By - Adedoyin Shittu
The current Ebola outbreak in Democratic Republic of Congo (DRC), first declared last August, is the second deadliest of the haemorrhagic fever since it was discovered in Congo in 1976 and it is the tenth outbreak in the country. It is believed to have killed at least 1400 people so far and infected about 2054 people.
The outbreak which could not be traced initially was later discovered to be concentrated in the North Kivu Province and Ituri region, and almost a year after, ebola crosses border into Uganda.
The North Kivu region in DR Congo shares a border with Uganda to the east (Beni and Butembo are approximately 100 kilometres from the border). This area sees a lot of trade, but also trafficking, including ‘illegal’ crossings. Some communities live on both sides of the border, meaning that it is quite common for people to cross the border to visit relatives or trade goods at the market on the other side.
Ebola enters Uganda
The first case of Ebola in Uganda was a boy who contracted the disease on his visit to the North Kivu region in DRC for his grandfather burial. Uganda’s health ministry said the boy’s mother, who is Congolese but married to a Ugandan and living in the Kasese district of Uganda, had travelled back to Congo to nurse her sick father, who subsequently died of Ebola.
The boy’s family, a family of 14, crossed at the formal border at Uganda on June 12, but five evaded the main port of entry knowingly. Instead they crossed over informally. Those five arrived with symptoms that included diarrhoea and bleeding. This implies a period of illness in the DR Congo and that they were most likely symptomatic while travelling. On returning to Uganda, the boy had started coughing up blood and vomiting and was taken to Kagando hospital where health workers immediately suspected Ebola. A sample of his blood tested positive for the virus and on Wednesday two of the boy’s relatives, thought to be his younger brother and grandmother, were also confirmed to have contracted the disease.
A day after the boy’s death, the grandmother also died.
The Ugandan health minister said the dead boy’s father, mother, three-year-old brother and their six-month-old baby, along with the family’s maid, were all repatriated to DR Congo.
The cases marked the first time the virus has crossed an international border since the current outbreak began in DR Congo last August.
Why is the DR Congo Ebola outbreak so difficult to contain
Since the first devastating West African Ebola epidemic between 2013 and 2016, medical scientists have worked fast to develop cutting edge vaccines, treatments and antibody-based therapies they hoped would prevent or halt future outbreaks of the Ebola virus. That includes an Ebola vaccine developed by Merck & Co Inc that proved more than 95 per cent effective in clinical trials.
When the virus broke out last year August, with breakthroughs in medical science towards this strain of ebola virus, the outbreak was supposed to quickly snuffed out but ten months later the end seem to still be afar off.
The DRC is one of the three poorest countries in the world based on gross domestic product per capita. This is in spite of immensely abundant natural resources, with an estimated $24 trillion in untapped mineral deposits, including some of the world’s richest stores of coltan.
The epicenter of the ebola outbreak in North Kivu province, the region is one of the richest sites in the country, very rich with a lot of mineral resources. This has made the region an area of conflicts with more than 100 armed active groups who battle for control of the resources found in the region.
DRC has been in civil war for a while and this province is a well known area of conflict for 25 years. Criminal activity, such as kidnapping, are relatively common and skirmishes between armed groups occur regularly across the whole area. Widespread violence has caused population displacement and made some areas in the region quite difficult to access.
The poverty level in the DRC caused by years of civil war, misrule and corruption has brought distrust between poor communities such as those found in this province and the government. This has led to misinformation about the disease.
A 2018 study found that 25.5% of North Kivu residents didn’t believe Ebola was real but a conspiracy theory engineered by foreigners. Residents of highly volatile region believe Ebola was brought to the region on purpose. Influx of foreigners in the region in response to the outbreak only heighten the suspicion of residents in the community.
