The Democratic Republic of Congo (DRC) is experiencing the deadliest Ebola outbreak in its history, with more than 2,300 deaths and 5,000 cases as of mid-August. The situation has become so dire that the epidemic is now killing one person every 30 minutes, in what has become the fastest growing Ebola outbreak on record, with more than 100 new cases reported on some days. There are fears that this outbreak could become the world’s largest, even surpassing the West African Ebola outbreak of 2014, which killed over 11,000 people and infected nearly 30,000.
“This is a terrifying time for people,” said Christian Aid’s Head of Global Humanitarian Response Salome Ntububa, who is based in Goma, the largest city in eastern DRC. “The fact it took nearly three months for the first 1,000 people to die from Ebola but less than three weeks for the number of deaths to double shows that this Ebola outbreak is at real risk of spiralling out of control.”
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The current outbreak, the DRC’s 17th since the virus was discovered 50 years ago, likely began in late April in the mining town of Mongwabalu in Ituri province in eastern DRC. While Ituri remains the epicentre of the outbreak, there have also been Eola cases confirmed in the four neighbouring provinces.
The DRC is one of the poorest countries in the world which makes efforts to contain the Ebola outbreak even more challenging. Over 85% of the DRC’s population live in extreme poverty, and more than 5 million people don’t get enough food to eat each day. Nearly 2 million people are in need of aid in Ituri province alone.
Reliable access to water is the first line of defence against Ebola but nearly 65% of people in the DRC lack basic access to water, and 85% are without proper toilets. The lack of transport and poor roads in eastern DRC also makes it hard for people to reach medical centres and receive the care they need in time.
There is currently no vaccine for the rare Bundibugyo strain of Ebola rampaging through eastern DRC and nearly 50% of cases lead to death. Given this stark reality, preventing the spread of the disease is the surest way to save lives.
Ebola is spread through contact with blood or bodily fluids of an infected person, often vomiting, diarrhoea and deadly bleeding, which are all symptoms. The body of someone who has died from the disease remains contagious and it is thought that it was at the funeral of the first victim that Ebola started to spread more widely, possibly through the local custom of paying respects by touching the body before it is put in the coffin.
To stop funerals becoming super-spreading events, there has been a concerted effort to make burials safe in eastern DRC, while maintaining the dignity to the deceased and respecting local customs, including the use of coffins with transparent side panels so mourners can still see inside.
Anyone experiencing the flu-like symptoms of the early stages of Ebola must immediately seek medical attention and be quarantined at a treatment centre before they can potentially infect anyone else.
However, a lack of trust in the authorities as well as rampant misinformation has hampered the health response. There were even several attacks on health workers and hospitals in the early stages of the outbreak.
Grace Shukuru Muguro, a 23-year-old nurse based in Bunia, the largest city in Ituri province, has seen firsthand the impact of false rumours.
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Conspiracy theories are a major problem here. People wrongly believe that the epidemic is a political plot by nurses. Others believe white people introduced this contagious disease. Some people believe that those who catch it never recover.
This is why a core element of Christian Aid’s response is making Ebola prevention messages are reaching local communities, which includes working with trusted local leaders, including pastors and priests to amplify the life-saving public health campaign.
“Religious leaders are much better placed to share health messages as they are much more in contact with people,” explained Moise Mbali, a 25-year-old pastor at a Baptist church in Bunia. “People trust the church far more than the authorities, as the church is considered a reliable source of information”.
Moises is one of 30 faith leaders who received Ebola prevention training from Christian Aid’s local partner CBCA (Community of Baptist Churches in Central Africa). Moises explained the main challenge of gaining the trust with local communities.
“The first obstacle is fear,” said Moise. “Many think they will die if they arrive at the hospital. Some say the disease was invented to make money or that it is caused by magic. These popular beliefs are driven by ignorance.”
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Following his training, Moise has called on his congregation to follow all safety protocols. He said: “We communicate these health messages during our sermons and pastoral visits. We tell them whenever someone shows signs of Ebola to immediately quarantine and go directly to the hospital.”
Health workers on the frontline of this Ebola outbreak are putting their lives at risk to stop the spread of the disease. Thanks to funding from Irish Aid, Christian Aid through our local partner CBCA, is supplying 20 health centres across Ituri province with hygiene and disinfectant kits, as well as protective clothing including gowns and gloves for health workers.
Sarah Borive Dhenyo, a 28-year-old nurse based in Bunia, fears not only the dangers she faces herself but the risks she is taking for her own family.
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Ebola has taken the lives of many nurses. We know that nurses are very exposed and that we can get this disease at any time. I am very afraid of being infected by the Ebola virus and infecting my family.
The situation in eastern DRC is made far more complex by ongoing fighting and attacks in Ituri and the neighbouring Ebola-affected provinces, where as many as 100 armed groups operate, often to control lucrative mineral rich areas.
Conflict both prevents the sick reaching treatment centres but also pushes large numbers of people into already overcrowded displacement camps, where it is even easier for the disease to spread. There are currently more than 1 million people displaced in Ituri province, living in nearly in 70 displacement camps.
William Mwesige Kabagambe works for another of Christian Aid’s local partners, ACC (Anglican Church of Congo), and has been responsible for sharing Ebola prevention messaging at Kigonze displacement camp, on the outskirts of Bunia.
More than 20,000 people forced to flee their homes to escape conflict now lives in Kigonze. The camp only has seven water points, and just one toilet for every 100 people, making it extremely difficult to maintain the hygiene standards necessary to prevent an outbreak. As of early July, at least 45 people have died from Ebola at Kigonze displacement camp.
An uncontrolled outbreak of Ebola in Kigonze camp would have disastrous consequences and there is a high risk of further spread to communities surrounding Bunia. Given the extremely high population density, the site represents a potential hotspot for Ebola transmission requiring an urgent prevention response.
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William explained that following USAID cuts two years ago, people at the camp have not received any food assistance. “Families struggle with malnutrition from a lack of food and resort to low paid day-labour,” he said.
The poverty in the camp also pushes people to take increased risks to find the money they need to buy food and other essentials. “Some families have adopted extreme measures to survive, including sending children begging or women engaging in sex in return for financial support,” explained William.
Despite the worrying increase in both cases and deaths in eastern DRC, the recent opening of a 100-bed treatment centre in Bunia offers a glimmer of hope. However, there are still many opportunities for improved coordination that would make a considerable difference in the response, including bringing Ebola testing laboratories closer to communities, ensuring all health workers have enough personal protective equipment and training more local volunteers to identify suspected cases.
The World Health Organisation is hopeful that it can reverse the spread within the next three months, and efforts to find a vaccine are underway. However, the scale of the unfolding crisis means that without a massive increase in emergency funding from the international community we are likely to see a speeding up of the spread of Ebola in eastern DRC and a further spike in the number of deaths.
For William at Kigonze camp, the urgent need to invest now in the Ebola response is crystal clear: “Every bit of support provided today means lives saved tomorrow.”
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