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Ebola outbreak in Democratic Republic of Congo (DRC) surpasses 1000 cases, daily case rate on the rise (25.03.2019)

As Ebola response workers face violence on an almost daily basis, working in partnership with the community is the key to bringing this outbreak to an end.

BUTEMBO, Democratic Republic of Congo, March 25, 2019 – Since the Ebola outbreak was declared in August, the confirmed and probable case count has now surpassed 1000; case numbers are on the rise which is not what we expect at this stage in the outbreak that may last another six to twelve months; in the past week we have seen 58 new reported cases – this is the highest number in a week in 2019. There could still be many more which have not been reported; working with the community is the key to getting this outbreak under control; IRC teams are supporting 59 facilities to improve infection prevention and control as well as working to protect women and children.

A thousand people have now contracted Ebola since the outbreak was declared in Democratic Republic of Congo (DRC) in August. This tragic milestone is a reminder that this outbreak is not yet under control and in order to make progress more must be done to work in partnership with the affected community. The ongoing mistrust facing health workers and the response is a symptom of the years of insecurity they have endured, and a sign that those responding must work even harder to combat the stigma and misunderstanding held by some in the community.

Tariq Riebl, IRC’s Emergency Response Director in DRC said: “Alarmingly at this stage in the outbreak, the number of cases of Ebola is once again on the rise. In the past week we have seen 58 new cases – this is the highest number in a week in 2019. With mistrust and security issues, cases are likely to be going unreported and the true figure could be even higher. These numbers show that despite the hard work being done, this outbreak is far from over. Insecurity and violence has led to the IRC and other agencies being forced to frequently suspend programs, which time and again we have seen lead to a spike in cases.

“Data shows us that working with the community is the key to stopping this outbreak. Without greater engagement we will see more lives lost. IRC’s team in North Kivu are redoubling their efforts to understand the concerns of people living in the impacted communities and to work with them to quash this outbreak. In the past weeks IRC teams have run a series of community meetings to understand their concerns as well as establishing focal points within affected neighborhoods and villages”.

“We are already almost seven months into this outbreak and at this stage we should be seeing the case rate declining, not on the rise. With an optimistic outlook this outbreak is predicted to last another six months — but realistically we could be looking towards another year of fighting this disease. The Ministry of Health and partners including the IRC are working around the clock to curtail the outbreak as quickly as possible to reduce the loss of life and further damage to the community.”

Leading on infection prevention and control, the IRC is working in 59 health clinics, training health workers to recognize symptoms and safely triage and transfer suspected Ebola patients to treatment centers; as well as working in women’s and children’s protection and community sensitization.

With more than 13 million people in need of aid, DRC is one of the world’s most complex, chronic and long-standing humanitarian crises. The IRC has been working in the Democratic Republic of Congo since 1996 responding to the humanitarian crisis in the east. It has since evolved into one of the largest providers of humanitarian assistance and post-conflict development, with life-saving programming in health, economic recovery, women’s and children protection, and livelihoods.

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WHO reaffirms commitment to the Democratic Republic of the Congo as Ebola outbreak nears 1 000 cases amid increased violence (23.03.2019)

WHO calls on international community to join urgent push to end outbreak

As the Ebola outbreak in the Democratic Republic of the Congo (DRC) approaches 1 000 cases amid increased violence, WHO reaffirmed its commitment both to ending the outbreak and working with the government and communities to build resilient health systems.

Since the outbreak was declared in August 2018 there have been 993 confirmed and probable cases and 621 deaths in North Kivu and Ituri provinces.

“We use words like ‘cases’ and ‘containment’ to be scientific, but behind every number is a person, a family and a community that is suffering,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This outbreak has gone on far too long. We owe it to the people of North Kivu to work with them in solidarity not only to end this outbreak as soon as possible, but to build the health systems that address the many other health threats they face on a daily basis.”

More than 96 000 people have been vaccinated against Ebola in DRC, along with health workers in Uganda and South Sudan. As of 21 March, 38 of 130 affected health areas have active transmission. More than 44 million border screenings have helped to slow the spread of Ebola in this highly mobile population. No cases have spread beyond North Kivu and Ituri provinces, and no cases have crossed international borders.

However, the risk of national and regional spread remains very high, especially when episodes of violence and instability impact the response.

