Violence threatens efforts to control Congo’s Ebola outbreak

A wave of violence in the Congo is threatening efforts to contain a serious outbreak of the Ebola virus in the African republic, according to the Irish head of the World Health Organisation’s response to the emergency.

Dr Mike Ryan, an assistant director general of WHO, is based in North Kivu province, where growing conflict is undermining efforts to bring the three-month-old outbreak under control.

“This is probably the first Ebola outbreak to happen in an active conflict zone,” he says on the phone from the town of Beni. “North Kivu is one of the most dangerous places in Congo, with constant attacks on security forces from various groups.”

Last week, Ryan’s team were forced to go to ground after gunmen killed 15 people in Beni, sparking a subsequent riot by frightened townspeople.

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“I was reminded of Belfast in 1972. We were driving back to town, the post office had been burned down, there were burning tyres in the street, stones and rocks everywhere in the aftermath of the riot.

“The city closes down and you can’t move. But every day we’re not out in the field tracking cases, you falling behind.”

The current outbreak has so far led to 266 cases and 168 deaths. Stemming the spread of the disease in a race against time, as aid workers travel to remote areas to track down new cases. They trace people who have been in contact with those infected and then look for the contacts of these contacts.

Ethnic killing

In September, a similar attack in Beni forced a two-day suspension of tracking activities and as a result the number of Ebola cases doubled.

North Kivu has been wracked by armed rebellion and ethnic killing since two civil wars in the late 1990s. The Allied Democratic Forces, an Islamist group based in Uganda but active in eastern Congo, has clashed with Congolese troops in Beni in recent weeks. Mai-Mai militia, comprising a number of armed groups that originally formed to resist Rwandan invasions in the 1990s, are also present in the region.

Ryan’s team have tracked down 5,700 contact cases so far, but they can’t operate when the security situation deteriorates.

Ryan's team have tracked down 5,700 contact cases so far, but they can't operate when security deteriorates

They also have to overcome distrust in communities wearied by years of violence, and Ryan says there are “pockets of resistance” to medical intervention.

The strategy is to create “social networks” centred on original cases, in which every contact will be vaccinated. So far, 127 of these networks have been created and vaccination rates are running at 97 per cent.

“The problem is that it’s not what you get, it’s what you miss. The virus spreads along the cracks,” says Ryan, who likens his work to “a detective story, the way you link all the evidence. Then you get cases you can’t fit into an existing transmission chain. That’s really bad news.”

Traditional healers

WHO staff have taken to working with traditional healers, who often enjoy greater trust in communities than mainstream health services, to improve their vaccination rates.

From Curry on the Sligo/Mayo border, Ryan studied in Galway and has been with the WHO since 1996. He says he has spent most of the time since then “chasing various viruses”.

He has spent most of the time since college 'chasing various viruses'

The development of a vaccine in recent years has helped provide greater protection for staff again Ebola, he says, but full precautions against the disease are still observed. Some 21 healthcare workers have been infected to date, of whom three have died.

The other major development since the massive Ebola outbreak in west Africa between 2014 and 2016 has been the development of drugs, which are still in the experimental phase, to treat the disease.

Ebola’s symptoms include fever, muscle pain and, sometimes, haemorrhaging from orifices. The disease can be spread through contact with body fluids from both living and dead victims – making safe burials vital in stopping its spread. In Beni alone, 350 burials have taken place.

For now, Ryan believes the situation in Beni is under control. “I’m pleased we’ve brought it under control. We’re doing well but need to remain vigilant. Hopefully, the security situation will remain calm.”