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DRC Ebola Emergency: 11 January 2020

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DRC Ebola Emergency: 11 January 2020

An intensification of military operations and a series of violent attacks by armed groups across the northeast of DRC have been the catalyst of protests across several towns in North Kivu, including Beni and Goma. These protests were directed against armed forces and the United Nations peacekeeping force (blue helmets) and at times turned very violent. Daily anti-UN demonstrations which began on 20 November turned into violent confrontations that lasted 10 days. Dozens of people have died during the protests and approximately 250 succumbed to violent attacks.

Health workers in the Ebola response have also been targeted. Three people were killed, and several Ebola responders were injured in a separate violent attack against a Ministry of Health (MOH)/WHO base in Biakato Mine on 27 November. Simultaneously the riposte base in Mangina was also targeted. This violence directed at response workers in Biakato caused the majority of the health personnel to be either evacuated or to flee.  

MSF, Doctors Without Borders, DRC, Ebola

On 4 December, after receiving multiple threats, MSF staff was evacuated from Biakato area and the management of the Biakato Ebola Treatment Centre (ETC) was handed over to the Ministry of Health (MOH). In the end of December, following the deployment of armed forces around and within the health structures, MSF decided to stop activities in Biakato.

Efforts to contain the Ebola outbreak in eastern DRC, which so far claimed over 2200 lives, have also been affected by the volatile security situation. While the number of new cases had been steadily declining in the previous months, the recent violence in North Kivu and Ituri which disrupted the provision of care, surveillance, vaccination, contact tracing and other activities of the Ebola response, forces MSF to remain extremely vigilant about the resurgence of the disease. A sharp increase in the weekly number of new cases was observed in  the first half of December, rising from 11 cases to 24 cases in the following week. In the second half of December, the number of cases stabilised and decreased to 14 cases per week. Out of 13 health areas currently reporting active transmission, the health area of Aloya (health zone of Mabalako) has notified more than half of the total confirmed patients during December.

In the last two weeks of 2019 and the first week of 2020, new cases were reported in five health zones that were not considered places of active transmission anymore (which means 42 days without cases), namely Biena, Butembo, Katwa, Kalunguta, and Mambasa. By 5th January, the origin of the chains of transmission of the cases in Kalunguta, Katwa, and Mambasa was not known.

MSF, Doctors Without Borders, DRC, Ebola
Ebola vaccination at the MSF-supported health center of Kanzulinzuli, in Beni, DRC. Photo: Samuel Sieber/MSF

Following the recent deterioration in security conditions, the movement of population has risen, with thousands now displaced across North Kivu. Similarly, the increase in military operations in the Kalehe region, in South Kivu (mainly FARDC [Armed Forces of the Democratic Republic of the Congo] against local armed groups caused the displacement of thousands of people. The growing movement of the population increases the risk of a geographic spread of the disease, especially as health controls along the roads are not effective because of insecurity and unrest. For example, following the November 28 attack and the evacuation of most Ebola responders, some points of entry and points of control surrounding Biakato, one of the main hotspots, were reactivated days later, but others remained closed due to threats or destruction for more time.

The MOH and WHO obtained a waiver from Merck to use 30,000 doses of the Ebola vaccine “out of the investigational protocol” which will reduce the paperwork and the size of the vaccination teams while expanding target. This will allow the population greater access to the vaccine and will enable teams to vaccinate people faster. So far, there have been delays in both bringing the additional stocks into the country as well as to define and communicate the microplanning for the targeted areas by the MoH/WHO.

MSF, Doctors Without Borders, DRC, Ebola
On 24th of February, the Ebola Treatment Centre operated by MSF in Katwa was attacked by unknown people. Part of the facility has been
burnt down and MSF suspended its activities in the centre. Photo: MSF

Medical facilities, personnel and patients have continued to be the targets of violent attacks, with an increase in attacks and violence over November and December as anti-Ebola response sentiment resurfaced. There have been more than 300 attacks on Ebola health workers recorded in 2019, leaving six dead and 70 wounded.

Epidemiologic Situation

As of 5 January, as per the Ministry of Health/WHO data

  • Total cases since the declaration of the epidemic: 3,388 cases (3270 confirmed and 118 probable)
  • Total number of deaths: 2233
  • Total number of people cured: 1114
  • Total number of people vaccinated : 261,285 Zebov (of which 1,213 in Beni by Msf in October) + 4,551 J&J in Goma
  • Current hotspots: Mabalako, Kalunguta, and Butembo (North Kivu).

