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Escalating Congo Ebola epidemic passes 2000 cases amid violence and suspicion

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l4062 (Published 05 June 2019) Cite this as: BMJ 2019;365:l4062

Linked BMJ Opinion

Congo’s Ebola epidemic—a failed response and the need for a reset

  1. Owen Dyer
  1. Montreal

The Ebola outbreak in the troubled north east of the Democratic Republic of the Congo has passed 2000 confirmed and probable cases, the World Health Organization has announced. The epidemic is now spreading faster than ever, as local suspicion and attacks from armed groups disable the medical response.

The 2000th case was a “sad and frustrating milestone,” said Tariq Riebl, emergency response director of the International Rescue Committee. At least 1346 people have died in the outbreak.

This is the second worst Ebola outbreak ever, though still far behind the 2014 west African epidemic that killed over 11 000 people. No other outbreak has killed over 300.

“To say that things are not going well is an understatement,” said Riebl. “It’s time the international community wakes up to the severity of this crisis.

“We are now seeing eight to 20 cases recorded each day, a number that is very likely an underestimate. Just a few months ago, we were only seeing three to five. To see such a spike in cases at this stage in the outbreak means a drastic change is required. This response requires a total and complete reset.”

Most worrying, he said, is that, although it took 224 days to reach the first thousand cases, it took only 71 more days to reach the second thousand.

Although this is the Congo’s 10th Ebola outbreak since the disease was discovered in 1976, the affected provinces (Kivu Nord and Ituri) had never seen the disease before. The peace that ended the second Congo war in 2003 has been largely theoretical in this region, and dozens of armed groups operate there.

Some local leaders claim that the Ebola outbreak is “fake news,” designed to justify the entry of outsiders whose real goal is to steal the region’s mineral wealth. Another circulating rumour contends that the disease is real but accuses the central government or international agencies of spreading it deliberately to justify their presence.

Attempts to safeguard medical staff against violence and infection with armed guards and protective clothing only feed suspicion and hostility, aid groups have said.

“Community members do not trust medical staff and aid organisations and are not coming into health facilities when they show Ebola symptoms,” said Riebl. “In Butembo, the current epicentre of the outbreak, doctors and nurses are being threatened and health centres attacked regularly.”

A Cameroonian doctor was killed last month in one attack on a hospital in Butembo, and since then, the pace of attacks has escalated. Matshidiso Moeti, WHO regional director for Africa, said there had been 174 healthcare related attacks on healthcare facilities, health workers, or volunteers.

Five health workers are known to have died from violence so far. The most recent was on 22 May when, according to the Congo’s health ministry, people from the village of Vusahiro “rose up and attacked the local Ebola response team, made up of village residents who were trained to carry out certain response activities.”

A hygienist from the infection prevention and control team died of his injuries after transfer to hospital, the ministry said.

On 30 May, 26 rebel fighters were killed attacking an army post near the town of Beni, where nearly 200 people have died from Ebola. The same day, WHO director general Tedros Adhanom Ghebreyesus told the annual World Health Assembly in Geneva that Ebola health workers had been attacked six times in the last eight days.

Ghebreyesus was one of the authors of a 29 May article describing the outbreak in the New England Journal of Medicine.1 It charted how local outbreaks of violence—a massacre of civilians last September in Beni, a violent electoral crisis in December, and the burning of Ebola treatment centres in Katwa and Butembo in February—were followed by local surges in new Ebola cases.

On 4 June, 13 civilians and two soldiers were killed and a teenage girl kidnapped in another attack near Beni.

“The risk of national and regional spread remains very high,” WHO warned, as on 3 June health workers were scrambling to contain the risk posed by an annual pilgrimage of Christians from the outbreak zone to Namugongo in neighbouring Uganda.

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