Updated on Tuesday, November 14, 2018:
The World Health Organization announced that the Ebola outbreak in eastern Democratic Republic of Congo could go on for at least six months. Already it dates back to mid-summer. As of Nov. 13, some 333 confirmed cases have been reported, of which more than 200 died.
Many of the victims were children, which is unusual and lead epidemiologists to track down one unexpected source for the disease: "tradi-modern" clinics that ostensibly offer both traditional medicine and modern cures. In fact they were unregulated, even to the extent of reusing hypodermic needles. Children had gone to the clinic for malaria shots only to leave with Ebola.
But the overriding problem in this epidemic is violence, as The Daily Beast reported last month.
One of the largest “armies,” the Allied Democratic Forces, which began as an Islamist movement in neighboring Uganda but now has no clear agenda, attacked not only a local Congolese army garrison and U.N. peacekeepers, but civilians.
Twenty-one people—17 of them civilians—died.
It was the seventh attack in August and September, six in all before this one on Sept. 22. The locals declared “ville morte” (literally, “dead city”) shutting down the town of more than 40,000 people for one day. Then another. Then another. For a time at least the violence subsided.
But during that lockdown, death came in by another door. It was Ebola.
The disease had already hit the town, but now it picked up its pace. The week after the two-and-a-half day ville morte there were 15 new confirmed and probable cases in Beni—a 50-percent increase over the week before the lockdown.
Beni is in North Kivu province, where an Ebola outbreak began last summer less than 20 miles away in the town of Mangina. North Kivu is a major thoroughfare in the Great Lakes region of Africa, adjacent to Uganda, Rwanda, and Burundi, with thousands of people crossing the borders every day at legal checkpoints.
Meanwhile, guerrilla organizations recognize no frontiers and answer to no one.
Since August 1, when the first case of Ebola was registered, the Congolese government, the World Health Organization, Médecins Sans Frontières, and others have been scrambling to contain the disease.
According to the latest WHO figures, as of Wednesday this week there have been 188 confirmed and probable cases; 118 have died. While the death rate is high, this latest outbreak is nowhere near the scale of the epidemic that swept through Guinea, Liberia, and Sierra Leone in 2014, which killed more than 11,000 people.
But Ebola has been on the move, and even more so because of the chaotic war zone.
Peter Salama, the World Health Organization’s head of emergency preparedness and response, told the press at the end of last month that the situation looks like a “perfect storm” amid “red zones” where fighters limit access to civilians. Distrust is heightened among people “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.” The DRC is due to vote for a new president on December 23.
World Health Organization Director-General Tedros Adhanom Ghebreyesus told the U.N. Security Council last week that the outbreak has reached a “critical point.”
“This epidemic is occurring in the context of much wider humanitarian needs, in a country whose people have suffered enormously over several decades,” Ghebreyesus said.
Although violence has not generally been directed at the health workers struggling against the epidemic, on October 2, barely a week after Salama described Ebola’s perfect storm in North Kivu, three Red Cross volunteers were attacked by members of the local community in Butembo, south of Beni. Two were seriously injured. They had been trying to bury Ebola victims safely, to limit the chance others would be infected.
More on the Fight Against Ebola:
Ebola spreads through contact with bodily fluids. One of the first priorities after people are diagnosed with the disease is to separate them from the general population. More than 15,500 doses of experimental vaccine have been administered in North Kivu, but that does not begin to contain the problem. All sorts of medical logistics have to be put in place, from isolation wards to labs testing for the virus.
Operations often are in areas where there is very little infrastructure. In the early days of the outbreak, in Mangina, internet communications were so spotty that much of the work had to be done on WhatsApp. But one of the most vital tasks is to track down anyone who might have come in contact with someone who’s infected, and watch them closely for symptoms.
“Finding suspect cases and their contacts is a kind of detective work,” says Tarik Jašarević, a WHO spokesman who recently returned from North Kivu to headquarters in Geneva. “It involves speaking with people, helping them remember who they met with and where they were. That’s how we find people who may be at risk of contracting the disease.”
That was one of the things that could not be done in Beni during ville morte.
“We certainly believe that the upsurge in cases in Beni that we are seeing in the last few days is related to the fact that we were unable to do the contact tracking,” WHO emergency response chief Salama told The Daily Beast in a phone interview on Wednesday.
And there is a new twist, born of fear and Congolese politics. “What we are seeing now is a relationship between the insecurity and reaction to the Ebola response,” said Salama.
Chaos and turmoil in Congo means the response has been messy. Civilians argue the that if the government and international community can’t protect them, then why bother?
Ebola response teams work with the Congolese government and the international community. The U.N. Organization Stabilization Mission in the Democratic Republic of the Congo, or MONUSCO, has some 20,000 people on the ground in the DRC—including more than 15,000 soldiers.
But they have not proved an effective match for “Mai-Mai” guerrillas, a catch-all term for small factions throughout the North Kivu region. And they’re certainly seem no match for the Allied Democratic Forces (ADF), which hit Beni last month only 600 meters from the WHO’s center of operations for the entire region.
Salama previously warned that the ADF “has enormous capabilities: They’ve been able to overrun entire FARDC [Congolese government army] bases in and around Beni. They’ve been able to ambush MONUSCO forces particularly on the road from Beni to Mavivi and they’ve been able to reach … right into the center of the city of Beni itself.”
“It’s very obscure, this group,” Salama told The Daily Beast. “We know they have some association with Islamist groups. But we know very little else about them.”
This tenth outbreak of Ebola in the Democratic Republic of Congo may yet be contained, and hopes for the vaccine are growing. But the disease of war defies a cure.
CORRECTION: An earlier version of this story mistakenly said the Red Cross workers in Butembo had been killed in September. In fact they were attacked and injured on October 2.