Occurring in the midst of a conflict zone, where residents live in daily fear of being shot or raped by one of many armed insurgency groups, and basic health infrastructure in clinics has been lacking – this outbreak may be the most complicated and difficult to manage ever.

Despite the use of an effective vaccine (over 100,000 people vaccinated), and the promise of novel treatments offered to all patients admitted to an Ebola Treatment Centre, the cases and fatalities continue to climb and transmission rates are actually increasing.  There has been a sharp upsurge in the number of new cases in the last 3 weeks.

Figure from WHO situation report May 14, 2019:

This is a new outbreak that started August 1, 2018 in north Kivu in Eastern DRC – just days after the previous outbreak 780 miles away in the Équateur province in Western DRC was declared over.   The Équateur province is very peaceful compared to north Kivu.  The Équateur outbreak was relatively quickly controlled – lasted less than 12 weeks (May 8 – July 24) – and had only 54 cases and 33 deaths.

In north Kivu there is a serious mistrust of healthcare workers and outsiders who have come to provide assistance.  This mistrust has often spilled over as violence and there have been more than one hundred armed attacks against healthcare workers since the north Kivu outbreak.

Context is essential.  This area has seen years of exploitation for mineral wealth and much of the violence and war that was pushed out of Rwanda after the genocide in 1994 settled here.  The mistrust follows years of watching and complaining that UN troops, with all their arsenal, logistics and soldiers, remained on the sidelines while villagers were attacked by armed gangs.*  The mistrust follows years of exploitation as over 60% of the world’s coltan for cellular phones comes from this area.*

A genuine commitment to the health of the Congolese people would mean ending the war and years of injustice and exploitation and not just stepping in when contagion threatens to spill across the borders.

 

Photo from Al Jazeera article: Who profits from the conflict in the DRC?