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 Tshisekedi is Kabila’s puppet. A man who has the office, but has to sufficiently serve his master. Peace.

RDC: Communique Conjoint FCC – CACH (06.03.2019)

RDC: PPRD – Communique (05.03.2019)

RDC: Bruno Tshibala Nzenzhe lettre au President Felix Tshisekedi – “Concerne: Organisation des interims des membres du Gouverement” (05.03.2019)

RDC: B.C.C lettre au President Felix Tshisekendi – “Concerne: Votre deplacement a Kingakati” (05.03.2019)

RDC: FCC – A tous chefs de regroupements membres du FCC (03.03.2019)

RDC: Hon. Jean-Paul Lumbulumbu Mutanava – Communique de Presse (04.03.2019)

RDC: Communique de Presse de l’ONG Humanitaire ALIMA a l’Intention de la population de la Ville de Butembo et des Territoires de Beni et Lubero (01.03.2019)