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Ebola outbreak - Butembo

Ebola response failing to gain the upper hand on the epidemic

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  • Despite a rapid and large outbreak response with new vaccines and treatments, the signs are that Ebola is not under control
  • Since the beginning of the year, more than 40 per cent of new Ebola cases are people who died of Ebola in the communities
  • Patients and communities must be treated as partners in the response; we must listen to their needs not preach to or coerce them

Seven months into the largest-ever Ebola outbreak in the Democratic Republic of the Congo (DRC), the Ebola response is failing to bring the epidemic under control in a climate of deepening community mistrust, Médecins Sans Frontières (MSF) said at a press conference in Geneva today.

Since the beginning of the year, more than 40 per cent of new cases are people who died of Ebola in the communities. At the epicentre of the epidemic, in Katwa and Butembo in North Kivu province, 43 per cent of patients in the last three weeks were still being infected without known links to other cases.

“We have a striking contradiction: on the one hand a rapid and large outbreak response with new medical tools such as vaccines and treatments that show promising outcomes when people come early – and on the other hand, people with Ebola are dying in their communities, and do not trust the Ebola response enough to come forward,” said International President of MSF, Dr Joanne Liu.

35 per cent of newly infected people are not in a known chain of transmission, meaning we don't know how they got it. Dr Joanne Liu, MSF International President

Last week, MSF suspended our Ebola activities in Katwa and Butembo, in North Kivu province, after successive attacks on the two treatment centres. While MSF does not know the motives or identities of the attackers, these incidents follow an escalation of tensions around the Ebola response. Dozens of security incidents occurred against the response as a whole in the month of February alone. While the causes of these acts are not all the same, it is clear that various political, social and economic grievances are increasingly crystallising around the response.

A range of issues have led to these tensions: from the massive deployment of financial resources focusing only on Ebola, in a neglected region suffering from conflict, violence and long-standing health needs; to elections being officially postponed due to the Ebola outbreak, exacerbating suspicions that Ebola is a political ploy.

To fix this response we must ensure we are looking from the patients’ perspective. Dr Joanne Liu, MSF International President

The use of police and armed forces to compel people to comply with health measures against Ebola is leading to further alienation of the community and is counterproductive to controlling the epidemic. Using coercion for activities such as safe burials, tracking of contacts and admission into treatment centres discourages people from coming forward and pushes them into hiding.

The Ebola response must take a new turn. Choices must be given back to patients and their families on how to manage the disease. Vaccination for Ebola must reach more people, and more vaccines are needed for this. Other dire health needs of communities should be addressed. And coercion must not be used as a tactic to track and treat patients, enforce safe burials or decontaminate homes.

“Ebola is a brutal disease, bringing fear, and isolation to patients, families and health care providers,” said Dr Joanne Liu. “The Ebola response needs to become patient and community centred. Patients must be treated as patients, and not as some kind of biothreat.”

Seven months since the beginning of the current Ebola outbreak in the provinces of North Kivu and Ituri, there have been 907 cases of Ebola cases (841 confirmed and 66 probable) and 569 people have died. [source: World Health Organization (WHO) report week 9]

Further to the suspension of its activities in Katwa and Butembo, MSF has maintained its Ebola-related activities in the North Kivu towns of Kayna and Lubéru, as well as its management of two Ebola transit  facilities in Ituri province, in the towns of Bwanasura and Bunia. In the city of Goma, MSF has been supporting emergency preparedness by reinforcing the surveillance system and ensuring there is adequate capacity to manage suspected cases.

It has almost been six years, since 11 July 2013, that three MSF staff remain missing after being abducted in Kamango, Nord Kivu, where they were carrying out a health assessment. MSF continues to search for them.

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Democratic Republic of Congo
Statement 28 February 2019