“As we mourn the lives lost, we must also recognize that thousands of people have been protected from this terrifying disease,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We are working in exceptionally challenging circumstances, but thanks to support from donors and the efforts of the Ministry of Health, WHO and partners, we have saved thousands of lives.”

WHO has more than 700 people in DRC and is working hard with partners to listen to the affected communities and address their concerns and give them greater ownership of the response, particularly in the current outbreak hotspots of Katwa and Butembo.

“The communities affected by this outbreak are already traumatized by conflict,” said Dr Tedros. ”Their fear of violence is now compounded by fear of Ebola. Community engagement takes time. There are no quick fixes. But we are learning and adapting to the evolving context every day.”

Despite the challenges, most communities accept response interventions. More than 90% of those eligible for vaccination accept it and agree to post-vaccination follow-up visits. Independent analysis of vaccination data indicate that the vaccine is protecting at least 95% of those who receive it in a timely manner. More than 80% of people also accept safe and dignified burials, a key to preventing onward transmission.

“Despite the increased frequency of attacks by armed groups, WHO will stay the course and will work with communities to end this outbreak together with the Ministry of Health and partners,” said Dr Tedros. “We need redoubled support from the international community, and a commitment to push together to bring this outbreak to an end.”

For the next 6 months, the combined financial need for all response partners is at least $148 million. As of 19 March, $US 74 million had been received.

“We count on donors to help close the funding gap so we can end this outbreak as soon as possible,” said Dr Tedros. “We will still be in DRC long after this outbreak has finished, working with the government and communities on the road to universal health coverage. We are committed to improving the health of the people of DRC now and in years to come.”

Ebola virus disease – Democratic Republic of the Congo (15.03.2019)

The greatest concern centres on the neighbouring urban areas of Katwa and Butembo, which continue to contribute about three-quarters of recent cases.

GENEVA, Switzerland, March 15, 2019 – The public health response to the Ebola virus disease (EVD) outbreak continues to make gains. During the last 21 days (20 February – 12 March 2019), no new cases have been detected in 10 of the 20 health zones that have been affected during the outbreak (Figure 1). There has also been fewer new cases observed over the past five weeks compared to January 2019 and earlier in the outbreak (Figure 2).

Currently, the greatest concern centres on the neighbouring urban areas of Katwa and Butembo, which continue to contribute about three-quarters of recent cases. Clusters in other areas of North Kivu and Ituri provinces have been linked to chains of transmission in Katwa and Butembo, and have thus far been contained to limited local transmissions with relatively small numbers of cases. A total of 74 confirmed cases were reported during the last 21 days from 32 of the 125 health areas affected to date (Table 1). Risk of further chains of transmission and spread remain high, as highlighted by the recent spread to Lubero Health Zone, and reintroduction to Biena Health Zone following a prolonged period without new cases.

Response teams are fully operational in all outbreak affected areas and there are encouraging improvements in community acceptance of the response, despite the challenges of ongoing insecurity caused by armed groups. For example, during the last 21 days in Katwa and Butembo, 88% of the 256 families with a family member who died and was suspected to have EVD, accepted the support from response teams to conduct a safe and dignified burial. Seventy-four new vaccination rings were launched, with over 90% of people eligible for vaccination accepting to do so, and over 90% of these participated in follow-up visits. A total of 5974 people (including 2159 health and frontline workers) consented and were vaccinated this period; overall 87,632 people have been vaccinated to date. Vaccination teams are continuing to follow-up on 12 rings wherein the families have not yet accepted the intervention, and two other rings that are in the process of being defined. Seven field laboratories have remained fully operational, sustaining similar testing rates as previous weeks. During the past week, 1213 samples from new suspected cases, community deaths and previously confirmed cases were tested within 48 hours. Outreach teams made up mostly of local volunteers also met with 6000 households during the past week, building local knowledge of Ebola, and referring sick individuals to either Ebola Treatment Centres (ETCs) or other health facilities as appropriate. In the last two weeks, community dialogues were held in several villages in Katwa and Vuhovi to find ways in engaging community members to build trust and ownership in the Ebola response.

Efforts to strengthen case finding and investigation, and contact tracing activities are also bearing fruit. Of 74 confirmed cases reported in the last 21 days, 83% (62 cases) have been epidemiologically linked to active chains of transmission; either listed as contacts at illness onset (47 cases) or linked retrospectively to other cases or health centre where they were likely exposed (15 cases). Investigations are ongoing to identify links for the remaining cases.

