Authorities in the Democratic Republic of Congo (DRC) have documented as of Monday over 8,000 confirmed cases of Ebola Bundibugyo, nearly half of them fatal, since an outbreak of the disease was identified there in May, and are concerned that the mass violence and displacement in the region will exacerbate the outbreak.
The World Health Organization (W.H.O.) confirmed in May an outbreak of the Bundibugyo strain of Ebola, which is less common than the Zaire and Sudan strains, for which treatments and potential vaccines exist. By the end of the month, W.H.O. Director-General Tedros Adhanom Ghebreyesus was in Ituri province, eastern DRC, meeting with health officials in the area and encouraging locals to accept the reality that Ebola was a documented viral disease and health workers were trying to help them.
Ebola is a viral disease that spreads through contact with infected animals or the infected bodily fluids of humans. Its symptoms include fever, body aches, diarrhea, vomiting, and, in its most severe form, significant loss of blood. It is not airborne, but has spread rapidly in DRC as a result of the close contact that locals have with the bodies of victims through the process of traditional burials. Authorities have attempted to discourage traditional burials, urging locals to engage in safe and dignified burials, instead, but the suggestion has amplified local outrage against health workers.
According to the W.H.O., as of Monday, authorities have confirmed 8,067 cases of Ebola as part of the DRC-centered outbreak identified in May. Of these, 3,901 people have died, a fatality rate of about 48 percent. The outbreak’s epicenter remains Ituri province, but cases in neighboring North Kivu are reportedly rising rapidly. Attempts to trace the contacts of confirmed Ebola cases have been significantly complicated by the mass displacement of thousands of people as warring militias vie for control of the local illicit mining industry. In one local displaced persons camp highlighted by the U.N., for example, 19,000 displaced people regularly face “armed violence, threats and intimidation against civilians, arrests, forced displacement and the destruction of shelters.”
“The UN fears that the unplanned departure of thousands of displaced people, combined with restricted access to the site, could hamper disease surveillance,” the global institution warned on Monday. “Today across Ituri province, more than 1.1 million people are displaced by conflict and violence, including more than 373,000 living in displacement sites.”
The DRC, and much of Africa where Ebola outbreaks have occurred, have struggled with widespread distrust of humanitarian workers and a pervasive belief that Ebola is not real but, rather, an excuse to kill local African people. The result has been widespread mob attacks against Ebola clinics, doctors, and others seeking to contain the disease.
On Sunday, authorities confirmed that Marie-Celestin Karondwa, a senior member of the ruling Union for Democracy and Social Progress (UDPS) political party, was beaten to death after appearing on local radio and encouraging Congolese to take precautions to contain the spread of the disease. Reports at press time have not identified the individuals or groups involved in the killing.
The safety of health workers has also been a persistent struggle for the DRC. In addition to those attacked by armed thugs who do not believe that Ebola is real, many providers work with insufficient personal protection. A Congolese doctors’ organization confirmed the death of a frontline doctor, Dr. Victor Kingombe, on Thursday after exposure to Ebola patients, protesting against “several dysfunctions” at treatment centers that require urgent attention. The doctors, according to the local outlet Radio Okapi, complained that treatment centers do not have enough working doctors sufficiently trained to address Ebola, not enough water, and a lack of cleaning products, hand sanitizer, and personal protective equipment (PPE).
“The trade union organizations are also calling for the opening of a thorough and independent investigation to establish the circumstances leading to the contamination and death of Dr. Victor Kingombe,” Radio Okapi added.
Dr. Kingombe died last week in Kisangani, the capital city of Tshopo province, while working at the Ebola treatment center there. Tshopo is located directly west of Ituri and borders both Ituri and North Kivu.
“Healthcare workers have also been faced with rampant mistrust at the community level, and treatment centres and burial teams have been attacked on numerous occasions,” AfricaNews observed in its coverage of Dr. Kingombe’s death on September 25. “Rumours have spread widely, and many people do not believe that Ebola is real.”
Contrary to reports from the United Nations and local doctors, the Congolese Ministry of Public Health announced an “overall favorable development” in containing the disease on Saturday. Authorities claimed to have successfully used contact tracing for 78.3 percent of implicated persons and identified seven “health zones” that have not documented a new case in 42 days. Reports agree that the acceleration of the number of cases in Ituri has diminished, though it remains the most affected province, but reports outside of the Public Health Ministry indicate that North Kivu and other neighboring provinces are still seeing significant increases in the number of documented cases.
In addition to tracking Ebola, the Public Health Ministry warned that it is now seeing a growing number of cases of other diseases, primarily malaria. Malaria is endemic to the DRC and spreads through mosquitos, which makes it more difficult to contain than Ebola.
“In that part of Africa, there is a lot of malaria, and this may feel exactly like malaria (a mosquito-borne parasitic disease),” Dr. Adi Nadimpalli, who spent weeks treating Ebola patients in DRC with Doctors Without Borders, told the radio program Florida Matters Live & Local on Monday. “You have an insect bite, and a few days later you have fevers, muscle pain, joint pain. and so people get treatment for malaria. Maybe the virus doesn’t affect them as badly. They get better and they go home.”
Bloomberg reported on Monday that DRC officials had documented a catastrophic drop in the use of health care in eastern DRC for non-Ebola conditions, including a significant drop in child vaccinations.
“The use of routinely-monitored services fell from almost 24,900 patient encounters in April to just over 14,300 in June in four health districts,” Bloomberg reported, citing the humanitarian research organization ACAPS.