The latest outbreak of Ebola in the Democratic Republic of Congo (DRC) is the worst ever recorded here and the second largest Ebola outbreak ever recorded. As of May 22, more than 1,200 people have died of the Ebola virus.

Nearly ten months after the start of the epidemic, the number of people with confirmed cases of Ebola continues to increase and conditions in the affected areas are deteriorating. Cases have been confirmed in the provinces of North Kivu and Ituri.

This is the tenth outbreak of the deadly virus in the country in 40 years. The DRC Ministry of Health officially declared the Ebola virus outbreak in North Kivu on August 1, but the outbreak probably began several months earlier.

Ebola Status Report as of 22 May 2019

Total cases: 1,877 cases
Confirmed: 1,789
Likely: 88

Number of deaths: 1,248
Confirmed: 1,160
Likely: 88

* Data published by the Ministry of Health of the DRC. "Probable" deaths refer to deaths related to confirmed cases of Ebola but not tested before burial.

The role of MSF

MSF remains an active player in the response to the Ebola virus. Following separate attacks on our Ebola treatment centers in Butembo and Katwa – at the epicenter of the epidemic – earlier this year, MSF does not run a treatment center. MSF is helping existing health care facilities in the provinces of North Kivu and Ituri to prepare and treat potential Ebola cases and to manage transit centers where patients suspected of Ebola will be treated. to be infected with the Ebola virus are tested and sent to the information processing centers if they are positive.

In addition, the organization participates in prevention activities by working to implement and strengthen disease surveillance and infection prevention and control (IPC) activities in the region. It also works with local structures to ensure that they have the capacity and equipment to isolate the positive risks. case.

Working closely with communities to identify and respond to their specific needs is essential. In addition to activities related to Ebola, MSF is helping to improve access to general health care to treat other common diseases and to improve water and sanitation to prevent the spread waterborne diseases. Better access to basic health care can help reduce the number of new cases of Ebola. It is safer to keep people out of hospitals, where they could get in touch with other people infected with the virus.

Local context

The epicenter of the epidemic is in North Kivu province, a densely populated region in the north-east of the country, with about seven million inhabitants. Despite the difficulties of rough terrain and bad roads, the population is very mobile. North Kivu shares a border with Uganda in the east and knows a lot of trade, human trafficking and "irregular" crossings. Some communities live on both sides of the border and frequently visit their parents or merchandise.

North Kivu has been a zone of conflict for more than 25 years. It is estimated that more than 100 armed groups are active. Criminal activities, such as kidnapping, are relatively common and skirmishes between armed groups occur regularly. Widespread violence uprooted people and made access to certain areas of the region difficult. While most urban areas are relatively less exposed to conflict, attacks and explosions took place in Beni, the regional administrative center, sometimes limiting MSF's ability to conduct operations.

The current epidemic was first reported in the small town of Mangina and the epicenter of the epidemic seems to have moved south, first in the city of Beni, then in the largest city of Butembo, a trading hub. Katwa, located nearby, became a new hotspot by the end of 2018 and cases were discovered further south. Meanwhile, sporadic cases have also appeared in the neighboring province of Ituri in the north.

Community challenges

All actors involved in the response to the Ebola virus have failed to create a climate of trust within the local community. Mistrust, as well as violent attacks against the Ebola response, hinder efforts to control the epidemic. People do not seek care in Ebola treatment centers. This results in an increased likelihood of spreading the virus in other health facilities without adequate infection control procedures and equipment.

About half of all new cases are deaths in the community, which means that people die at home or in health facilities in general. This is an indication of persistent lack of confidence in the intervention. People who die of Ebola in the community also have a significant risk of transmission to others.

In addition, violence and unrest, such as fighting between the army and armed groups early May and the assassination of a doctor from the World Health Organization in April to Butembo, have paralyzed many activities. For example, vaccination of contacts, contacts of contacts and front-line workers in Butembo and Katwa is sometimes temporarily suspended due to threats to the safety of vaccination teams.

It will not be possible to end this epidemic if there is no established trust between the Ebola response and those affected. We must listen to the needs of communities, give them the choice to manage their health and involve them in all aspects of the Ebola response.

Epidemiological concerns

Overall, the geographical spread of the epidemic seems unpredictable, with small, scattered clusters of cases occurring anywhere in the region. This trend makes the end of the epidemic even more difficult. With new confirmed cases further south, the risk of the epidemic reaching Goma, the provincial capital, is another cause for concern.

MSF is extremely concerned about the lack of visibility on the actual epidemiological situation, as more than 80% of confirmed new cases have not been identified as contacts. In addition, only 32% of new confirmed cases were linked to known contacts. This means that the contact list and the monitoring are not effective. The search for contacts is essential to control the evolution of the epidemic. It also means that even if the number of new cases reported is high, the actual number will probably be even higher.