The deadly Ebola outbreak in the Democratic Republic of the Congo (DRC) is rapidly approaching the one-year mark. Efforts to contain the spread of the virus have been constrained by ongoing violence in the region. The presence of multiple paramilitary organizations, looting of treatment centers, and local distrust of vaccines and healthcare workers has resulted in many people either being unable to seek medical aid or neglecting to report symptoms and spreading the virus.

According to the official figures released by the World Health Organization (WHO), this outbreak of Ebola Virus Disease (EVD) has infected close to 2,500 people and killed nearly 1,700 as of July 11, 2019. This makes it the second-largest outbreak of the deadly virus, surpassed only by the 2014-16 EVD epidemic, which swept through West Africa, spread to parts of Europe, the United Kingdom, and the United States of America, and killed over 11,000 people.

Timeline of the Outbreak

The outbreak started in the conflict-ridden North Kivu province on August 1, 2018, and tests revealed that it was the Zaire ebolavirus species – the same one responsible for the 2014-16 epidemic. An experimental vaccine and public health measures showed some success in slowing down the spread of the outbreak initially, but violence in the region started preventing aid workers from reaching cases and the number of potential exposures increased over the following months.

By September 2018, the WHO stated that it was “extremely concerned” about the outbreak, as the death toll reached over 100 people. In addition to the continued conflicts, fears about the Ebola vaccine also created pockets of resistance that became hotspots for new EVD infections. By November, the outbreak had grown to 426 confirmed cases and 245 confirmed deaths.

In February 2019, two Ebola treatment centers run by Doctors Without Borders were attacked and set on fire. Attacks on treatment centers by armed groups and violent pushback from distrustful locals continued throughout the spring. The WHO reported there were 42 attacks on health facilities between January and May, resulting in the injury or death of 85 care workers.

Recent Developments

The severity of the DRC situation has increased dramatically since June. Due to the continued violence in the region and interruptions in treatment efforts, the number of new EVD infections has tripled to over 2,000 confirmed cases. While the number of new infections has dropped in some former hotspots, previously undetected chains of transmission have resulted in a large number of people with confirmed or probable EVD exposure moving or traveling to other areas and causing new outbreaks, including areas where the virus had previously been under control.

Meanwhile, paramilitary groups have continued to target healthcare workers and loot Ebola treatment centers – with a total of 198 attacks since January. Even when not explicitly targeting healthcare providers, the continued conflict in the region has hampered efforts to treat and contain the outbreak. For example, on July 24th, militants attacked two towns in the epicenter of the Ebola outbreak, killing 12 people and forcing health workers to pull out of the area.

International Health Emergency

On July 17th, the WHO declared the Ebola crises in the DRC to be a “public health emergency of international concern” (PHEIC). This is the highest level of alarm for the WHO and has been issued only four times in the history of the organization. With over 2,612 cases and at least 1,746 deaths confirmed through July 23rd, the virus has a mortality rate of 67 percent. This is despite the use of an effective vaccine and personal protective equipment. Health workers point out that these totals represent bare minimum estimates, since many potential infection hotspots are often inaccessible due to conflict, making accurate recording and tracing of cases nearly impossible.

The outbreak has spread eastwards into the Ituri province and has been confirmed in cities near the borders of Uganda and Rwanda. There have been three confirmed EVD cases in Uganda – a family who traveled from the DRC into Uganda seeking medical care. As of July 3rd, 108 contacts exposed in this incident were identified, completed the 21-day follow-up period, and tested negative for the virus. At least another two dozen active cases of EVD have been caught at eastern border points of the DRC since the start of the outbreak.

Due to their own experiences with Ebola outbreaks, Uganda and Rwanda have implemented measures to strengthen early detection and containment of EVD. This has included vaccinating front-line workers and bolstering awareness campaigns to educate the public. The virus is highly contagious and can be spread directly through contact with the blood or bodily fluids of infected people, or indirectly by touching objects (such as medical equipment, toilets, etc) contaminated by such fluids. Widespread public awareness of the signs of EVD and how to report potential cases are critical to effectively contain the virus. However, other countries bordering the DRC have much less public health infrastructure in place, making them extremely vulnerable should the outbreak spread to their populations.

Global Response

Earlier in July, the WHO International Health Regulations Emergency Committee responsible for assessing the situation has expressed concern over delays in securing international funding to cover costs associated with the outbreak response – which amount close to $250 million. The committee also reinforced the need for countries to avoid unintended, but punitive, economic consequences that can occur by restricting travel and closing trade routes to the area. Increase economic hardship forces people to leave affected communities to seek work, contributing to the spread of the outbreak.

In response to the PHEIC declaration, the World Bank Group announced on July 24th that it would be mobilizing up to $300 million to help bolster the global response to the Ebola epidemic. This financial aid package will enable the DRC government, WHO, and other organizations involved in the relief effort to increase front line response and support the local economy of affected communities. According to a statement by World Bank CEO Kristalina Georgieva “The communities and health workers on the front line of this outbreak urgently need more support and resources from the international community to prevent this crisis from worsening inside the country and from spreading across borders”.

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