#EbolaUpdate: Series of War Zone Attacks Puts DRC Ebola Outbreak On ‘Edge of Crisis’

Global public health experts are growing increasingly alarmed about the Ebola outbreak in the northeast region of the Democratic Republic of Congo, which has killed 215 people so far. It is now the largest outbreak that the DRC has ever seen ― with 341 probable and confirmed cases ― and the third largest Ebola outbreak in history. And it’s continuing to expand.

While the risk of it spreading globally remains low, the threat for the country and its neighbors is very high. Constant incidents of rebel violence in the war-torn region, the resulting community protests and community resistance to medical intervention have hampered the ability of the World Health Organization, the DRC’s Ministry of Health and various non-governmental organizations to respond.


In response to an Aug. 24 incident, the U.S. pulled response team members back from the epicenter in North Kivu to the DRC capital of Kinshasa hundreds of miles away. The American response effort is now concentrated in Kinshasa and neighboring countries, and U.S. officials said in a briefing Wednesday that the situation is currently too dangerous for them to go back to North Kivu.

Containment efforts in this outbreak have also been made more difficult because a majority of the newest cases are not appearing among known contacts of other Ebola patients, said Dr. Peter Salama, the WHO’s head of emergency response.

In fact, over the last 30 days, two-thirds of the reported cases of the infectious disease have come from unknown contacts, according to Pierre Rollin, a top Ebola expert at the U.S. Centers for Disease Control and Prevention. That’s 85 cases out of 129.

Last week, Dr. Robert Redfield, director of the CDC, warned of the possibility of an “endemic” version of Ebola ― where the virus is not extinguished but continues to spread over an indefinite period of time among the population of North Kivu. Public health officials have argued that everything must be done to prevent the horror of continuous transmission of Ebola ― a situation that has never previously been seen.

This [Ebola outbreak] is going to get out of control fast. ... We are on the edge of crisis.
J. Stephen Morrison, director of CSIS’s Global Health Policy Center
Yet under a best-case scenario, Salama said the outbreak could be stopped within six months at the earliest. That’s a significantly different assessment from that being made by the CDC.

“Where we absolutely agree, this is arguably the absolutely most difficult context that we’ve ever faced for stopping an Ebola outbreak,” Salama told HuffPost. Global health leaders have had to re-evaluate many of the usual control tactics for battling the hemorrhagic fever, he said, because they’re now dealing with a massive displaced population in a war zone ― a situation that Salama has repeatedly described as a “perfect storm.”


Ron Klain, the Ebola czar under then-President Barack Obama, disagrees with that last characterization of a “perfect storm.” While Ebola has never been fought in a war zone before, he argues that this is the “new normal,” not a one-off situation, in an era of increasing outbreaks of the highest risk.

“We are going to increasingly see these disease outbreaks in troubled areas with histories of conflict, with refugees nearby, with difficult political situations because that’s what more and more of the world itself looks like,” Klain said.

“We can’t just treat this as some sort of flukish perfect storm of horrible facts that we’ll just have to deal with this one time and not ever again,” he said.

Salama acknowledges that 80 percent of serious disease outbreaks are occurring in fragile state settings. And his more optimistic take on controlling the Ebola outbreak comes with this caveat: “as long as the security holds.”


                                   War Zone Nightmare
Since the outbreak began in North Kivu at the end of July, attacks by rebel groups and community demonstrations have hampered the public health response, repeatedly driving response workers into lockdown and stopping vaccination efforts and contact tracing.

There have been at least 20 major security incidents of various kinds since the start of the outbreak, including one this past weekend, Salama said at a briefing Wednesday morning at the Washington-based Center for Strategic and International Studies (CSIS). All of these incidents have “set us back,” he said.

Jeremy Konyndyk, a senior policy fellow for the Washington-based Center for Global Development who previously led parts of the 2014 Ebola response for the Obama administration, stressed that no matter how effective the current response is, each rebel attack derails containment efforts.


“Every time we’re seeing one of these attacks, case monitoring is badly disrupted and drops off, people flee, and you see a corresponding increase in cases the following week,” Konyndyk said. “That means no matter how much progress we think is being made, it’s only as durable as the security situation allows it to be.”

Read more about the security situation in North Kivu here: “Experts Said A War Zone Ebola Outbreak Would Be A Nightmare. It’s Been Even Worse.”

The violence has led to a wave of new cases that began at the end of September. U.S. government and WHO officials say there has been increased coordination with the United Nations Organization Stabilization Mission in the Democratic Republic of the Congo, a peacekeeping force has been deployed in the area for years. MONUSCO (an acronym based on its name in French) is the U.N.’s largest peacekeeping mission, yet many are still concerned that the region’s violence will continue.

The threat of further attacks and protests in the lead-up to what were already expected to be contentious presidential, regional and legislative elections in the DRC on Dec. 23 is worrying global health leaders.

J. Stephen Morrison, the director of CSIS’s Global Health Policy Center who led a panel discussion at the think tank’s event, told HuffPost that “we are kidding ourselves” if people think the situation is going to improve soon.

“This [Ebola outbreak] is going to get out of control fast. Just look at the pattern of ADF hits and our inability to stop it,” he argued, referring to one of the two rebel groups responsible for the vast majority of the violence. “We are on the edge of crisis.”

The ultimate fear ― what Salama called a “game-changer” ― would be a directed attack against outside workers with the WHO or the NGOs who came to help. There have already been multiple attacks on local responders, including volunteers with the Red Cross, and two unarmed members of the DRC’s Medical Immediate Response Unit were killed.

Since the North Kivu region is currently labeled a Level 4 U.N. security threat, some sort of direct attack on outside medical responders would trigger a Level 5 label and result in evacuation of those forces ― which would be catastrophic for efforts to contain the outbreak.


That’s a frightening scenario, said Rear Adm. Tim Ziemer, who is currently serving as the U.S. Agency for International Development’s acting assistant administrator in the Bureau for Democracy, Conflict, and Humanitarian Assistance.

“We probably ought to be having a side meeting at a very high level to address what are the implications of that and what does that require all of us to do,” he said. “We can’t be blind and turn our back on this current challenge, as turning our back on it doesn’t mean it’s going to go away,” he added.

Ziemer previously served as the head of global health security at the National Security Council, which is coordinating the U.S. response to the DRC outbreak. Observers have argued that national security adviser John Bolton’s decision to reshuffle that agency earlier this year diminished the power of global health security experts in the Trump White House.

HUFFPOST