“Probable” refers to community deaths that have links to confirmed Ebola cases but which were not tested before burial

MSF, Doctors Without Borders, DRC, Ebola
A health worker disinfecting a room where a suspect Ebola case was passed. Photo: Alexis Huguet

MSF position and activities

MSF is supporting the Ebola response through patient care in two Ebola Treatment Centres in Beni and Goma, numerous decentralized isolation/transit zones and infection prevention and control activities (IPC) community-based surveillance and support to vaccination activities. MSF’s main priorities are to provide timely healthcare to Ebola patients, ensure appropriate IPC standards in healthcare facilities and improve access and quality of non-Ebola health care based on the assessment of the local community health care needs. Some of our activities have been affected by the recent surge in violence, which forced full or partial evacuation decisions.

In all our projects, we are striving to put patients and communities first, and are engaging with the local community and working with existing health centres to identify needs and prioritize activities. In addition to integrated isolation and treatment facilities for suspect Ebola patients, MSF strengthens health care capacities, builds infrastructure for clean water, sanitation and hygiene, and invests in community outreach and health messaging in health centres all over the region.

 

Location

Activity

Update

NORTH KIVU / Goma

 

 

 

 

 

ITURI/ Mambasa

  • GOMA
  • Management of a 10-bed ETC (up to 72)
  • Support access to primary/maternal healthcare to 2 health centres in the outskirts of Goma.
  • Health promotion, community engagement activities, including wash activities for the community.

 

  • Starting the land preparation (demolition + land leveling) to build the isolation ward at the Hôpital Provincial du Nord-Kivu (HPNK)

 

 

  • MAMBASA
  • Management of Primary Healthcare Centre + ITC Binase and Salama and management of the community-based surveillance system in the aire de santé of Binase

Ongoing – No confirmed cases + 46 suspect cases from week 46 to 50. Problems in accessing site during week 48 because of protests

 

 

To be started in the second week of 2020. Construction duration forecast: 3 months

 

 

Activities started in week 50. One week partial reduction of staff due to deterioration of the security in the region

ITURI/

Bunia

 

 

 

 

 

Mambasa

  • BUNIA and RWAMPARA Health Zone
  • Management of a 34-bed ETC handed over to MOH on 15/12
  • Support IPC in 6 health care facilities including the general hospital; as well as community based IPC
  • Health promotion, community engagement

 

  • MAMBASA
  • Community-based IPC and IPC support at 7 health structures
  • Ongoing 

 

  • Ongoing

ITURI/

Biakato

 

 

 

 

Mayuano/
Somé

  • BIAKATO MINE
  • Suspension of full activities in Biakato on 22/12/19 including:

20-bed ETC opened in November handed-over to MOH (previously an MSF managed ITC); support for primary healthcare, IPC and WASH in 4 health centres + maternal / paediatric secondary health care in one health centre, including building an 18-pediatric bed ward

 

  • MAYUANO:
  • Management of a 12-bed ITC + support IPC and primary health care in 3 health centres.

 

  • SOMÉ:
  • Management of 1-bed isolation unit, support IPC and primary health care in one health centre

Ongoing

 

 

Ongoing

 

 

Ongoing

NORTH KIVU/

Lubero

 

 

 

Goma

 

 

 

Beni

 

  • LUBERO:
  • Support to Lubero General Hospital and health centres – access to general healthcare and management of potential Ebola patients.
  • Conducted additional immunization activitiesfrom 11th - 18th December/ in 3 aires de santé at 17 sites in Lubero
  • GOMA:
  • Vaccination activities for Ad26.ZEBOV/MVA-BN-Filo (J&J Ebola vaccine) clinical study. Over 4,500 by 5th January
  • BENI:
  • Management of a 20 bed ETC (since 15/9/2019); support to 3 health centres (access to general healthcare, management of suspect Ebola cases);

Ongoing

 

 

 

 

 

 

 

Completed

 

Ongoing

 

NORTH KIVU

Mabalako

 

 

 

 

ITURI

Mambasa

  • MABALAKO
  • Support 4 health facilities: access to primary and secondary health care, including maternal care, + IPC;
  • Health promotion and awareness sessions in the community
  • MAMBASA
  • support 3 health care facilities, on the axis to Kisangani (Banana, Bandisende and Epulu). including  maternal care + IPC. Started on week 48Health promotion and awareness sessions in the community

Ongoing 

 

 

 

ongoing

SOUTH KIVU

Bukavu

 

 

 

 

 

MSF-supported preparedness activities:

  • Management of an 8-bed CTI in Bukavu;
  • Rapid Response Team on call 24/7 for alert investigation
  • Support IPC and isolation in 5 health centres.”

Ongoing 

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