One year has passed since the declaration of what became the largest Ebola outbreak in history, with more than 10,000 deaths and 24,000 people infected. But health experts and charities have warned the danger is far from over.
The epidemic broke out in Guinea in December 2013 and the three-month delay in its official recognition has been blamed for its rapid spread to neighbouring Sierra Leone and Liberia, while other west African countries such as Nigeria and Mali also suffered fatalities.
The World Health Organisation (WHO) has been criticised for its slow response while governments and charities have admitted they could have done things differently.
Medecins Sans Frontieres (MSF), which had emergency teams on the ground in Guinea before Ebola was even officially declared, said despite raising the alarm that the epidemic was out of control, "it was like shouting into a desert".
The medical humanitarian organisation has released a report to mark the anniversary, which it dedicated to the 500 healthcare workers who have died while fighting Ebola, including 14 involved with the charity itself.
It said there was little sharing of information between the affected countries at first, while their governments tried to downplay the problem for fear of causing panic and driving visitors and investors away.
MSF general director Christopher Stokes said: "The Ebola outbreak has often been described as a perfect storm: a cross-border epidemic in countries with weak public health systems that had never seen Ebola before.
“Yet this is too convenient an explanation. For the Ebola outbreak to spiral this far out of control required many institutions to fail. And they did, with tragic and avoidable consequences.”
Meanwhile Oxfam has said more efforts should have been put into engaging the community rather than focusing exclusively on medical treatment when the epidemic first broke out.
It said governments and aid agencies, including Oxfam, got the balance wrong and preventative measures should have been explored rather than purely technical solutions such as more beds, medical workers and medicines.
The outbreak saw sick people passing away on city streets, and new cases multiplied inside health care facilities, killing a significant proportion of the already inadequate health workforce of the three most affected countries, Liberia, Sierra Leone and Guinea.
However, after two American aid workers and a traveler to Nigeria fell ill last summer, setting off a panic, a massive global initiative to combat Ebola swung into place. The effort has been messy, inefficient and expensive, often lagging the epidemic’s twists in tragic ways.
But the effort has also established expertise that may be built upon to prevent similar tragedies in the future - and shown personal and institutional bravery.
"None of us have ever been involved in anything of this magnitude, complexity and potential severity before," said Dr David Nabarro, the United Nations special envoy for Ebola. "There's a huge process of analysis and lesson learning underway."
The African Union for the first time sent hundreds of health personnel to confront a medical crisis even as the logistics of their arrival were rocky. The US Centres for Disease Control and Prevention worked with multinational teams led by the World Health Organisation in more than a dozen unaffected African countries to help prevent the disease from spreading further.
It was part of the largest international deployment in the CDC’s nearly 70-year history, supported by a congressional appropriation of more than $1 billion made available for the larger American response. Despite difficulty filling positions, the WHO now reports that it has more than 700 people working at 77 field sites, the largest emergency response in its history.
Charities with no background treating Ebola patients began running hospitals specialised for Ebola care, some of which were built by militaries and others staffed by hundreds of personnel from China and Cuba who were also facing Ebola for the first time and trying to overcome language challenges.
The affected countries established strong crisis teams and mobilised thousands of health workers, grave diggers and student outreach teams to fight the disease. They worked in dangerous conditions, often without pay, sometimes shunned by their families and, unlike many foreign workers, without the option of medical evacuation to Western countries.
Reforms have been proposed, but agencies have been slow to acknowledge their mistakes publicly and reckon with them, decreasing the chances that change will occur.
New York Times/PA