This programme contains scenes some viewers may find upsetting from the start.
Monrovia, September 2014.
A suspected Ebola victim has escaped from hospital.
I got a call saying that there's a walker on his way down to market.
I hear and see the crowd of people screaming and shouting.
The crowd wants to kill him, but they're too scared to come close.
The guys in the suits wrestle him to the ground and lift him
into the back of the pick-up.
It was like watching a zombie movie.
It's just crazy, it's pure craziness.
"Where am I? How did I end up here? Was this just a bad dream?"
No, it wasn't. It was for real.
This is the inside story of the worst Ebola outbreak in history.
I start to wonder, "Maybe this is the end of the world.
"Maybe everybody's going to die."
I was afraid it would just be, like, this black plague with this
inexorable spread across the continent and beyond.
It's the story of how Ebola spread while the world wasn't looking.
We felt that our whole country was going to be destroyed.
We didn't know how many people would die.
The story of an avoidable tragedy...
We said it over and over - "Action needs to happen now!"
..catastrophic complacency...
I cannot hide it. It was wrong.
..and incompetence.
I was frankly furious.
The basic stuff wasn't happening on the front lines.
And it's a warning to us all.
There are going to be more of these. No matter what we think,
Ebola was not an exception, Ebola is a precedent.
Because, you know what? Everybody got it wrong on this one.
This is Ebola ground zero.
In December 2013, the children of Meliandou village discovered
hundreds of bats nesting in a hollow tree.
Bats are thought to carry the deadly virus.
THUNDER CRACKS
At the time, nobody knew what killed Emile Oumanou,
but he is now considered to be Patient Zero
of the worst Ebola outbreak in history.
His sister died nine days later.
Then his mother fell ill - she was seven months pregnant.
Within days, more of Etienne's family fell sick and died.
The Ebola virus is transmitted by direct contact with blood
and other bodily fluids.
But the villagers had never heard of Ebola.
A traditional healer gathered everyone together...
including the sick.
Emile's grandmother now fell sick.
She travelled to a hospital in a nearby town.
Ebola was spreading, killing people across the forest region of Guinea.
But for three months, local health workers
thought it was cholera or malaria.
By March, the virus had travelled hundreds of miles
and killed more than 50 people.
The government sent a team of scientists to investigate
and take blood samples.
The doctor tracked down a teenager called Khalil who was sick
with the mystery disease.
His colleague started filming on an iPad.
Khalil's blood was tested and the scientists found a match - Ebola.
Ebola was unknown in West Africa - every previous outbreak had
happened thousands of miles away.
The government of Guinea - one of the poorest countries in the world -
had no idea how to respond.
But the charity Medecins Sans Frontieres, MSF,
has decades of experience with Ebola.
Within 48 hours, they set up a field hospital
in the town of Gueckedou, the epicentre of the outbreak.
The first patients began to arrive.
Most of those cases came from different villages
or different areas in the city of Gueckedou.
That's a very bad sign, because it means that you don't have just one
cluster or one family or one village that is hit,
it means that it's already spread out.
Past outbreaks had shown that the key to stopping Ebola is to
isolate the sick, monitor anyone who had contact with the infected,
and safely bury the dead.
This complex operation now needed a level of manpower
and coordination far beyond the resources of MSF.
And I remember my headquarters asked me, like, "What do you think?
"Is it five villages, ten villages, 15 villages, or more?"
I remember I said, "If I have to choose between those three options,
"I do believe it's 15 or more."
Then I said, like, "I think we have a big problem."
The World Health Organization, the WHO, has a remit to help
governments coordinate the response to deadly outbreaks.
We deal with and hear about literally
hundreds of outbreaks during the year, so this is one of many
reports at that time that there's something going on.
Here is a disease that we have dealt with for a number of decades before
and in our own mind, we had the idea that Ebola
was something which was severe
but typically occurred in a certain way and then could be handled,
when we didn't really know how, how complex it was going to become.
The WHO left the response in the hands of its local officials
in Guinea, who had no experience of Ebola.
They set up what would become daily meetings with
the government of Guinea, MSF and other aid organisations.
Those daily meetings were a nightmare.
Every day, every day, day after day -
disorganised meeting, no decision taken,
no-one knowing what they were talking about.
WHO people were really not at the level required for the job.
