Ebola responses: Only a third of donors’ pledges have materialized where they are needed

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Analysis shows donors pledged more than asked, but delivery lags, while responders say gaps in outbreak control can reverse progress

When the World Health Organization issued an international appeal in April for the $4.8 million it estimated then would be needed to confront the Ebola outbreak, donors responded with pledges for $7 million. That started a pattern that continued over the months that followed as estimates of the costs of controlling the evolving epidemic evolved as well, to $71 million, to $600 million, to $1 billion, and finally in mid-November to a $1.5 billion. Donors kept pace — with pledges of contributions that by the end of the year, with $2.89 billion nearly doubled what had been asked, according to an analysis published Tuesday in the British Medical Journal.

The problem, according to the analysis of the United Nations online database that tracks humanitarian assistance during emergencies, is that only two thirds of pledged donations have actually been paid, and only a third of the donations have gone to the countries where they are needed. The lag continues a pattern that allowed the outbreak — and the costs of confronting it — to escalate, the author Karen A Grépin notes in the paper. She points out that the $1.5 billion called for represents a minimal cost for the present phase of the outbreak, and costs associated with recovery and rebuilding will likely call for a great deal more from donors. She also notes that with only 11.5 percent of donations having gone directly to governments in the affected countries, recovery is likely to be complicated.

The analysis comes as the international relief organization Médecins Sans Frontières, which estimates it has provided care for nearly 5000 patients — about a quarter of those stricken — during the current outbreak, has issued updates on the crisis in Sierra Leone, Guinea and Liberia, citing encouraging declines in cases, but also troubling gaps that could allow a resurgence of the epidemic. In addition to continuing “hot spots” of incidence, including in the capital of Sierra Leone, the organization cites a continuing lack of coordination between the three hardest hit countries that challenges efforts to trace Ebola patients’ contacts. The update notes that a single untracked patient could reignite the outbreak where it is currently controlled. At the same time, the decline of cases in Liberia has led to the cancellation of a trial to test a vaccine candidate against the virus, which called for large numbers of patients.

In addition to impacts on the economies of families, communities, the hardest hit nations and the region, long term challenges include the care and support of at least 11,000 children who have lost parents to the disease, and rebuilding a healthcare system that has lost more than 800 doctors, nurses and other care providers during the outbreak. In Sierra Leone, Columbia University’s Mailman School of Public Health’s ICAP program recently completed an assessment of Ebola care and noted that 200 health workers, in a  country where only 130 doctors and 1,000 nurses served a population of 6 million people, have died during the outbreak. That loss includes at least 13 physicians —  10 percent of its total physician workforce.

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