For months, health officials have issued a steady stream of warnings over the security situation in eastern Democratic Republic of Congo, where workers are racing the clock to contain an Ebola virus outbreak and treat its victims.
Another disruption at the weekend is underscoring fears that the situation could become a full-blown crisis beyond the global community’s best efforts, with an outbreak that respects no national borders.
The World Health Organization (WHO) evacuated 16 people following another rebel attack Friday on a United Nations peacekeeping mission near Beni – a city of about 200,000 near the border with Uganda, and the hotspot in an Ebola outbreak that has seen cases soar in recent weeks.
“The peacekeepers reacted immediately, pushing the rebel group after several hours of clashes, a few meters from the Ebola Response Emergency Operations Center and hotels in which several teams from the response were lodged,” said the Congolese Ministry of Health.
All field activities were briefly suspended but resumed on Sunday, the ministry said.
Dr. Oly Ilunga, the country’s health minister, condemned the violence he said “has once again wounded the people of Beni and is slowing the efforts of the response teams to end the Ebola outbreak.”
The fighting Friday night followed an attack earlier in the week on United Nations peacekeepers who were protecting civilians and supporting security for Ebola workers in Beni. Seven of the MONUSCO peacekeepers, six from Malawi and one from Tanzania, died in the attack.
“This should never have happened,” said Tedros Adhanom Ghebreyesus, WHO’s director general. “Without peacekeepers, fighting Ebola in DR Congo would be almost impossible. We condemn the attacks on those who risk their lives to ensure peace and security for others.”
The environment remained dangerous, especially in Beni, leading to the WHO decision to temporarily remove some staff after their building was hit by shells in the fighting. They were taken to Goma for psychiatric support, WHO said, but all were safe. Other teams continued to follow up on Ebola cases.
“WHO will continue to work side-by-side with the ministry and our partners to bring this Ebola outbreak to an end,” Tedros said in a follow-up statement. “We honor the memory of those who have died battling this outbreak, and deplore the continuing threats on the security of those still working to end it.”
A challenging Ebola response
That goal remains a challenge, despite the concerted efforts of Ebola response partners. There are now 366 cases – 319 of them confirmed – and 214 fatalities associated with the outbreak, which was first reported on August 1 in Mabalako. Nearly half of those cases are in Beni, with the rest scattered across a list that has grown to 13 other communities in the conflict zones of North Kivu and Ituri provinces.
This latest outbreak was traced to a 65-year-old woman living in Mangina who had been hospitalized a few days before being discharged in mid-July. She died at home a few days later, officials said. Seven family members in contact with her also died at the beginning of the outbreak, which WHO says has now surpassed the 1976 Yambuku incident with the DR Congo’s largest Ebola caseload in history.
New cases leveled off and even decreased for a few weeks, but now there’s a notable uptick in Ebola infections reported daily by the Congolese Ministry of Health. The virus is spreading into urban centers like Butembo even as gains are made in smaller villages, where information about treatment and first interventions are often viewed with suspicion and so are the workers sharing it.
There are many successes: Some 32,000 people have been vaccinated, for example, and about 100 have survived. Yet the years of a fragile political environment, and life in the shadow of armed rebel groups often engaged in ethnically based communal violence, have translated into an ongoing humanitarian crisis. There are a million people displaced in the region, according to WHO and the UN, and health workers often require armed escort.
Conflict adding to the crisis
Tedros, along with WHO’s Dr. Peter Salama, an Australian epidemiologist serving as Deputy Director-General for Emergency Preparedness and Response, has pleaded with armed groups to stop the violence and warned that the Ebola spread will be hard to stop if it continues. So have members of the UN Security Council, NGO leaders, and preparedness partners in at-risk neighboring nations like Uganda.
“Since the (epicenter) of the epidemic moved from Mangina to Beni, the outbreak has become harder to control,” said Gwenola Seroux of Doctors Without Borders (MSF) on Friday. “We now observe an increasing number of new cases further south, in the even bigger city of Butembo. We fear the situation might become even harder to manage, unless the response in this area is significantly strengthened.”
The organization said despite the risk, it was expanding its operations with a new center in Beni meant to allow for more patients to be treated and to keep them in better isolation conditions. The MSF site will add to the six treatment centers operated by ALIMA, International Medical Corps and others.
That adds capacity, but it doesn’t resolve the security crisis. Some health experts, including director Dr. Robert Redfield at the Centers for Disease Control and Prevention (CDC) in the United States, have wondered if the security crisis will create a context that global health workers have never seen before.
In the meantime, Ebola continues to spread with its lethal consequences – and the Congolese military and MONUSCO continue the fight against rebels interfering with the response.
“Insecurity is one virus, and Ebola is another virus,” Tedros said. “Because both kill people.”
Image: WHO file