Their coordinator never worked on Ebola before and WHO was
really downsizing the scale of the epidemic and were contradicting
our own statements.
Immediately, I thought, "Those people are useless.
"They don't even understand what they are supposed to do here."
From the start, there was a fatal confusion about who was in charge.
WHO, although it's a very important technical agency, our powers
are limited when we are operating in countries.
The countries take the lead,
we advise honestly and this is what we tried to do in Guinea.
MSF's greatest fear was that the virus
would enter a crowded African city.
And in the face of the chaotic response, that's just what happened.
Ebola hit the capital of Guinea - Conakry.
MSF decided to sound the alarm.
The government of Guinea was furious with MSF for going public
with their concerns.
The last thing they wanted was an Ebola panic causing foreign
companies to pull out of the country.
The government now tried to hide the true extent of the outbreak.
The Ministry of Health sent a memo to its teams in the field,
ordering them only to count laboratory-confirmed cases of Ebola
when, in reality, many people were dying before they could be tested.
The Ministry of Health in Guinea
ignored many deaths that were probable Ebola cases.
Some of these deaths were in the villages
along the international border with Sierra Leone.
Luisey Kamano lived in neighbouring Sierra Leone
but had family in Guinea and came there when her mother fell ill.
When Luisey fell sick,
she was frightened by rumours that foreign doctors were killing people.
Ill and frightened, Luisey decided to head home.
She walked through the bush, until she reached a river.
It was the border with Sierra Leone.
There were no checkpoints, no immigration police.
On the other side of the border,
Luisey hired a motorbike taxi to take her to her village.
No-one knew it yet, but Ebola had arrived in Sierra Leone.
THUNDER RUMBLES
What happened next was a tragic missed opportunity to save lives.
The WHO were tipped off that Luisey was sick
and had crossed the border.
Luisey's name and location were logged in an internal report
and passed on to the Sierra Leone government.
We did bring Luisey to the attention of the Sierra Leone government
and they came back and told us that
Luisey had gone back to Guinea
and that she was not in Sierra Leone.
That was the last that we heard of this particular case.
The Sierra Leone government denies it was ever informed about Luisey.
The opportunity was missed
and the disease was soon spreading through her village.
The death of one particular victim was about to take the outbreak
to another level.
Mendinor was a renowned healer.
She soon succumbed to the virus
and her body was prepared for burial.
The corpse of an Ebola victim is highly infectious,
but in West Africa, funerals involve the ritual washing of the body.
Burial practices played a major role in the spread of the virus.
Mourners often touch the body at the funeral itself.
The villagers feared that if they didn't bury Mendinor properly,
there would be consequences.
Mendinor was a local celebrity and hundreds came to her funeral.
It was a catastrophe.
Scientists were later to call it a "super-spreader" event,
and ultimately linked hundreds of deaths back to Mendinor's burial.
The outbreak was already raging in Guinea,
and now it began to spread unchecked through
the villages of Sierra Leone, wiping out entire families.
The healer's niece even carried the virus 300 miles to Monrovia -
the capital of neighbouring Liberia.
Nobody knew it, but the outbreak was now completely out of control.
For more than a month, the government of Sierra Leone
missed the deaths in its border villages.
MSF tried to get them to investigate,
but the government did little.
They had turned for advice to an American company called Metabiota,
who had a long-standing presence in the country
researching tropical diseases.
But Metabiota had no experience in controlling Ebola epidemics.
I said, "This outbreak will not last more than a few weeks."
That was after we identified the first week.
The first two weeks, we said, "OK, that's a normal outbreak,
"we are confident it will be over in two months."
What can I say?
Yes, it was Ebola but the magnitude had not hit us,
so we took steps at that time, that we were advised by Metabiota,
but we never knew that it was going to be so big.
The government then made a decision that would cost many lives.
They decided to treat Ebola victims at the state hospital
in the town of Kenema, which already had a ward
for Lassa fever - a disease similar to Ebola but less infectious.
The director of the clinic, Dr Sheik Humarr Khan, was a world
expert in Lassa fever and one of Sierra Leone's top medics.
But within days, his hospital was overrun with Ebola victims.
They infected other patients, then the nurses started to die.
If you go to the morgue, you see dead bodies,
15, 16, 17, 18 dead bodies, all in body bags.
