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Infighting, poor coordination hinder virus response in Liberia

NEW YORK — The global response to the Ebola virus in Liberia is being hampered by poor coordination and serious disagreements between Liberian officials and the donors and health agencies fighting the epidemic, according to minutes of top-level meetings and interviews with participants.

Even now, three months after donors began pouring resources into Liberia, many confirmed cases still go unreported, countries refuse to change plans to erect field hospitals in the wrong places, families cannot find out whether their relatives in treatment are alive or dead, health workers sent to take temperatures sometimes lack thermometers, and bodies have been cremated because a cemetery was not yet open.


The detailed accounts of high-level meetings obtained by The New York Times, the most recent from Monday, lift the veil on the messy and contentious process of running the sprawling response to Liberia's epidemic, one that now involves more than 100 government agencies, charities, and donors from around the world.

Despite these problems, with help from donors, Liberia, one of the three most afflicted West African countries and the one with the highest death toll, has seen new cases drop to about 20 a day from about 100 a day two months ago. Experts attribute that to fearful Liberians touching one another less, more safe burials of bodies, and distribution of protective gear to health care workers. But they also warn that cases could explode again.

Participants in the meetings of the Incident Management System — which replaced the National Ebola Task Force — said the atmosphere in the meetings should not be characterized as chaotic or bogged down in bickering, instead calling them "collegial" and "effective," although one who spoke on condition of anonymity described "showmanship and political posturing." Senior officials of the Centers for Disease Control and Prevention who attended — Dr. Frank J. Mahoney and Dr. Kevin M. De Cock — said in an e-mail that there were "differences of opinion accompanied by passionate discussions."


At the meeting Monday, De Cock cited logistics problems, including regular hospitals that cannot separate out Ebola patients, counties with no ambulances, and even temperature takers with no thermometers.

Also, the support documents with the minutes indicate there is no plan for Ebola survivors — either for reuniting them with their families or for using them to do nursing tasks because they are thought to be immune.

A report on the issue reads: "The current and planned work presented by the partners and government for survivors can be characterized as fragmented and lacking in scope, scale, comprehensiveness, evidence base, and survivor-driven programming."

US military helicopters ferrying doctors to remote areas were forbidden to fly back not only patients but even blood samples; recently, samples from a village had to be walked to a road four hours away. At Monday's meeting, according to the minutes, De Cock called this "unacceptable," adding, "This has to change this week."

In the minutes, Liberian officials regularly complain about the donors, and the donors argue back. On Nov. 12, James Dorbor Jallah, the task force's deputy manager, said: "People will sit in D.C. or Geneva and want to direct what is happening here."