Written by: Tara Osler
As of March 3rd 2020, the last patient being treated for Ebola in the Democratic Republic of Congo has been discharged. Masika Semida was the country’s last Ebola patient – other than her, there have been no recorded cases since February 17th 2020, prompting authorities in the DRC and worldwide to tentatively celebrate the end of an almost two-year epidemic. This outbreak (named the “Kivu Ebola Epidemic” by the World Health Organization) began in August of 2018, claiming approximately 2,264 lives in the DRC with a mortality rate of 68%. This outbreak has also been linked to a smaller-scale outbreak in neighbouring Uganda, where four people who had visited the DRC died of the illness.
During the epidemic, the ongoing civil conflict in the region put a further strain on medical resources. The conflict in North Kivu province (the epicentre of both the unrest and the outbreak) began in 2004 and has expanded into a multi-sided civil war involving several paramilitary groups in combat with the Congolese government. One of the most prominent groups is an armed group known as the Allied Democratic Forces (ADF), who have been supported in their insurgency by Rwandan Hutu Supremacist militants and the Islamic State of Syria and the Levant. The conflict has internally displaced more than 1.4 million people within the DRC. The fallout from this ongoing unrest has put immense strain on the resources of humanitarian aid organizations in the region. United Kingdom-based aid organization Oxfam suspended their work in the region indefinitely in 2018, followed quickly by the International Rescue Committee (IRC).
According to the WHO, over 420 attacks were carried out against healthcare facilities during the 18-month Ebola outbreak, resulting in 11 deaths and 86 people injured. These targeted strikes on healthcare facilities (many of which were run by international aide organizations) put a massive strain on a public health system already under considerable duress. After several attacks on medical personnel, the NGO Médecins Sans Frontières (MSF) made the decision to suspend all of their operations in North Kivu province indefinitely. In a statement following the decision, MSF Emergency Desk Managers Hugues Robert expressed his organization’s regret, saying “as medical responders, it is very painful to have to leave behind patients, their families and other members of the community at such a critical time in the Ebola response.” This decision proved controversial and forced MSF to re-evaluate their approach towards pandemic treatment in central Africa. Communities in the region were historically distrustful of the aid organizations treating the Ebola crisis as other local health issues were largely ignored by the international community. MSF’s decision to suspend operations was technically in violation of the organization’s official principles. MSF Is still operating in other regions of the DRC in a limited capacity to avoid further violence, focusing on nutrition programs and the ongoing provision of Ebola vaccines.
The outbreak has also prompted advancements in healthcare in the DRC. Approximately 300,000 people were vaccinated against Ebola as a result, and new treatments were developed and found to be effective, though according to MSF, the vaccine’s need for multiple doses to be administered is challenging in a region where patients are difficult to keep track of. The current vaccine also needs to be kept below -60c. this has severely limited the ability of healthcare workers to continue the vaccination campaign, as many Congolese communities do not have adequate infrastructure to provide reliable access. As a result, MSF began a campaign to push for more research and development into the Ebola vaccine.
Despite this victory, the risks in the DRC remain high. The outbreak cannot be officially declared as over until a 42-day waiting period has been successfully observed with no new cases, as per the advice of the WHO. The limited accessibility of communities in the DRC also makes tracking person-to-person transmission difficult, so several areas cannot be officially declared as Ebola-free for the time being. Other infectious diseases remain present in the region, and new flare-ups are not unlikely. The recent global COVID-19 pandemic also poses a considerable risk to the people of the DRC, where an estimated 1.19 million adults have HIV/AIDS and are immunocompromised. However, the decline in cases since the beginning of 2020 could be the light at the end of the tunnel.
In a statement on behalf of the WHO, Assistant Director-General Dr. Ibrahima Socé Fall expressed a cautious sense of optimism. “Right now the world risks dropping the baton at the finish line”, she warned, imploring the general public to support the efforts of the WHO in the coming months. “There is a lot more work to do.”