Then I start to wonder, "What is happening?
"Maybe this is the end of the world.
"Maybe everybody's going to die."
Far from containing the outbreak,
the hospital was helping to spread it.
Will Pooley, a British nurse,
volunteered to work on the Ebola ward.
He was shocked by what he found.
When a patient arrived, they'd walk in past these corpses
that would be piling up across the path and sometimes next to the path.
They were smelling quite bad until the burial team came -
and it might take days.
I was constantly gobsmacked that this wasn't a bigger deal.
Like, people weren't...
You know, that this wasn't being shouted about.
The government called in MSF.
The plan was to build a specialist Ebola clinic
in the neighbouring district.
MSF officials say that the government's advisers, Metabiota,
were still underestimating the scale of the problem.
Do you think Metabiota was the right organisation
to be doing outbreak response?
No, we are not specialised in outbreak response.
We know how to do it because we have some kind of expertise
in the domain, but we are too small. I mean, we are a very small company.
The truth was that nobody knew how bad things were
because Metabiota and the government had no working system to investigate
who Ebola victims had been in contact with.
This lack of what's called "contact tracing"
meant that hundreds of cases went undetected.
A month is a disaster. It is a disaster, yes. We wasted time.
It was wrong.
Yeah.
By June, seven months after Patient Zero, the outbreak covered
three countries - Guinea, Sierra Leone and Liberia.
Four neighbouring countries were at risk of imminent infection.
It was now the biggest Ebola outbreak the world had ever seen,
but the WHO decided not to declare an international emergency.
At that time, I think all of us thought,
"Wait a minute, let's be cautious.
"Let's see how it evolves. We are deploying people in the field,
"we think we are making headways."
But, with hindsight, if I went back to June 2014,
I would probably be saying something entirely different, I'd probably be
standing up and calling my Director General and saying, "Please, do it."
While the virus raged out of control,
the WHO opened a new outbreak coordination office in West Africa.
But they did little to address the shortage of medics and hospitals.
'There was absolutely no change at field level.
'Still the very same few organisations on the ground
'doing the work.
'No additional people coming to support.
'More people at coordination level, more meetings to be organised.
But on the ground, on the field, impact, zero.
Back at Kenema Hospital in Sierra Leone,
the staff desperately needed help.
The WHO had sent two doctors to help with the caseload.
But the locals had had almost no training in infection control.
The nurses began filming the shocking conditions.
One morning, a sick teenager turned up at the clinic.
The footage shows how little protection the nurses had.
This boy was hiccupping - it's classic signs and symptoms.
His mouth was bleeding, blood -
you can see blood from his lips, all over.
You can see his eyes, red eyes, hiccupping, hiccupping.
I would say, "Oh, my God, we are really exposing ourselves,"
because if you see that patient, he was standing very close to me
and other people were very close by the patients.
They are not in protective PPE.
Then the man I call, I say, "Come and take this patient."
The only dress that... It basically was disposable gown.
And you see him grabbing this patient... Oh, my God!
You'd have to be crazy to think that anything
but shutting that place down would be the thing to do,
and everyone knew that's what needed to happen, and that should have
happened months before that. And had that have happened, there's a whole
cohort of nurses, lab techs and cleaners that wouldn't have died.
So many lives would've been saved.
Dr Khan, the director of the hospital,
had been working long days in the high risk zone for weeks.
Now he called the nurses together to try to teach them
how to avoid infection.
'In that meeting, Dr Khan was telling the health workers,'
"This is a national sacrifice and it's everybody's responsibility."
And he was even saying that, "Look at me -
"this is the way I look like before, look at me now."
He was just encouraging the nurses.
Nobody knew it yet
but the doctor himself was already infected.
Three days later, Dr Khan developed a fever
and tested positive for Ebola.
SCREAMING AND SHOUTING
Panic now spread through the town,
along with wild rumours that the hospital staff were murdering people.
This crazy woman came out
and stood right at the centre of the town in the marketplace
and started shouting, "There is no Ebola!"
This woman was shouting, "I am a nurse,
"I am telling you people that we are just cannibal, doing cannibalism,
"we are the one that are killing people, we are removing their parts."
SHOUTING
And everybody in the marketplace was wild,
running, "Oh, there is no Ebola!
"A nurse is confessing that there is no Ebola,
"come and see the nurse, come and see, a nurse is confessing."
