The context of the Ebola epidemic presented extreme challenges for Oxfam, as it did for many organisations. At the onset of the epidemic, there was a general lack of understanding of the disease and how to respond to it effectively and safely. A pervasive and persistent climate of fear, coupled with changing predictions about the likely evolution of the epidemic, influenced analysis and response at all levels. There was strong pressure to treat the epidemic as a medical emergency requiring a medical response – organised through topdown processes – rather than standard humanitarian coordination