As a response to this suspicion, there have been outbursts of violence targeted at health personnels and foreigners in the region. There have been frequent attacks on the ebola treatment centers, gunmen storming Ebola treatment centers assassinating health workers and releasing sick people confirmed to carry the ebola virus into the public. Many international aid agencies have had to pull their staff out of hotspots, like the towns of Katwa and Butembo, leaving government health workers struggling to cope. Areas where aid workers are still operating, they do so under the armed escort of United Nations peacekeepers or Congolese security forces.
There was the suggestion that a lot of the violence is actually coordinated and used as a political weapon to destabilise the region and gain power rivals.This might not be far from the truth.
The recent outbreak started when the country was preparing for the first democratic presidential election in decades. After years of ruling by Joseph Kabila, he finally decided to step down. These elections were celebrated as an important step towards a more democratic process and popular sovereignty. But for selfish reasons,politicians decided to capitalise on the disease for selfish gains.
Politicians decided to politicise the disease by spreading the rumour that ebola does not exist but brought in by foreigners or it is a tool used by government to kill off opposition. Most of these politicians also have connections to these small armed groups all through the area that are said to be behind a lot of these attacks on Ebola responders.
The Ebola outbreak was also used by the Joseph Kabila government to control the electoral power of those likely to oppose his preferred candidate, Emmanuel Ramazani Shadary.
A pity there was an iota of truth in the rumour. The government decided to play a fast one with the people votes and postponed the elections in three areas in the North Kivu province (Beni, Beni ville, and Butembo) on December 26, 2018 citing concerns about the Ebola outbreak and terrorism. The area is an opposition stronghold and contains an estimate of about 1·2 million people. Many of voters in this region were likely to vote for the opposition leader, Martin Fayulu. The consequences of the postponement on the Ebola response are immeasurable, not only for its effect on epidemic control but also in terms of trust lost.
This distrust in authority, engagement and accurate information created the epidemic we see today because half or more of Ebola deaths have occurred in people who never sought help at a health clinic and more than half of the new cases cannot be traced to their source.
Africa Porous Borders
WHO acknowledged that it had been unable to track the origins of nearly half of new Ebola cases in the DRC, suggesting it did not know where the virus was spreading.
Africa is characterized by a high degree of population movement across exceptionally porous borders. These porous borders and insecurity have heightened fears that the Ebola outbreak could easily spread to neighbouring countries and later throughout the continent. The virus has successfully found its way into Uganda after many months of containment in DR Congo.
Residents at the common borders of Uganda and DR Congo said there were several feeder routes without Ebola screening points, health facilities and health workers.
Resident of South Sudan, another country that share border with Congo, have shown concern. “We are moving freely from DRC to South Sudan and nobody asked us about where we are coming. It’s only in Yei town I saw Ebola centers and concerns about the disease,” John Taban a resident of Senema area of Otogo County in South Sudan told Africa Review.
The government, humanitarian agencies and health authorities need to create more awareness especially in deep villages and border towns with DR Congo.
There are a lot of informal crossings than the formal ones, only those who cross the formal borders are captured by surveillance system so health authorities must be strategic in their interventions.
Chiefs and leaders of high risk towns and villages (places that share border with region of Ebola hotspot region in DR Congo) should also be included in the sensitization. These leaders can select people who will physically monitor individual crossing their border. A visitor log should also be kept to track down the origin of the traveller. A common building to keep new visitors is also established.
The visitors can then be tracked back to their village of origin to investigate any linkage to a cluster of cases.
This strategy was employed in Liberia during the latter part of the Ebola crisis in the region and was critical in preventing the cross-border import of cases.
Seth Berkley, a medical epidemiologist and chief executive of the Gavi global vaccines alliance, have this to say about the increase in ebola cases: “Let us be clear. It’s getting worse. The numbers are going up, not down”.
There has been a dramatic increase in the number of Ebola cases in the region. This is because residents of the region consider Ebola to be a minor case compared to poverty and hunger and efforts to contain the spread have been hampered by chronic violence and suspicion of outsiders.
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