Now, everybody started throwing stones at us.
They said we are going to the hospital,
we are going to burn the Kenema Government Hospital down
so some of the nurses, cos they run for their lives...
I was walking up to the unit
and there was this stream of nurses and lab techs walking
at a very hurried pace, past me in the other direction.
I could hear this mob, an angry mob, it's a really unique sound,
and the WHO, they all evacuated.
They got in to their cars and drove off,
leaving just a handful of people inside the whole hospital really,
when there was a risk of the hospital being overrun.
SHOUTING
The police used teargas to disperse the crowd.
EXPLOSION
The streets went quiet for now
but Sierra Leone was on a knife edge.
CRYING
Four days later, Dr Khan died.
It was a massive blow to the country.
He was a hero, the figurehead.
Until then, I'd been a bit worried -
at that point, I really sat down and thought about my chances
but leaving wasn't really an option any more
because of how bad the situation was
so for me to turn around and just run away at that point,
just, that's not, it wouldn't have been possible.
Three weeks later, Will Pooley fell ill.
CLOCK CHIMES
'A British man who's contracted the Ebola virus is being flown tonight by RAF jet
'to an isolation unit at a hospital in London...
'The moment Ebola arrived in Britain...
'Getting word in from the CDC - it's confirmed the first Ebola case...
'Two infected missionaries, flown from Liberia and in isolation
'at an Atlanta hospital...'
At last, eight months in to the outbreak,
the world was finally waking up to the unfolding disaster.
The outbreak had now killed more than 800 people in three countries -
yet there was still no major international response.
MSF had been urging the WHO to declare an international emergency.
I said that, "I've been telling the world for the last few months
"that it's an unprecedented out of control Ebola epidemic.
"I don't have the authority, people don't listen to me
"but YOU, you need to step up to the plate and declare it
"because you have the authority and you have the legitimacy."
It was what the virus did next that finally forced the WHO to act.
An infected Liberian travelled to Nigeria -
Africa's most populous country.
The outbreak there was contained
but the episode shocked the WHO in to action.
I am declaring the current outbreak of Ebola Virus Disease
a public health emergency of international concern.
The committee acknowledges the serious and unusual nature
of the outbreak and the potential for further international spread.
The WHO put a high-level team of experts in Geneva
in charge of the response.
They faced a daunting task.
We were looking at one of the most dangerous pathogens that we knew
growing at an exponential rate across a broad geographic area,
something we had never seen before.
We needed clinical management,
people to go in there and manage the Ebola cases.
We needed public health expertise on the ground
to be able to do the contact tracing
and I realised that capacity to manage something on this scale doesn't exist.
The WHO now had a plan
but nobody to carry it out.
They needed to convince wealthy governments
to provide money and manpower
and time was against them
because the outbreak was about to enter
its most shocking and deadly phase.
West Point -
the most densely populated district of Monrovia, capital of Liberia.
75,000 people live in less than a square mile.
There's no running water or sanitation -
perfect conditions for the spread of Ebola.
The first deaths were in the home of Finda Fallah.
SHE SPEAKS OWN LANGUAGE
I was called by the Minister of Health
to say that people were dying.
Total, total confusion, chaos, disbelief, fear,
no means to respond
because we didn't have the knowledge, we didn't have the equipment,
we didn't have the means whereby we could attend to people...
We did not have full awareness of how quickly this disease could spread,
how deadly this disease was. We were confounded
because it just spread so rapidly in these communities.
Monrovia had one small Ebola clinic
and it was soon full.
Desperate patients had nowhere to go.
By now, MSF were over-stretched.
They were struggling to construct a new 400-bed clinic.
In the meantime, the government response was crude and brutal.
Anyone suspected of having Ebola
was simply dumped in a makeshift isolation centre,
an empty school in the West Point slum.
Finda, whose husband had just died,
was forced to come here with her six children -
even though none of them appeared to be sick.
The centre had no doctors
and no separation between the sick and the healthy.
Very quickly, it was completely contaminated.
Finda's son Sasko fell sick.
Outside, West Point was growing tense.
The government was shipping patients from all over the city
into the isolation centre.
The slum was becoming the dumping ground for all of Monrovia's Ebola victims
and once again, rumours were spreading that Ebola was a hoax -
a conspiracy to kill poor Africans.
