WHO Scales Back Ebola Response Following Deadliest Attacks Ever On DRC Health Workers

WHO and its partners have evacuated Ebola response workers in the Biakato Mines Area of the Democratic Republic of Congo following two deadly attacks on Wednesday night that left 4 Congolese staff dead, and 6 staff wounded – including a WHO staff member. The scale back of the Ebola response raises the possibility of a resurgence of the Ebola virus just as the outbreak that has been raging for over a year appeared to be nearly vanquished.

“We are heartbroken that people have died in the line of duty as they worked to save others,” said World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus in a press release as well as videotaped remarks. “Ebola was retreating. These attacks will give it force again, and more people will die as a consequence.”

Only seven confirmed cases were reported between 18 to 24 November, down dramatically from a peak of 120 cases per week in April and a second peak of 85 cases per week in July.

Peacekeepers from the UN Organization Stabilization Mission in the Democratic Republic of the Congo (MONUSCO) on patrol in DRC’s IIturi Province to deter activities by militias that have targeted Ebola response teams. (Photo: MONUSCO)

But with the attacks on health workers in the Biakato Mines area, the latest event in a rash of violence in eastern DRC, critical outbreak response activities have been suspended in many areas where the threat of the virus still lingers.

“It will be a tragedy to see more unnecessary suffering in the communities that have already been through so much. Without responders, the virus spreads through the community undetected and uninterrupted,” Mike Ryan, WHO’s Emergency Ebola Coordinator told a Geneva press conference.

The interruption of the outbreak response has led to an over 50% decrease in alerts of suspected cases, a collapse in vaccination efforts, and a decrease in contact-tracing, said Ryan. These, he added, were “all of the key indicators that point towards ending the outbreak.” Case-management of Ebola patients, safe and dignified burials, and a very limited alert system continue in the Biakato Mines area.

He emphasized that this has been the deadliest attack of the Ebola outbreak so far, with the violence claiming the lives of one health worker responsible for immunizations  and two drivers in Biakato, as well as one policeman in nearby Mangina who was involved in security the Ebola response teams. In total, the WHO has recorded over 386 attacks against Ebola responders during this outbreak alone, resulting in 77 injuries, and 7 deaths.

“My heart goes out to the family and friends of the first responders killed in these attacks,” said WHO Regional Director for Africa Dr Matshidiso Moeti. “We are doing everything possible to bring the injured and front-line workers in the impacted areas to safety. These constant attacks must stop. We will continue to work with the DRC Government, partners and [UN peacekeeping troops] MONUSCO to ensure the security of our staff and other health workers.”

Tragedy On The Brink Of Ending The Outbreak

Surges of violence and unrest have been a frequent feature of this latest Ebola outbreak in Ituri and North Kivu provinces, which began in August of 2018. The latest attack comes just days after WHO was forced to evacuate 49 of its 120 staffers in Beni, following civil unrest there that led to angry attacks on the MONUSCO base, which in response to an attack by the rebel Allied Democratic Forced (ADF) on civilians that left at least 19 dead and many more displaced.  Protesters in Beni said that they were frustrated that MONUSCO had failed to protect them from rebel militias.

Ebola case map as of Nov 14, 2019. The epicenter in Mandima Health District has been the Biakato Mines area, the source of about half of recently reported cases. (Map by: EU Humanitarian Aid – @eu_echo)

As for the attack on Biakato Mines, Ryan noted that it was “unmistakably directed at the [Ebola] response.” He said it was unclear exactly who perpetrated the attack, although local officials told TRT World that Mai-Mai fighters had attacked the camp.

With the rash of violence, Ryan told reporters that WHO had lost access to “key communities” not only in Biakato Mines, but also in nearby Oicha, Lwemba and Beni where some of the last known Ebola chains of transmission had persisted.

Until very recently, some 98% of the known Ebola cases had been traced back to two chains of transmission involving those areas, but the suspension of activities due to the recent attacks could result in “losing some of those gains,” Ryan said. “The last stronghold of the virus was in these very areas, and now because of violence, because of insecurity, we’ve lost access to these communities.”

While no cases have been reported from the Biakato Mines area itself in almost two weeks, the risk of resurgence there and in the surrounding area remains high, says Ryan, noting that cases in Beni and Oicha had been previously traced back to Biakato Mines.

The Biakato Mines health centre also serves the Lwemba health area, he noted, and the Lwemba area has been one of the “most complex and difficult contexts, both in terms of disease transmission and community acceptance.” Without teams on the ground, Lwemba has become even more inaccessible, says Ryan.

Throughout the response, community acceptance and community engagement have been major challenges. But recently, more and more people suspected of having Ebola had been actively seeking treatment at Ebola Treatment Units.

“Just yesterday, a pastor and his family from Lwemba presented themselves for care at an Ebola Treatment Unit,” said Ryan. “The real tragedy is also losing access to those communities, just at the moment where their views and attitudes were turning,.”

Insecurity and Violence Hindering the Outbreak Response

The insecurity has been attributed to the multitude of armed groups in eastern DRC – estimated at around 100.  WHO has long warned that the militias’ presence has significantly complicated the work of Ebola responders who have to be deeply embedded in the community to trace and vaccinate individuals who have come into contact with infected individuals.

To date, 2,199 people have died from the current Ebola outbreak, among 3303 probable and confirmed cases, according to DRC officials.  Ebola is endemic to the region, and this represents the 10th outbreak, but also the most deadly, since the disease was identified in the 1970s.

See Video of Dr. Tedros’ remarks below:


Image Credits: @eu_echo, Monusco .

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