Challenges include further attacks by armed groups on affected communities and ETCs, elements of community mistrust, and persistent delays in getting people into care in ETCs for various reasons. The Ministry of Health, WHO and partners continue to work actively to build community trust and participation in the response, while reinforcing security measures to protect patients and response teams. The ETC in Butembo has been rebuilt following two attacks and is treating patients again, and the Katwa Transit Centre remains operational.

Since the beginning of the outbreak to 12 March 2019, 927 EVD cases1 (862 confirmed and 65 probable) have been reported, of which 57% (525) were female and 30% (280) were children aged less than 18 years. Cumulatively, cases have been reported from 125 of 319 health areas across 20 health zones of the North Kivu and Ituri provinces (Table 1). Overall, 584 deaths (case fatality ratio: 63%) have been reported, and 308 patients have been discharged from ETCs.

*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning.

 

Update: Ebola virus disease – Democratic Republic of the Congo (08.03.2019)

As of 5 March, 907 Ebola virus disease (EVD) cases1 (841 confirmed and 66 probable) have been reported.

GENEVA, Switzerland, March 8, 2019 – The Ebola virus disease (EVD) outbreak is continuing with moderate intensity. Katwa and Butembo remain the major health zones of concern, while small clusters continue simultaneously in some geographically dispersed locations. During the last 21 days (13 February – 5 March 2019), 76 new confirmed and probable cases have been reported from 31 health areas within nine health zones (Figure 1), including: Katwa (44), Butembo (17), Mandima (6), Masereka (3), Kalunguta (2), Beni (1), Vuhovi (1), Kyondo (1), and Rwampara (1). The emerging cluster in Mandima health zone is occurring in a previously unaffected village, with five of the recent cases epidemiologically linked and the sixth case likely exposed in Butembo; nonetheless, there remains a high risk of further spread. Similarly, recent cases (two confirmed and one probable) in Masereka stem from a Butembo chain of transmission. These events highlight the importance for response teams to remain active across all areas, including those with lower case incidence, to rapidly detect new cases and prevent onward transmission.

As of 5 March, 907 EVD cases1 (841 confirmed and 66 probable) have been reported, of which 57% (514) were female and 30% (273) were children aged less than 18 years. Cumulatively, cases have been reported from 121 of 301 health areas across 19 health zones of the North Kivu and Ituri provinces. Overall, 569 deaths (case fatality ratio: 63%) have been reported, and 304 patients have been discharged from Ebola Treatment Centres (ETCs). Although declining trends in case incidence are currently being observed, the high proportion of community deaths reported among confirmed cases, relatively low proportion of new cases who were known contacts under surveillance, persistent delays in detection and isolation in ETCs (related as well to recent violent incidents), and challenges in the timely reporting and response to probable cases, all increase the likelihood of further chains of transmission in affected communities and continued spread.

Following the attacks on two ETCs in Katwa and Butembo, patients were temporarily transferred to the Katwa Transit Centre. On 2 March, the Butembo ETC was rehabilitated and resumed treatment of EVD patients. Response teams are progressively resuming activities in all affected areas with the exception of two health areas where security and community resistance remain a challenge.

Public health response

For further detailed information about the public health response actions by the MoH, WHO, and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa:

WHO risk assessment

WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. National and regional risk levels remain very high, though global risk levels remain low. This EVD outbreak is primarily affecting the north-eastern provinces of the Democratic Republic of the Congo bordering Uganda, Rwanda and South Sudan. There is a potential risk for transmission of EVD at the national and regional levels due to extensive travel between the affected areas, the rest of the country, and neighbouring countries for economic and personal reasons, as well as due to insecurity. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria, measles) and a long-term humanitarian crisis. Additionally, the fragile security situation in North Kivu and Ituri, further limits the implementation of response activities.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.

WHO advice

International traffic: WHO advises against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

DRC: Ebola response failing to gain the upper hand on the epidemic (07.03.2019)

The Ebola response must take a new turn.

GENEVA, Switzerland, March 7, 2019 – 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% of new cases are people who died of Ebola in the communities. At the epicenter of the epidemic, in Katwa and Butembo, 43% 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.

Last week, MSF suspended its 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 crystalizing 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.

