While there are new reasons to be optimistic about the Ebola outbreak in the Democratic Republic of Congo, the progress remains uneven as Congolese officials and the international community respond to one of the most complex scenarios that anyone could have envisioned when the first case appeared more than a year ago.

What began with a few cases in the Mangina and Mabalako communities of the Beni region at the beginning of August 2018 has now claimed nearly 2,000 lives with no end in sight, though there are hard-won victories in terms of treatment. The security situation, though still volatile in the affected eastern provinces of Ituri and North Kivu – and now South Kivu too – appears to be better controlled. Recent funding commitments, including a new US$50 million commitment from World Bank, will support medical teams and humanitarian aid, though a financing gap remains.

The Congolese Ministry of Health, partnering with the World Health Organization (WHO) and other global entities, has delivered on training, immunizations and other strategies, with more than 200,000 people vaccinated in the month of August alone, according to ministry figures. Neighboring countries, notably Rwanda and Uganda, are aggressive about protecting their borders and preventing the spread of Ebola beyond DR Congo, especially after the first case was reported in the travel hub of Goma in July.

The controversial decision to place Dr. Jean-Jacques Muyembe-Tamfum, the director of the National Institute of Biomedical Research (INRB) and an award-winning professor at University of Kinshasa, at the helm of the government’s response – also in July – seemed a promising move. The 77-year-old doctor helped to discover Ebola and has made the disease his life’s work for more than 40 years, and that work has been rewarded with, among other things, a prestigious award worth nearly $1 million from the Japanese government earlier this year.

Yet the outbreak continues.

According to the latest WHO numbers, total cases are just shy of the 3,000 mark with 1,986 fatalities. Roughly two out of three people who contract Ebola have died. There are now four confirmed cases in the Mwenga community of South Kivu, which is as far south as the outbreak has reached and brings it closer to the nation of Burundi. Officials there began a vaccination campaign for health workers and other frontline staff two weeks ago, and understandably so. There are 154 response workers who have been infected since the beginning of this outbreak, WHO said.

There are four suspected cases – one confirmed – in Pinga, an inland North Kivu spot with a long history of armed groups and conflict. There are no known or obvious connections to the other Ebola cases, and the transmission route remains a mystery to health workers.

“Pinga presents an added challenge to response teams in terms of remoteness, limited telecommunications, security risks, and resistance within the affected family and community,” said WHO in its most recent update. In other words, many of the same conditions that already have made the Ebola response so complicated in parts of the DR Congo where workers have spent a year trying to mitigate those challenges with varying degrees of success.

In places where the severity of this Ebola crisis first became clear, including Beni and Katwa – each with more than 600 confirmed cases – people are still dying. The latest report from Congolese officials shows new fatalities in those communities as well as Butembo and Mabalako. So while there is no explosion in new cases in some of the hardest-hit health zones, or the kind of spikes seen in April and to a lesser extent July, there are still new cases reported in emerging hotspots such as Mambasa, where 14 cases emerged in the three-week period ending Thursday.

Addressing the region’s security issues is a priority and there have been fewer reported attacks on Ebola workers, but armed groups continue to operate particularly in the Beni region. Communities there said Monday that they welcome a newly established government, one that has been delayed for months since the disputed election of President Felix Tshisekedi. It’s hoped that political stability – the lack of which has played a role in damaging community trust, and meant danger for Ebola response teams – will contribute to progress in containing the outbreak.

Trust is what Mark Green, the director for United States Agency for International Development (USAID), warns is at the heart of the Ebola challenge, yet repairing it is not as simple as ending the region’s armed conflict or protecting people from it.

“Decades of corrupt, authoritarian rule during which communities were denied any meaningful voice in their government have undermined the Congolese people’s trust in institutions,” he wrote in a CNN piece published last week.

“This has fueled sweeping distrust of outsiders – including, too often, heroic health care workers who are trying to manage the Ebola response. In order to enable the public health response to work effectively, the community distrust of domestic institutions and outside assistance must be addressed.”

Most experts have agreed, but that hasn’t yet happened. Recent Ebola response activities were briefly suspended again in the Beni region as people in affected communities protested about the security situation. Sadly, it probably won’t be for the last time as the Ebola death toll reaches the 2,000 mark.

Image: WHO