Sierra Leone + 2 more

Duty of care and health worker protections in the age of Ebola: lessons from Médecins Sans Frontières

Evaluation and Lessons Learned
Originally published
View original


Melissa McDiarmid, Rosa Crestani

Summary box

  • Health workers were differentially infected during the 2014 to 2016 Ebola outbreak with an incidence rate of 30 to 44/1000 depending on their job duties, compared to the wider population’s rate of 1.4/1000, according to the WHO.

  • Médecins Sans Frontières (MSF) health workers had a much lower incidence rate of 4.3/1000, explained as the result of MSF’s ‘duty of care’ toward staff safety.

  • Duty of care is defined as an obligation to conform to certain standards of conduct for the protection of others against an unreasonable risk of harm.

  • The duty of care was operationalised through four actions: performing risk assessments prior to deployment, organising work and work practices to minimise exposure, providing extensive risk communication and training of staff and providing medical follow-up for staff exposures.

  • Adopting and consistently enforcing these broader, duty of care safety policies in deployed teams augments and fortifies standard infection prevention practices, creating a more protective, comprehensive safety programme.

  • Prioritising staff safety by taking such actions will help avoid the catastrophic loss of the health work force and assist in building resilient health systems.


Protecting health workers from preventable illness, disability and death must become a fundamental first step in building resilient health systems capable of planning for and effectively responding to public health emergencies while maintaining core services.1 2 The health sector is already known as a ‘high-hazard’ employment zone, even when workers provide routine clinical care under circumstances clearly safer than an emergency response.3 Beyond the anticipated infectious agents such as tuberculosis and hepatitis that a worker might encounter, other hazard categories include chemical, physical and psychological risks which threaten worker health and safety.

The sector’s poor workforce illness and injury rates reflect these hazards, even in well-resourced settings. In the UK, for example, illness and injury rates are about 30% higher than the all industry average.5 These hazards not only endanger the personal safety of skilled health staff, but cripple health systems already burdened by workforce shortages.

In the special case of public health emergencies, unique threats arising from the complexity of urgent care delivery add to the heightened health worker occupational risk. This was especially evident in the Ebola context, where significant health worker infections and deaths occurred during the initial emergence and in subsequent early hospital-based outbreaks.

Recent review of the largely WHO-led Ebola response of 2014 to 2015 examined health worker infections and deaths. Though exact numbers were never finalised, two-thirds of the 815 known and presumed health workers infected were reported to have died of the disease. The estimated cumulative Ebola Virus Disease incidence rate for health workers was reported to range from about 30 to 44 per 1000 persons depending on job title, compared with the non-health worker rate of 1.4 per 1000.6 Compare this to the incidence rate of Médecins Sans Frontières (MSF) health workers, at about 4.3 per 1000 based on 28 infections among about 6500 responders.