The second-largest Ebola outbreak in history has now surpassed 500 reported deaths in the Democratic Republic of the Congo (DRC). This outbreak, first declared in August 2018, now only falls behind the outbreak in western Africa between 2014-2016. The Health Ministry claims a vaccination programme has protected over 76,000 people and prevented “thousands” of deaths. Nevertheless, Doctors Without Borders reported that there has been a surge in cases since January 15. The violence has seriously hampered the ability to contain the outbreak in a civil conflict that is now almost 25 years old.
The ‘perfect storm’ or the ‘new norm’
Many believe this type of disease outbreak will become more frequent. Increasingly, more countries face similar political instability, insecurity, and refugee crises. Peter Salama, the emergency chief for the World Health Organization (WHO), said the current Ebola outbreak in DRC is “arguably the most difficult context that we’ve ever encountered”. In the case of the DRC, the outbreak is primarily concentrated in North Kivu province. Several confounding factors have contributed to the prolonged duration and inflated severity of the epidemic:
- The high mobility of the population caused by forced displacement
- Rumours and mistrust in the health system and the government generally
- The much-delayed presidential election on Dec 30 created an upsurge in violence, protest, instability and general uncertainty
- The transmission of illness in “traditional” facilities, which combine traditional healing with modern medicine, is not optimal for best practices.
- The security situation has made managing the spread of the disease difficult, resulting in the delay or suspension of prevention and treatment efforts.
Never-ending violence at the epicentre of the outbreak
An intensification in the targeting of civilians by rebel groups and militias, as well as battles between armed groups and the government, has driven violence. Although over 100 armed groups operate in North Kivu, the upsurge of violence comes primarily from two groups. On the one hand, The Allied Democratic Forces (ADF), an Islamist group based in Uganda but active in eastern DRC. The other is the Mai-Mai militia. This was a combination of armed groups whose main objective was to resist Rwandan invasions in the 1990s. These rebel groups use surprise attacks while others attack from different towns simultaneously to limit the Congolese army’s response. The army even suspects that a new rebel movement, not identified yet, has carried out some attacks. The military’s inability to prevent attacks has led to even more anger and suspicion among the communities in the region.
On Nov 15 2018, assailants killed and wounded seven UN peacekeepers and several DRC soldiers in a military operation. This was in combination with government forces against the ADF in North Kivu. This was the deadliest attack against blue helmets since Dec 7 2017. In that attack, at least 15 Tanzanian peacekeepers died, 43 wounded, and one peacekeeper went missing. UN investigators have blamed the ADF for carrying out the deadliest single assault on the UN peacekeeping mission in the DRC for almost 25 years. In recent attacks, ADF rebels have also killed civilians and abducted children. Child kidnappings for ransom are a relatively new tactic for insurgents in the region.
Ebola Relief Caught in the Cross-fire
On Oct 21 2018, Mai-Mai rebels shot and killed two medical agents with the DRC army. Rebels in this Ebola outbreak killed the first time health workers. The rebels rushed from the forest and opened fire on the unarmed agents with the army’s rapid intervention medical unit. An army statement said the daytime attack appeared premeditated. It was reported that health teams responding to the outbreak are attacked three or four times a week on average. This is happening at levels not seen in previous outbreaks in the country.
The violence is not limited to the rebels but also traumatized and frustrated residents. The Health Ministry has reported numerous aggressions against health workers and injured Red Cross volunteers. These rebel groups attacks have repeatedly disrupted treatment, burials and vaccination programs in recent months. The U.S. pulled its response team members out of North Kivu on Aug 24 2018. They are now based in the DRC capital of Kinshasa and claim North Kivu’s situation is too dangerous.
Conclusion
The DRC Ebola outbreak remains one of the world’s most challenging public health crises. The Centers for Disease Control and Prevention (CDC) warned of the possibility of an “endemic” version of Ebola. The virus has not been extinguished but continues to spread indefinitely in the North Kivu population. It is now thought that 80% of severe disease outbreaks occur in fragile state settings.” Over a million internally displaced people are travelling in and out of North Kivu. The escalating conflict will undoubtedly prolong the outbreak. This outbreak is contained in this particular instance. Nonetheless, there is a high likelihood of recurring and potentially being more severe. The effects could be more devastating if the disease spreads to other fragile neighbours experiencing similar conflict, such as South Sudan.
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