The world has never been so prepared for an Ebola outbreak, but the latest emergence of the virus in the Democratic Republic of Congo’s conflict-ridden east is proving the most dangerous in years. Seventy-two out of 111 patients who have been infected with the haemorrhagic fever have died, making this outbreak the deadliest in more than a decade in Congo, where the disease was first diagnosed in 1976 and named after the nearby Ebola River. While the current death toll is far off the 11,300 people who perished when Ebola spread through West Africa from 2014 to 2016, international health officials worry about containing the virus in an area dense with armed militias and close to the porous border with Uganda. “This outbreak is still in the escalation phase,” said Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, which has staff working to stem the outbreak in Congo, neighbouring countries and the Geneva headquarters of the World Health Organization. “The key is identifying (patients’) contacts and getting people vaccinated.”
Since 2014, international health groups, governments and pharmaceutical companies have raced to strengthen their defences against Ebola. Congo has approved the use of an experimental vaccine made by U.S.-based Merck & Co., which helped snuff out an outbreak in northwestern Congo last month. It has also cleared five experimental treatments meant to reduce the mortality of the virus, which on average kills half of those infected. Two of the first 10 patients who received a medication which contains an antibody isolated from a survivor of an Ebola outbreak in 1995 have recovered, Congo’s health ministry said Saturday. The eight others remain in treatment. In a region that has seen a spike in violence, including beheadings, in recent months, health workers have struggled to reach patients and implement safe-burial protocols that proved key to controlling recent outbreaks. Ebola, which causes fever, diarrhoea, vomiting and internal bleeding, is passed on through bodily fluids, including from corpses.
On Friday, the WHO said a doctor in the town of Oicha in Ituri province had become ill with Ebola and may have infected his wife. The cases are the first in “an area of high insecurity,” said Peter Salama, the WHO’s emergency response chief. “It was the problem we were anticipating, and the problem at the same time that we were dreading,” he said. Officials have identified 97 people in the town who may have been exposed and need to be vaccinated, but haven’t been able to reach them all due to security concerns, Dr Salama said. While Oicha itself isn’t under rebel control, it is surrounded almost entirely by territory controlled by the Allied Democratic Forces, Uganda’s Islamic dissidents that are one of the dozens of foreign and local armed groups operating in Congo’s gold and tin mining heartlands. Large numbers of civilians have been killed around Oicha and aid workers, priests and government officials are being held hostage, Dr Salama said. Health teams from the U.N. and Congo’s government managed to reach the town accompanied by military escorts, but staff from nongovernmental groups have been locked out. Dr Salama said the WHO expects at least one more wave of cases. “We are truly at the crossroads,” he said.
Officials are concerned that the outbreak in Ituri and North Kivu provinces could spill into neighbouring countries, including Uganda, Rwanda and South Sudan. The Ugandan government has enhanced health screening at border crossings, where thousands of people transit daily. “It’s very probable that cases will cross the border into Uganda, but it’s also probable that they will be diagnosed rapidly,” said Dr Redfield, who travelled to eastern Congo earlier this month. The 1.3 million people, including thousands of refugees, who live in the region have endured violent insurgencies dating back to the 1990s. But it is their first time experiencing an Ebola outbreak, stunning a rural population where many believe the virus is sent by evil spirits, aid officials say. “Many can’t comprehend the idea of not being able to bury dead loved ones according to tradition,” said Hassan Coulibaly, a field director in eastern Congo for the International Rescue Committee. “We are trying to educate them, but the environment is hostile” Last week, locals angered by health officials’ insisting they forego traditional burial practices, including washing bodies to avoid infection, burned down a health centre in Mangina, the epicentre of the outbreak, pushing out medical personnel, according to the WHO. A local team administering vaccinations was also beaten up in Manbangu village, some 10 kilometres west of Mangina, while the IRC was forced to close down its health facility in the village of Mabalako following an attack from locals. The threat of militias has prompted Kinshasa to deploy more troops to protect health officials, said Congo’s Information Minister Lambert Mende. “The state of insecurity means we are dealing with a whole new experience,” said Gwenola Seroux, head of emergency teams at medical charity Doctors Without Borders. “We would like to keep in close contact with all the affected people, but the prevailing security situation dictates otherwise.”
Credit: Nicholas Bariyo and Betsy McKay for The Wall Street Journal, 26 August 2018.