Attacks on aid workers undermining DR Congo Ebola response

Militia attacks and mistrust of health workers by local communities in the restive eastern DR Congo are undermining concerted efforts to contain the latest Ebola outbreak that has now spread to Uganda. Armed rebels have repeatedly attacked Ebola treatment centres, while mistrust by some local communities who blame foreigners for the outbreak of the disease have seriously complicated efforts to end the epidemic in the conflict-torn Ituri and Kivu regions.

The UNHCR said more than 300,000 people have been displaced by resurgent violence in the region this month alone. DR Congo has recorded 2,025 Ebola cases and 1,357 deaths from the disease since the epidemic began in August 2018. Two people who crossed from DR Congo into Uganda died on 12 June, a development that sparked concern of a regional escalation. However, on 14 June, the World Health Organisation (WHO), which is coordinating an emergency response alongside DR Congo’s Ministry of Health, decided not to declare the disease an international public health emergency. At least 11,300 people died of the disease during a 2013 – 2016 outbreak in Guinea, Sierra Leone and Liberia.

Timeline of attacks on health workers and aid centres

The UN has reported more than 174 incidents of violence affecting the Ebola response teams or centres in Ituri and Nord Kivu since the outbreak began. The prominent incidents are:

ATTACKS IN 2018

22-24 September: An incursion by Uganda’s Allied Defence Forces (ADF) in Beni, Nord Kivu in which 18 people died led to “dead city” protest and disruptions to Ebola response activities.

20 October: Twelve people are killed in an ADF attack on Beni and Ebola response is interrupted for a few days.

23 October: Two nurses from an Armed Forces of the Democratic Republic of Congo (FARDC) medical unit are killed in Butembo on 22 October.

8 November: Mayi-Mayi militia briefly holds Ebola response team hostage.

27 December: Patients flee when an angry crowd ransacks an Ebola assessment centre in Beni.

ATTACKS IN 2019

16 February: Residents ransack premises of Ebola response unit in Ituri Province.

24 February: Armed men torch an Ebola treatment centre in Katwa, Butembo town.

27 February: Security officer killed and 31 patients flee after an arson attack on a Doctors without Borders (MSF) Ebola treatment centre in Butembo.

9 March: Two people, including a police officer, are killed in attack on an Ebola treatment centre in Butembo.

14 March: One person is killed in an arson attack on an Ebola clinic in Mamboa, Lubero Territory, Nord Kivu.

5 April: Armed men raid and loot MSF premises in Byakato, Ituri. No loss of human life reported.

19 April: A Cameroonian doctor working for the WHO is shot dead in attack at the Graben University (UCG) clinic in Butembo.

20 April: An attack on Katwa Hospital in Butembo is repulsed by security forces. An assailant is killed.

3 May: Ebola response operations are suspended in Butembo after clashes between motorcycle operators and Ebola safe burial (EDS) teams.

8 May: Ebola response operations in Butembo after a Mayi Mayi militia attack in which ten assailants were killed. Operations had just resumed after a three day suspension.

10 May: Leaflets threaten Ebola health workers in Beni, Butembo and Oicha, telling them to leave.

13 May: Security forces repel attack on Katwa Ebola treatment centre in Butembo, assailant is killed.

13-14 May: Mutiri Health centre in Lubero Territory is raided, medical supplies are destroyed and medical personnel are threatened.

17 May: A dignified and safe burial (EDS) team assaulted by family members of deceased persons in Bunia. In Butembo, an EDS team is stoned.

25 May: The triage area of Butembo’s Vulamba Health Centre is vandalised. In Vusahiro village of the Mabalako health zone, residents attack health workers, killing one.

3 June: Equipment is stolen from a medical laboratory in Komanda health zone. Ten people are killed in an armed incursion in Rwangoma, Beni, shortly after a community dialogue organised by an Ebola response team.

4 June: Protests in Beni disrupt Ebola public health activities.

16 June: Motorcycle operators and infection control team clash in Rwampara, Ituri.

17 June: An EDS team is attacked by youths in Bunia. Team members are assaulted and robbed.

History of Ebola outbreaks

This is DR Congo’s tenth Ebola outbreak. A previous outbreak in Bikoro, in the northern Equateur Province ended in July 2018. The outbreak in Equateur involved four separate locations, including an urban centre with river connections to the capital, Kinshasa, and remote rainforest villages. The latest outbreak in Ituri and Nord Kivu provinces has affected densely populated areas but also communities, some in areas where active armed groups operate.

World Health Organisation and government response

DR Congo’s Health Ministry has won applause for its handling of prior Ebola outbreaks. The Congolese authorities and the international community have left the day-to-day management of the outbreak to the local health authorities and the WHO. However, in Butembo the murder of a Cameroonian WHO epidemiologist by Mai-Mai rebels marked a change in the urgency as it became clear that Ebola response was overwhelmed by the climate of insecurity in eastern DR Congo.

The incident was followed by a series of attacks in which infection rates doubled and a public approach to the crisis proved to be inadequate. “It is not possible to stop Ebola in such a situation where there are tensions with the community, political interference and armed groups. The situation on the ground is not sufficiently stable for public health operations,”said Mike Ryan, the WHO director of the health
emergencies programme. The spike in new cases and deaths prompted a visit by newly-elected President Felix Tshisekedi, who toured an Ebola treatment centre in Beni. He established a high-level
coordination group to be headed by the prime minister but it is unclear if any initiatives have emerged from it or indeed whether it has even met.

In May, the UN stepped up its approach to the epidemic by appointing the deputy head to the UN mission in DR Congo, David Gressly, as the UN’s Ebola emergency coordinator. He is charged with overseeing the response across UN agencies and strengthening support for the response. Incidentally, although the current epidemic is in an opposition stronghold, efforts by opposition leaders have been underwhelming.

Ebola Vaccinations

communities as well for frontline health workers in the area and neighbouring countries. This “ring-vaccination” strategy, which has targeted more than 100,000 people, is credited with helping to slow down the outbreak inside the current hotspots as it attempts to disrupt chains of transmission. The experimental rVSV-ZEBOV-GP vaccine is also proving to be effective. Preliminary results from DR Congo’s National Institute of Biomedical Research (INRB) and the WHO show that its effectiveness is estimated at 97.5 per cent.

New Ebola Infections

However, at various points over the past few months, the WHO has said the crisis has been on an “epidemiological knife edge”. The looming question is the extent to which Ebola cases go undetected. Given the suspicion and resistance in the local population and the insecurity in the region, a relatively large number of cases have been detected late, leading to tens of deaths in the community. In addition, frequent population displacements due to insecurity has sparked fears that the disease will spread to neighbouring countries and provinces. The WHO estimates it may be , underscoring missing up to a quarter of cases that the epidemic is still far from being brought under control.

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