It has been just over one year since the first reported case of Ebola in North Kivu province of the DRC, and the outbreak is showing no signs of slowing down. Figures released on the 17thof July by the DRC health ministry put the number of confirmed cases at over 2,400, with 1,600 deaths confirmed from the disease – triggering the World Health Organisation to declare a Public Health Emergency of International Concern.
Fears are growing that the virus will spread outwards from North Kivu, crossing the borders in to Uganda and South Sudan as public health teams and DRC authorities struggle to engage the population in the response. These fears have been accelerated by a fatal case of Ebola in a woman in the DRC who had recently travelled to a busy market in Uganda. Incidents like this highlight the difficulty in preventing the transmission of the disease, especially across porous borders, where contact tracing in densely populated areas proves difficult.
Efforts to contain the spread of Ebola within the DRC have also been hampered recently, with the death of a man in the city of Goma, around 350 km south of the epicentre of Beni, and just kilometres from the border with Rwanda. These recent cases demonstrate the continuing difficulty in public engagement seen in the outbreak response, as both individuals were aware that they were in high-risk groups and had been asked to not travel.
The availability of efficacious vaccines in this outbreak has meant that all contacts in the recent cases in the city of Goma were traced within three days and immunised. However, if any spread of the virus does occur in the city of Goma, the outbreak could enter a new phase that would further tax a response effort that is already underfunded and over-worked. The emergency declaration of a PHEIC by the WHO triggered several countries to release further funding for the response; the Department for International Development in the United Kingdom to release a further $62 million to bolster aid efforts in the region, with the hopes that other international players would follow suit. However, it is not clear if further funds will facilitate resolution of the outbreak when much of the population still does not believe in Ebola and refuses vaccination or to participate in the response.
Delivering an effective and managed aid response relies not only on financial assets, but personal ones also. Aid workers from diverse backgrounds must work collaboratively to respond quickly to disease outbreaks such as in the DRC, and this routinely proves to be a complex and often dangerous endeavour. Humanitarian efforts rarely have to deal with a single problem in a response. In the case of Ebola in the DRC, the secondary issue is one of social and political unrest. The Kivu province has been in a state of internal and external conflict for 15 years, with many factions fighting over sovereignty, religious beliefs and cultural differences.
This unrest has contributed to a pervasive distrust of foreigners, including aid workers, and in some cases has even resulted in violent attacks against aid workers and Ebola treatment centres, causing several of the world’s largest humanitarian organisations to cease operations within the DRC. Médecins Sans Frontières, the International Rescue Committee and Oxfam have already pulled out from the primary response effort, and aid workers with other national and international organisations have voiced serious concerns about their personal safety, and the safety of treatment centres.
In April, Dr. Richard Mouzoko, a Cameroonian epidemiologist attached to a WHO response unit in Butembo, was killed when unknown assailants stormed his treatment centre. The main hospital in Butembo, as well as satellite treatment centres in the city as well as the town of Katwa, were also burnt to the ground. The WHO reports that, since January 2019, there have been almost 200 attacks on Ebola treatment facilities in North Kivu province, causing seven fatalities amongst healthcare and humanitarian workers. Not only does this deter aid workers from performing their roles due to fear, it also drastically reduces the ability of organisations and authorities to trace contacts and perform safe and respectful burials of victims.
Sadly, without enhanced community outreach and engagement, the conflicts and difficulties seen in this ongoing Ebola virus outbreak in the DRC are unlikely to be over soon.
