https://www.vox.com/2019/3/1/18245905/e ... reak-congo
Arsonists attacked 2 facilities treating Ebola patients in Congo. That’s a major setback.
The second-worst Ebola outbreak in history is proving difficult to contain.
By Julia
Belluz@juliaoftorontojulia.belluz@voxmedia.com Mar 1, 2019, 10:20am EST
The humanitarian agency Doctors Without Borders was forced to suspend operations in two areas where it’s been responding to the Democratic Republic of Congo Ebola outbreak, following arson attacks on its health care facilities this week.
“More than six months after the beginning of the Ebola outbreak in North Kivu and Ituri, the epidemic is not under control,” the agency, known as MSF, warned. At least 885 people have contracted the virus, and 555 have died, in an outbreak that’s been ongoing since August — the first known Ebola cases in a war zone (DRC’s eastern North Kivu and Ituri provinces).
The attacks happened on MSF’s treatment centers in the most active hot spots in the outbreak, neighboring cities called Katwa and Butembo. The first setback came on February 24 in Katwa. Late at night, assailants — who haven’t been identified — threw stones at MSF’s building and then proceeded to set it on fire, forcing workers to evacuate and to move patients to other hospitals.
“This attack has crippled our ability to respond to what is now the epicenter of the outbreak,” said Emmanuel Massart, MSF’s emergency coordinator in Katwa, in a statement.
Four days later, on February 27, arsonists set MSF’s Butembo operation on fire. “The blazes were contained and no staff or patients were harmed, but the teams were forced to immediately cease patient care,” according to a second MSF statement. “In light of these two violent incidents,” MSF emergency desk manager Hugues Robert added, “we have no choice but to suspend our activities until further notice.”
Butembo and Katwa are the two areas in DRC where the virus is most active, with a combined 317 confirmed cases to date and another 40 suspected infections. This pause on MSF’s operations in these cities is disturbing for two reasons. First, it means fewer workers will be available to identify, isolate, and treat Ebola patients. And in an Ebola response, when people with the virus remain in the community, they can spread it to others. “We can expect a significant increase in cases in the health zones of Katwa and Butembo in the coming days,” DRC’s health ministry warned on Thursday.
But even worse, the arson attacks suggest that at least some community members are resisting the humanitarian work to help stop the outbreak. They may be a minority, but they pose a significant threat to the Ebola response. Instead of cooperating with aid workers, they’re burning down the medical units set up to protect them. That’s a major setback for DRC and its Ebola responders.
The success of this Ebola response hinges on trust. The arson attacks suggest there’s a trust problem.
Stamping out an Ebola outbreak requires a very high level of community buy-in. The virus is spread through direct contact with the bodily fluids, like vomit, urine, or blood, of someone who is already sick and has symptoms. The sicker people get, and the closer to the death, the more contagious they become. (That’s why caring for the very ill and attending funerals is especially dangerous.)
Because we have no cure for Ebola, health workers rely on traditional public health measures: finding, treating, and isolating the sick, and breaking the chains of transmission so the virus stops spreading.
They mount vigorous public health awareness campaigns to remind people to wash their hands; that touching and kissing friends and neighbors is a potential health risk; and that burial practices need to be modified. (Again, funerals can act as Ebola super-spreaders since people who die of the virus are extremely contagious, and families prepare, touch, and kiss corpses as part of traditional funerary rituals.)
Responders also employ a strategy called “contact tracing”: finding all the contacts of people who are sick and following up with them for 21 days — the period during which Ebola incubates.
Every one of these measures can only succeed if community members trust and cooperate with Ebola responders.
They need to let aid workers into their home to test for the virus and agree to be followed up with for 21 days. They need to accept the painful reality of sending family members with the virus to treatment centers for isolation, so they can’t infect others around them.
They need to follow basic public health measures such as hand washing, and safe burial practices, which can mean putting aside centuries of family tradition and personal beliefs to stop the spread of the virus.
In this case, responders also have an effective vaccine at their disposal — and to date, more than 84,000 people have been vaccinated, including 21,662 in Katwa and 10,512 in Butembo.
But that doesn’t necessarily mean people are cooperating with the other parts of the Ebola response. A recent Lancet survey of locals’ attitudes toward the Ebola response in DRC suggested that people’s willingness to get the Ebola vaccine was really high — but most respondents said they would not send their family to treatment centers and would actively hide family members with Ebola from the authorities.
“To overcome [an Ebola] outbreak, we need to gain the hearts of the population,” Michel Yao, the World Health Organization’s incident manager in Butembo, told Vox. “We need to have them fully on board.” Yao believes community resistance has been improving overall, but the attacks on MSF suggest there may be more trouble ahead.
