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Ebola Outbreak in Democratic Republic of the Congo

Mar 20, 2020

Overview

Despite the implementation of a peace agreement in 2003, the eastern Democratic Republic of the Congo (DRC) continues to face localized armed conflicts among state security forces, multiple non-state armed groups and local militia (self-defense groups), restricted humanitarian access in conflict zones, weak state institutions, poor infrastructure, forced recruitment into armed groups, and food insecurity. Conflict that targets civilians and a breakdown in law and order has fueled the rate of sexual violence and triggered mass internal displacement and refugee outflows into neighboring countries1

In 2018, the situation worsened with an outbreak of Ebola Virus Disease (EVD). EVD is endemic to some animal species in the DRC, resulting in episodic human disease outbreaks; the country has experienced 10 recorded EVD outbreaks since 1976. The Ministry of Health (MoH) declared the current outbreak—the second largest recorded globally—on August 1, 20182. On July 17, 2019, WHO Director-General Dr. Tedros Adhanom Ghebreyesus declared the EVD outbreak in the DRC a Public Health Emergency of International Concern, which is defined as an extraordinary event that is determined to constitute a public health risk to other countries and may require immediate international action or a coordinated international response3. The current EVD outbreak is the first to occur in Ituri and North Kivu, conflict-affected provinces with high-density population areas, highly transient populations, significant insecurity-related access constraints, high-volume of cross-border commerce, and porous borders with neighboring countries. Decades of conflict between the state and non-state armed groups and the postponement of the 2018 Presidential elections in the region affected by EVD have resulted in widespread distrust of national authorities. Given the limited engagement of humanitarian actors in these areas prior to EVD in spite of long-standing humanitarian needs, the local population is suspicious of the national government and the international humanitarian actors who descended into their midst to manage the outbreak2. The politicization of EVD has contributed to the spread of misinformation about the disease, as well as persistent community mistrust and hostility of government- and UN-led response efforts4. Attacks on Ebola responders from the UN, Ebola treatment centres, and other persons and infrastructure associated with the response have further hindered efforts to control and eradicate the disease. Health workers are reporting high levels of stress leading to absenteeism, errors at work, and most tragically, persistent high risk of nosocomial infection.

As of February 17, 2020, there have been over 3,431 cases and 2,253 deaths in this outbreak5. The overall case fatality rate is 66%, which is well over the final case fatality rate of 43% in the West African crisis. Of the total confirmed and probable cases, 56% were female, 28% were children aged less than 18 years, and 6% were health workers (which is much higher than in previous outbreaks)6. Learning from the West African EVD outbreak tells us that such epidemics have a negative impact across the health system, and that sexual and reproductive health (SRH) services are generally disrupted leading to negative outcomes for women, men, girls and boys7, 8. To understand if similar impacts were felt in DRC’s current outbreak, the IRC commissioned a program assessment in October 2019 that used the MISP as a framework to analyze how community members, health workers and Ebola response workers perceive SRH in this complex context. Results show that every pillar of the MISP is affected by the Ebola virus and the response set up to mitigate its transmission. Particularly, this assessment demonstrates the increased delays in access to emergency obstetric care and other SRH services because of added barriers inadvertently introduced as part of the Ebola response9.

  1. For more information on the humanitarian context in DRC: https://www.crisisgroup.org/africa/central-africa/democratic-republic-congo.
  2. Ilunga Kalenga, O., Moeti, M., Sparrow, A., Nguyen, V.K., Lucey, D. and Ghebreyesus, T.A., 2019. The ongoing Ebola Epidemic in the Democratic Republic of Congo, 2018–2019. New England Journal of Medicine.
  3. https://www.who.int/news-room/detail/17-07-2019-ebola-outbreak-in-the-democratic-republic-of-the-congo-declared-a-public-health-emergency-of-international-concern
  4. Nidhi Kapur. Gender Analysis: Prevention and Response to Ebola Virus Disease in the Democratic Republic of Congo. January 2020. Care International.
  5. World Health Organization. EVD DRC External SitRep Feb 17, 2020.
  6. WHO, Ebola Virus Disease, Democratic Republic of Congo: External Situation Report 69/2019 (published 24 November 2019). Available at: https://www.who.int/emergencies/diseases/ebola/drc-2019/situation-reports.
  7. Figueroa, C.A., Linhart, C.L., Beckley, W. and Pardosi, J.F., 2018. Maternal mortality in Sierra Leone: from civil war to Ebola and the Sustainable Development Goals.
  8. For more evidence of the disproportionate impact of the EVD outbreak on women and girls, see IRC’s report from March 2019 titled “Everything on her shoulders: rapid assessment on gender and violence against women and girls in the Ebola outbreak in Beni, DRC. March 15, 2019.
  9. McKay G, Black B, Mbambu Kahamba S, Wheeler E, Mearns S, Janvrin A. Not All That Bleeds Is Ebola: How has the DRC Ebola outbreak impacted Sexual and Reproductive Health in North-Kivu? New York, USA: The International Rescue Committee 2019.