Ebola resurfaces in DRC, response stifled by ongoing conflict

ABIDJAN — Less than two weeks after an Ebola outbreak in the Northwest Équateur Province of the Democratic Republic of the Congo was officially declared over, the Congolese government has announced another outbreak in the Northeast North Kivu region. Although it’s DRC’s 10th outbreak of Ebola, it’s the first in a conflict zone.

Ebola is endemic in DRC, and while the government remains largely applauded by humanitarian actors for its quick reaction to possible cases, humanitarians also believe this outbreak may prove more challenging to contain due to heightened insecurity in the region.

Oxfam’s DRC country director Jose Barahona said Ebola response is often well-coordinated by the Congolese Ministry of Health, but that this outbreak is unlike any other.

“Here, the government of Congo publicly declares an outbreak after one case is confirmed, calls for help, accepts help, and takes the lead very well,” Barahona explained.

“Usually Ebola outbreaks are easy to control because they erupt in isolated rainforest villages, but this area is in ongoing conflict with a much higher population density and lots of movement,” he said.

Growing concerns about the wide geographical area of case appearances this time around also suggests containment could be difficult, “with the level of access, we are expecting more actors [to be involved], which could become more difficult to coordinate,” Barahona said.

Since declaring the latest outbreak on Aug. 1, the World Health Organization has confirmed 16 cases, 27 probable cases, and 34 deaths across seven districts and two provinces. Authorities in North Kivu originally alerted the health ministry to cases of hemorrhagic fever around the town of Mangina, roughly 100 km from the DRC-Uganda border. This resource-rich region already has the highest number of internally displaced persons in DRC, according to the UN Refugee Agency, and has long been an epicenter of armed violence and intercommunal conflict.

“So far the epicenter of the crisis is reachable, with no security risks or incidents in that area,” Barahona explained. However, he fears that as more suspected cases are announced in surrounding communities, actors may face backlash in trying to reach them.

Many of the responders — such as logisticians, epidemiologists, clinical care specialists, and emergency coordinators — who supported the response to the Ebola outbreak in Northwest Équateur province in May, remained in the country and have since been relocated to North Kivu, WHO regional emergency director for Africa, Ibrahima Socé Fall, told Devex. In addition, many crucial supplies, including testing kits, medical equipment, and protective gear, have been easily gathered from stocks left behind last month.

“While we were able to quickly move teams to affected areas, our initial response was rapid but there are some fundamental concerns such as certain roadblocks that can’t be used for response,” he said. “The approach will be difficult but we are still committed at the same level, it just may take more time to find all the cases.”

Fall told Devex that in order to navigate security limitations and protect areas while trying to save lives, WHO will heed the advice of the U.N. secretariat and MONUSCO, the U.N. peacekeeping mission in DRC, on security protocols and how to access the most remote locations — for example, with the use of armored vehicles.

While DRC has experienced nine other Ebola outbreaks since 1976, there haven’t been any in this region. Risk communication and using local radio to educate populations on how to avoid disease spread will be critical, Fall explained.

Aside from developing a security strategy, many other interventions used during the Équateur outbreak will remain the same, including contact tracing and use of the investigational Ebola vaccine.

Last month, a “ring vaccination” method which vaccinated health workers, along with all immediate and secondary contacts of Ebola patients, was seen as a game changer in quickly containing the outbreak. Protocols on who will receive vaccinations this time round had not yet been determined when Devex spoke with Fall on Monday.

“There is some discussion to finalize the protocol, prior to using our standard ring vaccination,” Fall explained. “We will still vaccinate health workers who are at high risk, but instead of ring vaccination — because of the high-security risk — we will target geographic areas. Instead of looking for specific contacts of contacts, we can vaccinate a certain group of people in an area.”

Health experts in Beni, the city closest to the epicenter of the outbreak, are organizing “cold chains” — a series of measures to keep the vaccines at the recommended temperature of -70 degrees Celsius when being transported from the capital, Kinshasa.

DRC is a country experiencing compounded crises: On top of Ebola outbreaks, it is dealing with political tensions, and intercommunal violence that has left 13.1 million people in need of humanitarian assistance and protection. To date, only 21 percent of the $1.7 billion needed to finance the updated 2017-2019 DRC Humanitarian Response Plan has been funded.

The initial draft of this latest Ebola response plan will cost $40 million, of which $2 million has been released by the WHO Contingency Fund for Emergencies with another $2 million approved by the U.N. Central Emergency Response Fund, but Fall told Devex they will need to seek out additional resources from donors to fully respond to this outbreak.

WHO will also continue working with bordering countries to increase surveillance and preparedness activities, especially in Rwanda, Uganda, and Burundi, where internally displaced people have historically fled when escaping violence in North Kivu.