The latest Ebola epidemic is the worst ever documented in Democratic Republic of Congo (DRC)—and the second-largest Ebola outbreak recorded anywhere. Efforts to stop the spread of the disease are challenged by the realities of fighting an epidemic in a conflict zone.
DRC’s Ministry of Health officially declared a new outbreak of Ebola virus disease in North Kivu on August 1. It is the country's tenth outbreak of the deadly virus in 40 years.
At the request of the Ministry of Health (MoH), Doctors Without Borders/Médecins Sans Frontières (MSF) is part of the national task force coordinating the intervention based on several pillars of the Ebola response. As of January 27, 2019, MSF had received 3,292 people at its Ebola treatment centers and transit centers in the affected region. We have treated a total of 321 patients confirmed with Ebola. MSF has also vaccinated more than 4,800 frontline health workers, who are among those at greatest risk of contracting the disease.
Medical activities have been suspended at MSF's Ebola treatment centers in Butembo and Katwa after the facilities were attacked by unidentified assailants in late February. MSF has evacuated staff from the area for their safety pending a thorough analysis of the risks associated with continuing to provide medical care there.
Violence and political unrest
The epicenter of the outbreak is in North Kivu, a densely populated area in the country’s northeast. North Kivu shares a border with Uganda and is a hub for travel and trade, as well as human trafficking. North Kivu has also been an area of conflict for over 25 years, with more than 100 armed groups active in the region.
As the number of new confirmed Ebola cases continues to grow, violence and political unrest in the affected areas have further restricted the community’s access to health care. Security constraints are hindering the Ebola response, making it difficult to identify new cases, trace contacts, and conduct vital community outreach activities. Some health centers have been damaged or temporarily closed.
“In this situation people might have no other choice than to seek medical help in health facilities that do not have adequate triage or infection prevention and control measures in place, which makes the risk of contamination higher,” said Laurence Sailly, MSF emergency coordinator in Beni. “We are talking about a population that has endured many years of conflict. On top of that, they are now faced with the deadliest Ebola outbreak the country has ever seen. The unrest … adds even more to their plight by limiting their chances of finding adequate medical care.”
On February 24, 2019, unidentified assailants attacked the MSF-managed Ebola treatment center in Katwa, setting the structure on fire and destroying medical wards and equipment. Three days later MSF's Butembo treatment center was also attacked and burned. All medical activities at the two sites have been suspended.
At our Ebola treatment centers, MSF teams worked to increase the level of supportive care—ensuring proper hydration, providing treatment for malaria and other co-infections, as well as treatment of the symptoms of Ebola. Our clinicians also now have the ability to use experimental therapeutics under various mechanisms, including compassionate care protocols and participation in a randomized controlled trial. The four experimental therapeutics being used in the trial are Remdesivir (GS5734), REGN3470-3471-3479, ZMapp, and mAb114. These treatments are given only with the informed consent of the patient (or a family member, if the patient is too young or too sick) and are provided in addition to supportive care.
Ending the outbreak
The epidemic is not yet under control. The geographic spread of the epidemic appears to be unpredictable, with diffused small clusters potentially occurring anywhere in the region. This pattern makes ending the outbreak even more challenging. Given the appearance of new confirmed cases further south, there is a risk that the epidemic could reach Goma, the capital of North Kivu.
Raising awareness among communities about Ebola containment measures remains one of the main challenges of the outbreak response. Heightened political tensions and unrest have made it difficult for health workers to reach communities. In an atmosphere where rumors and misinformation are widespread, people can be hesitant to accept unfamiliar infection prevention and control practices, such as safe burials or decontamination activities.
“With Ebola, treatment centers alone are not enough. Connecting with the communities and building mutual trust is key to get the outbreak under control,” said Roberto Wright, MSF anthropologist in Katwa. “We need to increase our efforts to engage the population as active participants in the fight against the outbreak. This includes listening to their broader needs.” At the end of December, MSF distributed trauma kits to local health centers to support their response to outbursts of violence. Our transit centers not only identify Ebola patients and refer them for treatment, but also help ensure adequate care for other health issues. “Visiting communities to present our activities before we actually launch them can go a long way in terms of improving mutual understanding and facilitating better collaboration in the long run,” said Wright.