DRC: Malaria outbreak now under control, MSF withdraws from Haut-Uélé province

Interview with Florent Uzzeni, deputy head of MSF’s emergency unit in Geneva, Switzerland

On 20 August, after four months of addressing a massive malaria outbreak, MSF concluded its medical activities in the Pawa and Boma-Mangbetu health zones in the Haut-Uélé province in northeast Democratic Republic of Congo (DRC). Florent Uzzeni, deputy head of MSF’s emergency unit in Geneva, explains this decision.

With MSF withdrawing from Haut-Uélé, does this mean that the malaria outbreak is over?

The emergency phase is over, and the malaria outbreak is now under control. For several weeks, the number of cases in health centres and hospitals has been in sharp decline. We launched an emergency response in early May, when the local health facilities were completely overwhelmed by the number of patients with simple and complicated malaria. In three months, our medical teams, in collaboration with the Ministry of Health, supported nearly 82,000 patients infected with malaria, the majority being children under five years of age. Of these, nearly 3,000 suffered from a severe form of the disease and were hospitalised. We also carried out 1,100 blood transfusions. Our withdrawal was gradual and we have donated medicines to enable local health facilities to cope with the end of the malaria peak season.

MSF responded to an unprecedented malaria outbreak in the same region in 2012. Do you think the 2016 crisis has been better managed?

In 2016, the alert system worked well and the Pawa and Boma-Mangbetu health authorities began to worry about the increase in cases of malaria in December. In March, when the epidemic curve dramatically rose, they alerted the Isiro provincial health department. The warning came on time but the response to the emergency was too slow. MSF was called upon to help a health system that was overwhelmed. Comparing to 2012, the positive aspect is that our teams responded much earlier, helping avoid the catastrophic situation we saw four years ago.

The major problem we observed was the drug supply. When we arrived in early May, the number of patients was very high and there were barely any medicines in the health centres, health posts, or community care sites in Pawa and Boma-Mangbetu, sometimes for many weeks. Despite the early warning, the health authorities were unable to deliver immediate and sufficient malaria treatments. Without treatment, severe malaria cases increased, hospitals became overwhelmed and the number of deaths increased.

Do you think that such an outbreak could happen again in the future?

Yes, malaria is endemic in the region and given what has happened 2012 and 2016, it is very likely that a similar outbreak will occur again. To respond to such a situation, two steps must be prioritised: (1) making drugs available for a population who often cannot afford to go to hospitals or referral health centres, and (2) guaranteeing free care.

Flexibility and the ability to react quickly is crucial during a malaria outbreak. In Pawa and Boma-Mangbetu health zones, our teams saw a somewhat functional health system, including health facilities with trained staff who were able to detect this outbreak. If emergency response measures were immediately put in place as soon as the alert threshold had been reached, the mortality could have been controlled, even without the support of MSF.