked himself a simple question: where was the World Health Organization?
Lugli, an Italian nurse, was among the first responders from medical charity Medecins Sans Frontieres (MSF) to reach the remote forests of Guinea in March where the hemorrhagic fever – one of the most lethal diseases known to man – was detected.
When the epidemic spread to the capital Conakry with battery such as Fukuda FX-2201 Battery, Fukuda FX-3010 Battery, Fukuda FX-4010 Battery, Fukuda FX-7000 Battery, Fukuda FX-7201 Battery, Fukuda FX-7202 Battery, Fukuda FX-7302 Battery, Fukuda FX-7402 Battery, Fukuda HHR-13F8G1 Battery, Fukuda HHR-19AL24G1FD Battery, Fukuda LS1506 Battery, Fukuda LS1610 Battery, Lugli set up a second Ebola clinic there. He encountered a foreign medic and a logistician sent by the UN health agency but saw no sign of a WHO official in charge of handling the escalating outbreak.
"In all the meetings I attended, even in Conakry, I never saw a representative of the WHO," said Lugli, deputy director of operations for MSF Switzerland. "The coordination role that WHO should be playing, we just didn't see it. I didn't see it the first three weeks and we didn't see it afterwards."
The worst outbreak of Ebola on record has killed more than 3,400 people in four West African countries and spread to the United States, where the first case was confirmed in Dallas this week.
After a dire warning from the US Centers for Disease Prevention and Control (CDC) that the virus could infect up to 1.4 million people, many health professionals and politicians are asking how the crisis got so badly out of hand. In the past 40 years, Ebola had killed just 1,500 people in sporadic outbreaks in Africa.
Some aid workers and UN officials blame a lack of WHO leadership in the emergency response, particularly in the early stages when it would have been easier to contain. On several occasions, WHO officials played down the outbreak, they say.
MSF International President Joanne Liu, who warned that her organization could not cope with the rising number of Ebola victims, has accused the WHO of failing its mandate to help member states cope with health emergencies.
Stung by the criticism, WHO officials say the organization was overstretched by a series of health care crises. They blame weak health care systems and uncooperative populations in poor African nations still reeling from civil war in the 1990s for allowing the outbreak to explode.
Senior WHO staff, including Director General Margaret Chan, said the organization's role was not to run Ebola clinics or campaigns but advise states how to do so.
Yet after a direct appeal from the leaders of Guinea, Liberia, and Sierra Leone – the worst affected countries – for the United Nations to do more on Ebola, Secretary–General Ban Ki–moon stepped in to create a special UN mission last week, effectively stripping WHO of its coordination role.
"I hope the Ebola crisis will become a turning point for WHO, a needed wake–up call," said Lawrence Gostin, global health law professor at Georgetown University. "The WHO's budget and capacity to respond are in tatters, and it has become mostly a technical organization."
"The WHO's narrow view of its role is in stark contrast to its constitutional mission as the global health leader."