The number of suspected Ebola cases in eastern Democratic Republic of Congo has risen to 73. The fact that it broke out in the middle of a conflict area has made responding to it more difficult.
The entrance to the local hospital in Goma, a provincial capital in eastern Democratic Republic of Congo (DRC), is locked. Even ambulances are only admitted after being checked, as is anyone who wants to enter. Health Ministry officials are looking out for fever, and making sure hands are washed and shoes are disinfected.
Eastern DRC, especially in Goma – where one-million people live close to the border with Rwanda – is on high alert for Ebola and trying to contain the latest outbreak. A single case in Goma would dramatically increase the risk of it spreading across the region and borders.
The epicenter is about 240 kilometers to the north of Goma, near Beni, a city of about 230,000 people. There have been 73 suspected cases of Ebola, according to the DRC's Health Ministry. Forty-six have been confirmed, and 27 patients are under observation for showing symptoms such as high fever, headache and bleeding. So far, 16 people are confirmed dead from the disease, according to the World Health Organization (WHO), and Ebola is the suspected cause of another 27 deaths.
"The numbers are rising," said Richard Kitenge, a local doctor and one of the country's Ebola commissioners. Still, he is confident. The DRC knows Ebola all too well; the disease's name derives from a river that flows through the country.
The Health Ministry declared another outbreak in the country's north as contained two weeks ago, aftera vaccine was tried out there. Doctors, nurses and patients' families received it. Now, the vaccine is being used in Beni.
"With the vaccine, we hope to see a reduction in new cases over the next few weeks," Kitenge said. "This is a test. We can evaluate later the results of systematic treatment."
Learning from past mistakes
A number of nongovernmental organizations (NGOs), the United Nations and the WHO are on the ground to get the outbreak under control. Medical professionals and other experts, armed with vaccines and other supplies, were already in northern DRC battling the outbreak there. That was an advantage, said Karin Huster, the Ebola Emergency Coordinator for Doctors Without Borders.
The organization was already working in the region near Beni before the outbreak. That gave them the chance to act quickly, setting up a treatment center in Mangina, a village about 30 kilometers from Beni. The station has an isolation unit with four beds, all occupied.
Just as important is equipping the region's dilapidated health clinics, Huster said, which was a lesson learned from the last Ebola outbreak in West Africa. "The health centers were not well protected. People went there for treatment for other things and were then exposed to patients suspected of having Ebola," she said.
Doctors Without Borders has set up collection stations where people showing signs of Ebola can be isolated, Huster said by telephone from Beni. "Then they can be transferred directly to an Ebola treatment center when a suspected case is confirmed," she added.
Battling Ebola amid armed conflict
The ongoing conflict in eastern DRC makes containing the Ebola outbreak more difficult. More than 100 rebel groups operate in North Kivu and Ituri, provinces where Ebola has emerged. Congo's army is carrying out military operations against the groups with the help of UN peacekeepers. Recent history suggests just how brutal the situation in the region around Beni is, the site of fighting, civilian massacres and systematic abductions.
Ebola has been confirmed in Oicha, a village 45 kilometers from Beni. It is also considered the frontline between the army and rebels. Much of the population there has fled. Medical professionals can only access the area with a UN troop escort. Health organizations like the WHO have said this makes containing the deadly virus all the more challenging.
High risk of Ebola spreading
The next task is to prevent the further spread of the disease - which is transmitted via bodily fluids - said Guido Kraus from the German aid group, Diakonie Disaster Relief Assistance. "It's important that people understand how they can avoid it," he said. Diakonie therefore conducts awareness campaigns provides sanitary equipment such as sinks at health centers, churches and schools. Wells need to be repaired, too, because the region lacks water for proper hand washing.
The real danger is the incubation period, Kraus said. It can take up to three weeks to show symptoms, which means "someone won't immediately know they're infected and could even travel to another region."
Years of war have forced many to flee, which raises the risk of hunger and other diseases. This is especially so in the Ebola epicenter of Mangina, said Mirijam Steglich of Germany's Welthungerhilfe aid group, because many of those driven out by fighting have resettled there. The hunger assistance organization supports an agricultural project there, which is "an important source of agricultural production" for the region because of the area's relative long-term stability, she said. The corn harvest there is due, and farmers need to plant anew immediately thereafter.
Mangina's proximity to Beni poses a risk. "If people aren't confident that the health system really can contain Ebola, the worst-case scenario would be that they leave," Steglich said. If the corn harvest went to waste, she added, it would lead to fatal food shortages.