MANILA — Days of violent protests in Beni, a city in northeastern Democratic Republic of the Congo, have complicated efforts to contain Ebola in the area. The violence has led to United Nations and NGO staff relocations and suspension of operations in affected areas, such as Oicha, where there has been “very limited or no activity” for several days, said David Gressly, U.N. emergency Ebola response coordinator in DRC.
The protests were triggered by deadly attacks against civilians in Beni, believed to be carried out by the rebel group Allied Democratic Forces. Residents are angered by the inability of the U.N. Peacekeeping Forces to protect civilians against the attacks.
“[Staff] didn't really evacuate; they just relocated — I mean that's the terminology that we would use.”— David Gressly, DRC emergency Ebola response coordinator, U.N.
While things seemed to have calmed down on Wednesday, the situation continued to remain tense, Gressly said: “There's still threats of violence circulating on social media, so we need to continue to be vigilant,” he told Devex over the phone from London.
His main concern is the Oicha area, where these incidents have caused a “significant suspension in our contact tracing, monitoring, and vaccination work. So … hopefully we can catch up quickly if the situation holds without violence,” he said.
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Devex caught up with Gressly for an update on the situation’s likely impact on the response, the current state of the outbreak’s containment, and whether teams are already preparing for a post-Ebola response.
This conversation has been edited for length and clarity.
How long has contact tracing and monitoring been suspended due to the violence?
Well, I mean, it varies. In areas not affected by the violence, of course, it continued. So it's only partial. It's not like we sat down across the board.
[Activities were suspended] primarily in the Oicha area over the last several days … Since the violence began … that is the area where we're most concerned at this time because that is several days of very, very limited, or no activity. In other parts of the country [there was] much more activity. In parts of Beni, it was only partial. Outside of the areas where there wasn't violence, work continued.
There were other areas like Butembo, where there has been some suspension. But it also has less of an issue of cases, [as] there are a few cases that we're trying to track down in that area.
How about those that were evacuated. Will they continue to work remotely for now?
They didn't really evacuate; they just relocated — I mean that's the terminology that we would use — to an area where they could continue to provide back-office support remotely. But both UNICEF and WHO maintain their people on the ground as did my team, so it was non-essential personnel that were relocated and ones who could provide that kind of support remotely.
The very, very large majority of people who are working on the response are Congolese and where they could work, they continue to work.
Prior to these violent protests, there was an increasing sense over the past few weeks that because of the declining number of cases, the outbreak is near containment. But what is the status?
That was the status up until the moment that the violence started in Beni. Things were looking reasonably good. We had three geographical areas where there was still a known transmission going on. But the bulk of the areas that had been affected by Ebola have been clear for many, many days, or weeks. So in that sense, we were in a much better position than anytime before. Just to put numbers to it, I think it was in May we had about 125 cases a week.
In the most recent week, we were about seven to 10 cases, about an average of one a day. So that's a significant improvement both in terms of a reduction [in] cases but in reduction of geographical coverage. And then finally, just the number of people that we had to monitor who were in contact with an Ebola patient declined significantly. So from 20,000 people in August to currently around 3,000. So those are all indicators of the progress made.
Now, the core question is, how much will this violence have an impact on that? In the Beni area and particularly in the Oicha area, it's impossible to say precisely, but it would be difficult to imagine it didn't have a negative impact simply because these cases had just been identified and there's a need to get in quickly to identify contacts and vaccinate them, and isolate those who might be symptomatic. So that work was delayed and will likely lead to more transmission.
In other areas, like in Mabalako ... the work was able to continue so I don't think that's an issue. And as I said earlier in the Ituri area, we actually had a breakthrough [Wednesday] in getting more access into an area of concern where there was ongoing transmission. So it varies.
So the answer to your question will reveal itself over the next week and days when we see the magnitude of any new cases that came out as a result of the suspension. But I'm confident that we have the teams on the ground that will overcome this, provided they can continue to get full access to the areas affected.
There have been numerous issues throughout the response, from community engagement to insecurity, to funding issues. Apart from what's currently happening, what challenges remain and what’s being done to overcome them?
Well, apart from what I've just described, I think there is still resistance in the Ituri forest area. It doesn't affect too many people in terms of numbers. It's a rural area; it's rainforests. But there are different pockets there that we have some difficulty getting to. So we need to get there and make sure that there is no transmission, or if there is that we can help manage it and end it in those pockets. So that's one major question mark that we need to take care of.
Secondly, there was this case, it came into Oicha in addition to the problems that came up because of the violence. It was a problematic case anyway, because the origin of that particular case was not clear. And so further investigation is required to really determine where the case came from, the chain of transmission that led to it, so that we can ensure that all of those who might have been infected along that path are identified, isolated, their contacts vaccinated.
So those are the two big issues in front. And then I would say another level is to continue to stay vigilant in the areas not affected ... Because the population remains very mobile.
Because of the declining number of cases in recent weeks, have you started discussing post-Ebola outbreak activities?
Absolutely. We're talking with the government. We're talking with major funders, World Bank, major donors, but also the implementing partners on the ground. For myself, this is extremely important that we get this going.
There are already many areas that were affected by Ebola, at one point or another, that had been Ebola-free for 60 days, 70 days, 80 days. So they've already in many ways entered the post-Ebola kind of period. So yes, we are working on that, trying to work to identify the specific interventions. Obviously, this is under the leadership of the government, so we work with them.
What will the possible set up on the ground look like? How many organizations will continue to stay? Because I understand there are still several issues on the ground. There's the issue of measles, for example.
Oh, absolutely. We'll need to do continued support. What is clear is that continued support to survivors will be extremely important. We do know from the West African experience that a percentage of survivors will continue to suffer from health problems as a result of having had the disease. They may have neurological damage as well. They will continue psychosocial support, and we need to avoid the issues of stigmatization of those individuals.
There'll be a continued need [for] robust surveillance systems in place in case there's a new outbreak, because a small percentage of survivors can continue to transmit the disease. Not too likely, but it can happen. So we need to be vigilant on that.
And then as you basically alluded to, we need to really start supporting the recovery of health systems. Education was very much affected. We've identified needs for water, sanitation, nutrition support. All of that will be important in a post-Ebola period.
We've talked about the complications of the violence and insecurity. Continued support to reconciliation, stabilization will be essential, I believe, to create a foundation for the other interventions to take place, particularly if you're talking about strengthening systems. You need stability in the area as well, if that's really going to take hold. That's a broad outline. There can be other interventions as well, but I think it gives you a general idea.
Throughout this outbreak, there's been a lot of calls for funding. There've been funding gaps throughout the response. Do you see this becoming an issue post-Ebola outbreak?
I would say the primary problem we're having is not only overall availability of funding because I think it's there, it's the ability to fine-tune that funding to be targeted to the right communities, particularly when we're talking about the support for the non-Ebola-related problems that communities face, whether it's malaria, measles, cholera, etcetera. These are all things where the funding has been more problematic to get and to fine-tune towards those communities most in need.
And so that takes us to the post-Ebola period where my primary concern is once the Ebola epidemic ends, everybody will just pack up and go home and say, “you know, mission accomplished” and yet leaving behind an area that's been badly affected, as I described earlier, without the means to recover.
I do think it's important right now to work towards getting the commitment from the various donors, and they seem to be ready right now to step forward. So I think we need to bring that to conclusion, to get this formalized so that it's not lost, not forgotten after the epidemic is declared over.