Just four days after it opened,
protesters stormed the holding centre.
SHOUTING
People looted mattresses and sheets contaminated with the virus
and the Ebola victims disappeared back into the slum.
West Point was now out of control.
'Fellow citizens,
'it has become necessary to impose additional sanctions.
'The communities of West Point in Monrovia'
are quarantined on a full security watch.
This means there will be no movement in and out of those areas.
We ordered the military to quarantine the place,
to stop anybody from leaving.
Our fear was people would run away and come from there
and then go into other communities, that's why we did that.
GUNFIRE
As panic and anger swept through the slum,
the army opened fire with live ammunition.
A 14-year-old boy was shot and later died.
ANGRY SHOUTING AND CRYING
The use of soldiers was a mistake.
The whole military approach was really ill thought out.
The picture of this young man with his leg shattered
was placed in to everybody's consciousness.
At that point,
some of the young people were calling for anybody to do anything,
calling them to rebel.
At this stage, I think we felt
that our whole country was going to be destroyed.
The military cordon didn't work -
Ebola was already all over the city
and inside the West Point slum,
the sick had nowhere to go except the streets
so the virus spread more quickly.
A local film-maker who found a way past the cordon
discovered Finda and her children homeless and sick with Ebola.
By now, her son Sasko was dead.
The rest of the children desperately needed help.
As West Point descended into hopelessness and despair,
MSF had been frantically constructing ELWA 3,
the biggest Ebola hospital ever built
but when it opened,
it was clear it would not be enough.
Brett Adamson was MSF's field coordinator.
People were dying outside,
families were dying in taxi cabs outside,
they were arriving seeking care, the families had nowhere else to go,
the centre was full and essentially they were,
the centre was waiting for someone to die to then make space.
Stefan Liljegren was recruited at short notice to work at the hospital.
Like many of the team, he had no Ebola experience.
I arrive and there are mattresses just next to each other,
full of people, and they're dead.
And I look back at them
and, "OK, so that's how a dead person look like."
They're telling me that, "Stefan, we can't just watch,
"we need to go in and move bodies.
"Are you ready for it?"
And I start to panic and my pulse goes very high.
There are dead bodies in there.
And in gruesome...positions.
We go to the next one and there are dead bodies in there as well.
And we go up to a man in a chair...
The guy with the spray goes up
and he starts spraying his face and that's when it really hits you,
"Yeah, he is really dead," and we place out the body bag
and zip him up and then we carry him away.
And family are crying and screaming and yelling
and...many are in panic.
That was my first day with Ebola.
BREATHING THROUGH MASK
A normal medical round for me would be going in,
pronouncing five or six people dead,
and it's extremely horrible, because people are dying
sometimes, er...very distressing deaths, beside a child.
The mother that was trying to care for her child, dead,
and then you've got a baby, and trying to work out
how on earth are you going to try and deal with an unaccompanied child
in an overfull centre.
It was...really hard.
It was just so far beyond
what could normally be expected of humanitarian workers, I would say.
The pointlessness of it, that's what it felt like.
You know, normally if you work to the point of exhaustion
you can come away from something and feel...a degree of satisfaction,
knowing that you did what you could.
I didn't feel any satisfaction at all.
The shame of having to turn away an Ebola patient,
there's no greater example of a failure of a response
when that happens.
It was never about feeling like
you'd failed in the level of medical acuity.
We did everything we could.
It was about feeling the shame of what the world
had to offer for Liberia at that time
and, yeah, the sheer number of... death.
It was just really seeing death.
Yeah.
After sleeping on the streets for five days,
Finda and her surviving children
were finally picked up by an ambulance crew in West Point.
BLAST OF SIREN
They were taken to the new MSF clinic.
But when they arrived there was no room for them.
It's just crazy.
To stand there and look in the face of people
and tell them that there is no space.
It's...surreal, really surreal.
If you had to make a choice, who do you take?
"If I have to take someone,
"I have to take this woman that lies on the ground here,
"she is very, very sick,
"and if I have to take someone I have to take her.
"I can't take you.
"There is no space for you here today."
Eventually, the MSF team found room for Finda and the children.
But by now Finda's youngest boy, Tamba, was slipping away.
Ebola killed most of Finda's family.
Three of her children died,
as did her husband, her mother and her sister.
