The Democratic Republic of the Congo (DRC) confirmed via its public health agency on Sunday that at least 2,325 people have died of Ebola infections in the current outbreak in the east of the country, making it the deadliest such outbreak in the country’s history.
Experts noted that the extremely high death toll is likely not a full count of the people killed by the disease, as the World Health Organization (W.H.O.) was slow to identify an outbreak in the affected area, and that only one other known Ebola outbreak – the 2014-2016 outbreak in Guinea, Sierra Leone, and Liberia – has resulted in more deaths. The death rate of identified patients has increased in the past few months and resources to aid those diagnosed remain insufficient, health experts lament.
The current public health emergency is an outbreak of Ebola Bundibugyo, a strain for which no treatment or cure has been approved at press time. The strain is distinct from Ebola Zaire, the one responsible for the west African outbreak a decade ago and for which a vaccine product exists as a result of research conducted after that outbreak. That the current outbreak is being fueled by Bundibugyo is one of several factors complicating emergency response. The part of DRC affected, the eastern provinces of Ituri and North Kivu, are among the least stable and most remote in the country, plagued by incessant fighting among a host of militias and warlords seeking to control the illicit mining industry.
Locals have also reportedly shown high levels of distrust of foreign humanitarian aid workers and others in the health sector, attacking quarantine locations, stealing the bodies of the dead, and spreading rumors that Ebola is not a real disease. The violence against health workers has led to several strikes as those at highest risk demand higher salaries and more protection from both infection and mob attacks.
The United Nations warned this week that the outbreak in eastern DRC is the “fastest growing on record.” During a visit to the affected areas in early August, World Health Organization (W.H.O.) Director-General Tedros Adhanom Ghebreyesus said the outbreak would outpace the west African outbreak of the past decade if the pace at which the pathogen was spreading kept up.
“Ebola is winning in the Democratic Republic of the Congo. We cannot let the virus outrun our response,” U.N. Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Tom Fletcher was quoted as saying this weekend. Reports noted at the time that the current death rate documented in infected people is 46 percent, more than double what it was in early June.
Tedros held meetings in Kinshasa, the national capital, with DRC officials on August 5 to discuss expanding health access for those in affected zones, acknowledging that more support for the safety of health workers and better communication with locals who fear international aid workers was necessary.
In a statement following those meetings Tedros said:
We all agree that we must urgently and massively scale up all our efforts across all pillars of the response and by all partners,” “That means reaching every affected community despite insecurity and displacement, strengthening coordination under the Government’s leadership, ensuring health workers have the protection, training, and support they need, and accelerating access to care, surveillance, and safe, dignified burials.
Tedros warned last week that the outbreak is “moving faster than any previous” and predicted, “at its current pace, it is on track to eclipse the West African Ebola outbreak of 2014 to 2016.”
“Most concerningly, we see a high proportion of deaths in communities instead of treatment units, outside of known contact lists,” he explained. “That tells us there are chains of transmission we don’t know about, and until we know about – and break – every chain of transmission, we will not stop the outbreak.”
The issue of safe burials is paramount, as many local Congolese seek to honor the dead with traditional burial rites that require extensive touching and cleaning of their bodies. These traditional burials expose practitioners to infection and facilitate the spread of the disease.
The Congolese news outlet Radio Okapi reported on Sunday that Catholic leaders are urging locals to trust health professionals with preventive measures such as safe burials. Speaking in the city of Butembo, North Kivu, which has been heavily affected by the outbreak, Monsignor Melchizedek Sikuli Paluku, the bishop in charge of the diocese of Butembo-Beni, asked locals to refrain from stealing bodies or handling them inappropriately.
“What are they looking for with the bodies?” he asked body thieves, calling such an action “an attack on human life.”
“You are told it is dangerous and you go there knowing that it can kill you and others, too. Let us be responsible, let us be aware of the danger there is, and let us not expose the community to an epidemic which (has killed several) people,” the bishop added.
Officials with the Red Cross, active in the emergency response, also lamented the lack of trust they see in locals. In an article published by the regional outlet All Africa on Monday, International Federation of Red Cross and Red Crescent Societies (IFRC) operations manager Bruno Michon cited burial safety as one of the first pillars of disease containment that falls without a trusting relationship between the community and public health experts.
“Building community trust is absolutely key to an effective Ebola response,” Michon was quoted as saying. “Without community buy-in, all the other components of the response, such as Safe and Dignified Burials, will suffer, making the outbreak harder to contain.”
Health worker strikes, fueled in part by community attacks on them, also hamper Ebola response.
“You cannot fight Ebola if you don’t pay the people fighting it,” International Council of Nurses (ICN) CEO Howard Catton was quoted as saying in All Africa. “Nurses are risking their lives to protect their communities, often at great personal risk, yet months into this crisis many are still waiting to be paid.”
“Our calls are clear: Pay health workers what they are owed, guarantee they will be paid regularly from now on, and give them the protection they need to do their jobs,” Catton added.
In late July, health workers went on strike in Ituri, protesting that the government had simply stopped paying them.
“We need to be paid, because in the meantime the disease is spreading at the treatment center. I’ve already had five people die who are still inside there. A solution must be found for us,” striking health worker Martin Bolombi told the Associated Press (AP) at the time.