When 1-year-old Emile Ouamouno fell sick in the Guinean village of Meliandou in December 2013, no one could have guessed that the most devastating Ebola outbreak in history had begun. Emile is believed to be the first victim of the outbreak. In the following days, his sister, pregnant mother and grandmother all died too.
The outbreak has now killed nearly 11,000 people, and infected more than 26,000 across West Africa. At first, Ebola quietly spread through villages in Guinea’s forest region as its symptoms were mistaken for Lassa fever, cholera or malaria. It would be March 2014 before the ministry of health charged a team of scientists with finding out what was killing so many people.
On March 22, Guinea finally confirmed that the mysterious illness that had already killed more than 50 people was Ebola.
Within 48 hours, Doctors Without Borders -- known internationally as Médecins Sans Frontières [MSF] -- set up a hospital in Gueckedou, the epicenter of the outbreak. Its top Ebola expert warned of an “unprecedented epidemic.” Guinea’s minister of health, Remy Lamah, was not happy.
“I said I didn’t appreciate them saying things unilaterally, different from our official line,” Lamah told FRONTLINE. “We had our own analysis. At that point, we thought we could contain the outbreak."
By March 30, neighboring Liberia had confirmed its first cases of Ebola.
"We are facing an epidemic of a magnitude never before seen in terms of the distribution of cases in the country."
– Mariano Lugli, deputy director of operations for Doctors Without Borders, on the situation in Guinea, March 31, 2014
In April and early May, the number of new cases in Guinea seemed to slow, and experts thought this one was winding down too.
But the region where the outbreak began was on the border of Guinea and Sierra Leone and locals regularly traveled back and forth across the porous international border. Although no one knew it at the time, Ebola had in fact reached Sierra Leone as far back as February. But it wasn’t until May 25 that the government notified the World Health Organization (WHO) of its first confirmed case.
"The lack of collaboration with some affected families has allowed this epidemic to continue to spread invisibly between family members."
Pierre Fromenty , WHO viral haemorrhagic fever expert, May 28, 2014
Sierra Leone turned to a U.S. company, Metabiota, for advice. The company, which researched tropical diseases, had a longstanding presence there but no experience controlling Ebola outbreaks. The government did not have a system in place to monitor those whom infected patients had come in contact with.
The WHO considered declaring an international health emergency, but officials were concerned about causing panic.
On June 21, MSF warned it had reached the limits of what its teams could do and said that controlling the Ebola epidemic would require "a massive deployment of resources by governments in West Africa and aid organizations."
"The epidemic is out of control... With the appearance of new sites in Guinea, Sierra Leone and Liberia, there is a real risk of it spreading to other areas... We have reached our limits."
– Dr. Bart Janssens, director of operations, Doctors Without Borders, June 21, 2014
Ebola had now killed more than 800 people in three countries. As the death count rose, MSF urged the WHO to declare an international emergency.
Then the outbreak moved to the next level. Near the end of July, a Liberian man infected with Ebola travelled to Nigeria, taking the virus to Africa's most populous country.
"I’ve been telling the world for the last few months that it’s an unprecedented out of control Ebola epidemic... People don’t listen to me but you, as the WHO, you need to step up to the plate and declare it because you have the authority and you have the legitimacy."
– Joanne Liu, president, Doctors Without Borders
On Aug. 8., the WHO declared an international emergency, putting a high-level team in Geneva in charge of the response.
By this point, Ebola had reached West Point, a densely packed slum in Liberia’s capital. Officials decided to isolate sick and suspected patients in a holding center, but four days after it opened, the facility was overrun. Rumors spread that Ebola was a hoax. Looters grabbed contaminated mattresses and sick patients disappeared back into the community.
On Aug. 19, President Ellen Johnson Sirleaf imposed a quarantine on West Point. It backfired, igniting violent protests. The infected had nowhere to go but the streets. The virus spread more quickly.
"This is the largest, most severe, most complex outbreak in the nearly four-decade history of the disease... I am declaring the current outbreak of the Ebola virus disease a public health emergency of international concern..."
– Dr. Margaret Chan, director general, WHO, Aug. 8, 2014
Lacking enough medics, authority and budget to deal with the outbreak, the WHO asked wealthy countries for assistance. MSF, dealing with an exponentially rising number of cases across West Africa, made a direct plea to the U.S. for soldiers to help isolate and treat the sick.
Tom Frieden, director of the U.S. Centers for Disease Control, visited West Africa in late August. Frieden said he told President Barack Obama, “This isn’t about the response in the next three months, it’s about the response in the next three days that matters.”
On Sept. 16, Obama unveiled a plan that included sending thousands of troops and medics to West Africa. Other countries followed suit.
"The scenes that we’re witnessing in West Africa today are absolutely gut-wrenching ...These men and women and children are just sitting, waiting to die, right now. And it doesn’t have to be this way. The reality is that this epidemic is going to get worse before it gets better. But right now, the world still has an opportunity to save countless lives."
– President Obama, Sept. 16, 2014
Nearly a year and a half after the Ebola outbreak began, the disease has reached nine nations in total, but the number of infections is slowly winding down thanks to an influx of aid, as well as efforts by the citizens of West Africa to change how they lived their lives, nursed their sick and buried their dead. Liberia has not reported any confirmed cases of the disease in five weeks. Guinea and Sierra Leone continue to report new cases of Ebola, but they are far below the levels seen during the height of the crisis.
The WHO announced in April 2015 that the Ebola outbreak continues to be a public health emergency of international concern. On April 16, the WHO released a statement acknowledging that the Ebola outbreak “served as a reminder that the world, including WHO, is ill-prepared for a large and sustained disease outbreak.”
"There are going to be more of these, no matter what we think. More and more new diseases are emerging. We’ve seen pandemic flu. We’ve seen SARS. We’ve seen Ebola like this. And we are not prepared," WHO’s Assistant Director-General Bruce Aylward warned. "Ebola was not an exception, Ebola is a precedent."
Sources: Doctors Without Borders, World Health Organization, Centers for Disease Control and Prevention, White House, The New York Times, Reuters, Associated Press, Agence France Presse
Interactive by Priyanka Boghani and Ly Chheng, with contributions from Chris Amico and Frank LeClair