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 centered. 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.

Opinion: Tshisekedi is officially Kabila’s puppet!

As the announced results in the recent election in Democratic Republic of Congo was coming in. There was clear speculation of secret meetings between CACH and FCC. That was happening as the announced successor came from the “opposition” and not the “heir”.

Yesterday, the reality of those came into motion, as the Kabila Party are going in Coalition Government with newly minted President Felix Tshisekedi. The Joint CACH-FCC announcement, which shows the reality and its ugly face.

You cannot make this up… this is not speculations, not political satire or drama. However, the smartly configured scenario, where the head of state is still controlled by the former one. Tshisekedi is in the mercy of Kabila. No matter where he moves and adjust. He needs the blessing of Kabila. That is the mere reality of the scheme. To say otherwise at this point is to be naïve and blind to the reality.

Because CACH, Vital Kamerhe and Felix Tshisekedi is both now on a journey, where the captain is Kabila. Whether they like it or not. Because the Parliament and elsewhere, Kabila’s men is lingering. They are there to either stifle or shift the ways, because CACH doesn’t have the capacity nor representation to fight with the FCC. That is why the whole play for the façade is now broken. By yesterday’s announcement.

If you ever thought Kabila left, you were wrong son. Terribly wrong. He is just right there. In the midst of power, playing the guards and the public, being a shadow actor. Kabila now uses that position and ways in a clever way, that he still gets the benefits without the hazel of being in office.

The ones that thought this was a transition and a peaceful one that, you were wrong. It was a trade-off, made in January before the announcement of the results. To certify the President and ensure the power of Kabila would still be there. That is why his been so relaxed and jolly. That is why he hasn’t made a fuzz or made any spectacle. Because, he don’t have too.

We can play along, but by every day and every announcement like this. It is clear that Tshisekdi is Kabila’s puppet. A man who has the office, but has to sufficiently serve his master. Peace.

Opinion: Kabila will be lurking in Tshisekedi’s shadow!

Today, there been reports of a 4 hour meeting between President Felix Tshisekedi and former President Joseph Kabila in Kinshasa. Not long ago that Tshisekedi was inaugurated as President. The FCC-CACH agreement is really going into fruition.

Why can really wonder what went down, as even the Press Service of the Head of State or the President have not delivered any statement on the meeting. The 4 hours between the men us apparently not recorded. Who knows if the previous President is ensuring his own benefits and his allies. So, that the new President is not following or looking into the cronyism of the predecessor.

Even as the PR Team of the President is saying the meeting was friendly and they was hugging. That is not strange, as the Tshisekedi has made deals with the FCC and needs the support of the predecessors MPs and such. As they have majority in the Parliament, the CACH alliance has lesser power there. That is why Kabila is all smiles, because he can wine and dine… and get the deals he wants.

This is just another proof of the questionable behaviour and the secret dealings that was before the announcement of the polls of the 30th December 2018 Elections. The results was announced on the 6th January 2019, as well as the inauguration was done on the 24th January 2019.

We can wonder if this is a continuation of the back-room deal and if there are some requests, that the PR Team of the President doesn’t want public. When a meeting like this is made, it is not only to get advice or even tricks of the trade. But since there was a peaceful transition, there are some coins and what leverage the predecessor have.

That Kabila was in a good mood is that he is not in office, but surely lingering around the chambers of power. He might not be the Head of State, but surely have reach still. There has been nothing ceased of his businesses or any assets, which has been looted an mass. Therefore, the reign of Tshisekedi will only prove to be a change. When they are able to address the corruption of the previous one.

Kabila is surely still the king, since he seems to be untouchable, also the same with his cronies who even given a Golden Handshake as they are retired. Tshisekedi are doing this, as this was one of the last decrees of the regime of Kabila.

Clearly, we can wonder what they talked about today. Since, it was nothing official from the meeting. Than, we can start to speculate. Tshisekedi looks like second fiddle, as he doesn’t have the courage to be transparent about a simple meeting at his residence today. Peace.

RDC: Alternance pour la Republique “AR” – Communique de Presse (29.01.2019)

RDC: UDPS – Mandat Special a Monsieur Jean Marc Kabund (22.01.2019)

RDC: Communique Offciel a l’Itention des Chefs des Etablisements d’Enseignement Superieur et Universitaire (27.01.2019)

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