Finda herself, and three of her children, survived
and returned to West Point.
MSF were now at breaking point.
Their treatment centre was dangerously full.
The organisation made a direct plea to the United States
to provide thousands of soldiers to help isolate and treat patients.
The director of the US Centers for Disease Control
and Prevention came to Monrovia to see the situation for himself.
I still get goose bumps thinking about it
and I will never forget the experience.
I've worked all over the world for decades in public health,
I've seen starvation, I've seen epidemics,
but in ELWA 3 I saw a level of devastation that I have never seen,
where you had people dying in a healthcare facility
and not enough people to remove the dead.
I went into one of the tents
and there was a woman lying on the ground.
Er, she had beautifully plaited hair.
When I looked more closely I realised that she was dead
and the staff were too busy trying to care for the living
to even remove her.
It was driving around Monrovia and seeing dead bodies on the street,
it was seeing a country essentially in freefall,
and knowing, knowing with certainty, that no matter what we did
it was going to get a lot worse before it got better.
Tom Frieden called President Obama.
I was frankly furious.
What I said was that this isn't about
response in the next three months,
it's response in the next three DAYS that matters.
Cases were increasing exponentially,
they were doubling every three weeks.
Each month of delay would result in a TRIPLING of cases.
The world still has an opportunity to save countless lives.
Right now the world has a responsibility to act,
to step up and to do more.
Ten months after the outbreak began, the fightback was underway.
The United States sent in thousands of troops and medics,
and the UK and other countries followed suit.
The UN created a new emergency mission to coordinate the response.
Work began building new treatment centres and training burial teams.
But the virus was still running ahead of the medics.
In an age of cheap international travel,
the disease threatened to spread beyond Africa.
Cases in Spain, Britain and America
forced the disease into the headlines around the world.
NEWSCASTER: A second healthcare worker in Dallas
has tested positive for the Ebola virus.
Public health officials confirm the first human to human
transmission of Ebola in the US...
'We definitely arrived too late, I mean, there's no doubt about that.
'I was absolutely petrified,
'I was scared to death.'
I was afraid it would just be like this black plague
with this inexorable spread across the continent and beyond.
We were also deathly afraid that, oh, someone would get on a plane
and go to Dakar or Jakarta or Johannesburg, somewhere,
and land in an urban setting
and Ebola get totally out of control.
We didn't have a Plan B.
Then, in Monrovia, something extraordinary happened.
Cases began to drop sharply.
When we saw the numbers starting to go down I was really worried.
It was cause for more concern than jubilation because the response
still seemed so inadequate
that it was inconceivable that it could be successful
and of course the fear is that, if people are not presenting,
that they were staying at home,
which means if they're staying at home they're infecting more people,
that then the curve would bounce back in a much more dramatic way.
And that was the fear.
But the drop in numbers was real.
With death all around them,
millions of Liberians were changing how they lived their lives.
They stopped trying to nurse their sick
and began to bury their dead safely.
The entire Monrovia knew Ebola was real, Ebola kills,
Ebola's going to kill me unless I do one or two things differently.
There was a huge fear
and they changed their behaviours
in ways which suddenly slowed down and took the heat out of this thing,
because, remember, this virus can only go to person to person.
And that's what turned it around, Liberians turned their country around.
We got in there a little bit afterward and took a lot of credit.
Thousands more were still to die across West Africa.
But the changing behaviour of the population,
and the massive international response, gradually turned the tide.
Today, the battle against Ebola is still far from over.
A quicker and better international response
could have saved many lives.
Officially, more than 10,000 people have died.
The true figure is much higher.
37 health workers died at the Kenema Government Hospital, here.
37, including doctors, nurses, porters,
cleaners, securities, lab technicians.
37 of them died in this hospital.
Nurse Rebecca, Alex Mogboi, Nancy Yoko,
Sister Mbalu,
Dr Khan, Nurse Alice...
LIST OF NAMES FADES OUT
Sometimes the world has got to learn things the hard way.
There are going to be more of these.
No matter what we think.
Ebola was not an exception, Ebola is a precedent.
More and more new diseases are emerging.
We've seen pandemic flu, we've seen Sars,
we've seen Ebola like this, so there will be more of these
and we are not prepared.
Cos you know what? Everybody got it wrong on this one.