An outbreak of Ebola in a volatile region of eastern Democratic Republic of Congo is now the second worst in history.
At least 426 people have been infected with the virus and 245 people have died since August, the country’s health ministry said late on Thursday.
"The outbreak in North-Kivu has become the second largest Ebola outbreak in the world, after the one in west Africa, " Olly Illunga Kalenga, minister for health, said.
Congo has suffered 10 outbreaks of the virus, since it was discovered in 1976 near the Ebola river in the centre of the country. Over the decades, Congolese health officials and foreign aid workers have become skilled at containing infection when outbreaks occur but those incidents have mainly occurred in peaceful, sparsely populated parts of the country.
The latest outbreak poses a new challenge. North Kivu province is densely populated and patrolled by dozens of armed groups, making it difficult for victims to seek help and for medical response workers to get to victims.
Evacuated
Earlier this month the World Health Organisation temporarily evacuated 16 staff from the town of Beni in the north of the province after fighting between armed groups flared.
"Insecurity affects the ability of victims to come and get help, and heavily affects the ability of response workers to get to where they need to be," Stacey Mearns, Ebola response programme director at the International Rescue Committee, said in Butembo in North-Kivu.
“Looking at the average case numbers we’ve had, looking at how the outbreak has evolved into new areas, I still think we are climbing towards the peak of the epidemic curve and we are nowhere near the top yet,” she said. “Things are going to get a lot worse before they get better.”
Containment
Containment of the virus has also been complicated by surprisingly high levels of community resistance, Ms Mearns said.
Ebola is spread through contact with bodily fluids and causes haemorrhagic fever with severe vomiting, diarrhoea and bleeding. Successful containment requires the quick isolation of suspected patients and the safe burial of those who have died. A failure to quickly enforce these practices in 2014 among communities in west Africa, where outbreaks are less common, killed more than 11,000 people in two years in Liberia, Guinea and Sierra Leone – the worst outbreak ever.
In North-Kivu a general suspicion of public authorities due to decades of conflict is feeding into the community resistance normally associated with Ebola outbreaks, Ms Mearns said. Communities have staged protests when suspected patients are quarantined and some family members continue to forcibly remove the bodies of Ebola victims from hospitals after they have died.
“It is worrying to be this far into an outbreak and still see such big acts of resistance,” Ms Mearns said.
Preventive vaccine
Other aspects of the response have been positive. The first cases in August were identified fast, the local and international response was mobilised quickly and a new, preventive vaccine has already saved thousands of lives.
Still, the outbreak is spreading, underlining the social dimension of containment, Mr Kalenga, the minister of health, said.
“Beyond the medical response, it is the community that must decide to end the spread of this outbreak by collaborating and respecting prevention measures,” he said.
The centre of the outbreak is also close to the border with Uganda and Rwanda, increasing the risk of regional spread, though no cases have been confirmed in those countries yet. – Copyright The Financial Times Limited 2018