Ebola Response in DRC Continuously Complicated by Violence

Health officials in the Democratic Republic of the Congo (DRC) have faced numerous challenges in recent days, including a surge in violence, as they fight to gain control of the Ebola outbreak there.

"It's almost like we're war medics in a sense," Dr. Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, told Contagion^® of the response efforts.

As of Thursday, there were 885 reported cases, including 820 confirmed and 65 probable, CIDRAP reported, citing reports from the health ministry, which identified 8 new cases in Katwa, 1 in Butembo, and 1 in Kalunguta on Wednesday and Thursday. Total deaths from the outbreak reached 555.

"I think that the big issue is that this outbreak is still ongoing," Anne W. Rimoin, PhD, MPH, professor at the UCLA Jonathan and Karin Fielding School of Public Health, told Contagion^®. "We saw this in West Africa, too. Just when you think that things are moving in one direction they might go in another direction.”

Dr. Rimoin, director of the UCLA-DRC Health Research and Training Program and the Center for Global and Immigrant Health, has led work in the DRC for the past 17 years. A team of investigators associated with her recently released a study reporting that many health workers in the DRC showed reactivity to the Ebola virus despite never having reported symptoms.

But there’s still a lot of work to be done, Dr. Rimoin said. “The fact that this is happening in a conflict zone makes it quite complicated."

Indeed, an attack Wednesday at an Ebola Treatment Center (ETC) in Butembo forced work there to be suspended after some facilities and vehicles were set on fire, according to Doctors Without Borders (MSF). No one was injured at the center, which was serving 57 patients, including 15 confirmed to have Ebola. Patients were transferred to a transit center.

On Tuesday, MSF suspended work at an ETC in Katwa after it was partially burned down in a violent attack Sunday evening that left 1 caregiver dead. Patients transferred from that facility included 6 suspected to have Ebola and 4 confirmed.

On Feb. 20, a nurse in Vuhovi was abducted and murdered, halting efforts at the Bisongo health center there, CIDRAP noted.

Before the surge of violence, health care workers noted progress in Beni, where no new cases had been reported in more than 3 weeks—a full incubation period. But 2 days later a new case was reported in the city.

"I think Beni still reflects basically a major success. The case we had this past week was a contact case," Dr. Osterholm told Contagion^®. "I for one am very positive on the activities that are going on over there and what they're doing to try to limit this. But, at the same time, I'm also the first to say expect the unexpected in situations like this. It's not over ’til it's over."

He said efforts to vaccinate have been crucial to limiting the spread of the disease. Since August, more than 82,000 people have been vaccinated in the DRC and nearby countries, with about half of those vaccinations occurring in the hots zones of Katwa and Beni.

Dr. Osterholm called the response of the public health community in the DRC "remarkable" despite social, political, and economic problems creating an uphill battle along with such issues as misinformation and cultural challenges contributing to hesitancy to among some to get vaccinated.

"It's hard to have a command structure here when you have people burning down your clinics and killing your workers," he concluded.