DRC Ebola outbreak: 100 dead of infection, rebel attacks intensify

Almost 2 months into the Democratic Republic of the Congo’s 10th Ebola outbreak, the virus has killed at least 100 people and escalating violence by armed government opposition groups continues to complicate the response, a WHO official said today.

At a news conference, Peter Salama, MBBS, MPH, WHO deputy director-general for emergency preparedness and response, said the response in North Kivu province has reached “a critical juncture.”

According to Salama, there have been 150 confirmed and probable cases of Ebola and at least 100 deaths from the virus in the current outbreak, but he said overall the trends have been positive in recent weeks, with case counts falling from about 40 per week to 10. Additionally, response teams have been able to contact and treat nearly 100% of all confirmed case contacts through the ring-vaccination method.

“We’ve seen some real breakthroughs in the tools we have at our disposal, particularly the vaccination program using the investigational Merck vaccine,” Salama said. “It has now reached more than 11,700 people, which is the largest scale use of an Ebola vaccine that we’ve ever seen.”

However, Salama said the response is facing a series of “grave obstacles,” including an increase in attacks by armed opposition groups in the area of the outbreak. He said there have been attacks on seven occasions: on Aug. 24 and six attacks now between Sept. 3 and Sept. 22.

Salama characterized the most recent attack in the city of Beni — the base for WHO’s response operation — as the most violent and dramatic attack thus far. He said it resulted in at least 21 deaths, including 17 civilians, and was the first in which civilians were indiscriminately targeted instead of state forces or United Nations peacekeepers.

“I’ve previously referred to the Ebola outbreak in North Kivu as arguably the most difficult context we have ever faced,” Salama said. “We are now extremely concerned that several factors may be coming together over the next weeks to months to create a potential perfect storm, a perfect storm of active conflict, limiting our ability to access civilians; distrust by segments of the community already traumatized by decades of conflict; and of murder, driven by a fear of a terrifying disease but also exploited and manipulated by local politicians prior to an election, and of course a frightening high-threat pathogen that will exploit these community and political fault lines and not respect borders whether they are provincial or international.”

Salama said residents of Beni and surrounding communities would be protesting and mourning through Friday, effectively shutting down WHO activities. The more than 80 WHO staff in Beni have been confined to the Emergency Operation Center or to their hotels for the time being, he said, having a negative impact on Ebola outreach.

“Yesterday, we only reached 20% of contacts of confirmed and probable cases, meaning 80% of people at risk were unable to be reached,” Salama said. “This whole week we may have cases that become more symptomatic and infectious.”

Salama explained that although most of the community has been responsive, there are large pockets of community distrust and resistance being exploited by politicians and rebel group leaders. This exploitation is causing people to refuse active follow-up and care, and flee in to surrounding forests, contributing to missed cases and the spread of Ebola into red zones and border countries, he said.

“We call again on all parties and any governances or groups that have influences over these parties to help protect responders and civilians and our access to them,” Salama said. “We call on the international community to continue to fund response in North Kivu and neighboring provinces and surrounding countries with priority on Uganda, Rwanda, South Sudan, and Burundi, and we call on those countries [to prepare].” – by Caitlyn Stulpin

Disclosure: Salama reports no relevant financial disclosures.

Almost 2 months into the Democratic Republic of the Congo’s 10th Ebola outbreak, the virus has killed at least 100 people and escalating violence by armed government opposition groups continues to complicate the response, a WHO official said today.

At a news conference, Peter Salama, MBBS, MPH, WHO deputy director-general for emergency preparedness and response, said the response in North Kivu province has reached “a critical juncture.”

According to Salama, there have been 150 confirmed and probable cases of Ebola and at least 100 deaths from the virus in the current outbreak, but he said overall the trends have been positive in recent weeks, with case counts falling from about 40 per week to 10. Additionally, response teams have been able to contact and treat nearly 100% of all confirmed case contacts through the ring-vaccination method.

“We’ve seen some real breakthroughs in the tools we have at our disposal, particularly the vaccination program using the investigational Merck vaccine,” Salama said. “It has now reached more than 11,700 people, which is the largest scale use of an Ebola vaccine that we’ve ever seen.”

However, Salama said the response is facing a series of “grave obstacles,” including an increase in attacks by armed opposition groups in the area of the outbreak. He said there have been attacks on seven occasions: on Aug. 24 and six attacks now between Sept. 3 and Sept. 22.

Salama characterized the most recent attack in the city of Beni — the base for WHO’s response operation — as the most violent and dramatic attack thus far. He said it resulted in at least 21 deaths, including 17 civilians, and was the first in which civilians were indiscriminately targeted instead of state forces or United Nations peacekeepers.

“I’ve previously referred to the Ebola outbreak in North Kivu as arguably the most difficult context we have ever faced,” Salama said. “We are now extremely concerned that several factors may be coming together over the next weeks to months to create a potential perfect storm, a perfect storm of active conflict, limiting our ability to access civilians; distrust by segments of the community already traumatized by decades of conflict; and of murder, driven by a fear of a terrifying disease but also exploited and manipulated by local politicians prior to an election, and of course a frightening high-threat pathogen that will exploit these community and political fault lines and not respect borders whether they are provincial or international.”

Salama said residents of Beni and surrounding communities would be protesting and mourning through Friday, effectively shutting down WHO activities. The more than 80 WHO staff in Beni have been confined to the Emergency Operation Center or to their hotels for the time being, he said, having a negative impact on Ebola outreach.

“Yesterday, we only reached 20% of contacts of confirmed and probable cases, meaning 80% of people at risk were unable to be reached,” Salama said. “This whole week we may have cases that become more symptomatic and infectious.”

Salama explained that although most of the community has been responsive, there are large pockets of community distrust and resistance being exploited by politicians and rebel group leaders. This exploitation is causing people to refuse active follow-up and care, and flee in to surrounding forests, contributing to missed cases and the spread of Ebola into red zones and border countries, he said.

“We call again on all parties and any governances or groups that have influences over these parties to help protect responders and civilians and our access to them,” Salama said. “We call on the international community to continue to fund response in North Kivu and neighboring provinces and surrounding countries with priority on Uganda, Rwanda, South Sudan, and Burundi, and we call on those countries [to prepare].” – by Caitlyn Stulpin

Disclosure: Salama reports no relevant financial disclosures.