Why Health Officials Are Struggling To Manage Congo’s Ebola Outbreak

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Health officials are warning the ongoing Ebola epidemic in the Democratic Republic of Congo is “outpacing” containment efforts and approaching a “catastrophic” tipping point as workers struggle to effectively treat cases and contain spread due to a series of violent clashes in a decades-old conflict (see live updates on the outbreak here).

Key Facts

World Health Organization director general Tedros Ghebreyesus on Wednesday warned the Eastern DRC is facing a “catastrophic collision of disease and conflict,” and the Centers for Disease Control and Prevention cited “ongoing security concerns” as a major barrier to providing support to the region.

Violence in the country has been ongoing to various degrees since the Second Congo War started in 1998, and militias backing the Hema and Lendu ethnic groups, respectively, have killed more than 50,000 people, raided villages, attacked hospitals and displaced millions over nearly three decades.

The conflict is rooted in deep ethnic resentment—and a fight for land and minerals in the gold-rich province of Ituri—that has been building for more than 100 years, since Congo was under Belgian colonial rule, and despite occasional progress has resulted in generations of governmental neglect and a resulting distrust of authority, foreigners, volunteers and aid workers.

Relations between the Hema and Lendu communities have severely deteriorated since 2017, when the Lendu-linked CODECO militia reemerged and resumed violence against civilians, including village raids that have reportedly displaced more than 1 million people.

That displacement has forced people into overcrowded camps with poor sanitation and close contact—hampering Ebola-control and contact-tracing efforts—and in regions where trust of government and outside institutions is lowest, some believe Ebola is not a deadly virus but the result of political manipulation, witchcraft and evil spirits.

Crucial Quote

“We are not just fighting a deadly virus,” Saani Yakubu, Congo country director for the ActionAid charity told the Wall Street Journal. “We are fighting myths, fear and deep-seated suspicion.”

Surprising Fact

The conflict in Congo is one of eight “wars” President Donald Trump has claimed to have solved. The Democratic Republic of the Congo and Rwanda, which has had a presence in Ituri since the Second Congo War, signed an agreement in December at the White House to force Rwandan troops to withdraw from eastern Congo and establish a regional economic framework. Fighting continues between the two sides, but there have been small signs of progress.

Key Background

The Africa Centers for Disease Control and Prevention confirmed an Ebola outbreak in the Ituri province of Congo on May 15, the country’s 17th in the last 50 years. By the time the outbreak was declared, it had already sickened 246 people and killed 65. Laboratory tests soon confirmed the outbreak is of the Bundibugyo strain, an Ebola variant with a mortality rate over 30% for which there is no vaccine or treatment. More than 1,000 people have since been infected with the illness, and more than 220 have died. The WHO declared the outbreak an “extraordinary event” that could pose a public health risk to multiple nations. The WHO, Africa CDC, African governments, United Nations, charities and public health agencies from the West have cobbled together a fragmented response to the outbreak and workers are trying to coordinate surveillance, isolation, treatment, laboratory testing and travel screening to prevent spread. The U.S. CDC has activated a Level 2 emergency response and is deploying staff for epidemiology, contact tracing, lab support and traveler monitoring through existing offices in Congo and Uganda. International donors have pledged roughly $500 million to fight the outbreak, according to WHO, including $23 million from the U.S. government and $15 million from the Bill & Melinda Gates Foundation. Traditionally, American help for Ebola outbreaks would come from USAID, the U.S. Agency for International Development, but that agency was largely dismantled under Trump.

Violence Hampering Ebola Response

In the last week, Congo has seen treatment centers burned, hospitals stormed by angry crowds and health workers threatened or attacked amid fighting between the region’s armed groups. An Ebola treatment center in Rwampara, a mining zone in the Ituri province, was set on fire last week by locals who became angry when they weren’t allowed to retrieve the body of a friend who’d died. Contact with the body of an Ebola victim is an easy way for the disease to spread, but sanitary disposal of a body conflicts with the cultural burial rites of the Congolese. The same frustrations spurred a confrontation between relatives of a person who’d died and Red Cross volunteers at Mongbwalu General Hospital, and police and soldiers are still at the hospital to defend against further attacks. Also in Mongbwalu, a tent being used to treat Ebola victims was burned and at least 18 people with suspected cases of Ebola fled during the attack.

Tangent

It’s not just violence that is making the Ebola outbreak hard to manage. The rural and remote geography of Ituri, as well as its relative lack of infrastructure make containment difficult, NPR reported. Ituri is a mining area, so people often travel there for work and then return home, possibly carrying the virus with them. Health workers are confronting severe shortages of basic supplies, like medicine, masks, gloves, face shields, medicine, testing kits, body bags, running water and soap. Several charity groups and public-health experts have decried international aid cuts in recent years from the U.S. and European countries and said they may have been able to identify the Ebola outbreak earlier if they’d had funding for surveillance systems and emergency supplies. Aid workers are also fighting resentment tied to the so-called “Ebola business” in Congo, which have plagued past outbreaks with accusations of profiteering and fraud as some residents are convinced aid organizations benefit financially from prolonged crises.

Further Reading

ForbesFrontline Workers ‘Risking Everything’ To Contain ‘Catastrophic’ Ebola Outbreak (Live Updates)ForbesU.S. Issues New Ebola Travel RestrictionsForbesWHO Declares Ebola Outbreak In Africa ‘Extraordinary’ Public Health Emergency

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