Two months into the Ebola outbreak: where do we stand?

The outbreak is gaining ground

To date, the death toll has exceeded 700. According to the WHO, this is the most virulent Ebola outbreak observed in Africa during its first month, with a record number of confirmed cases. “For several weeks now, we have been recording more than 300 cases a week,” says Michele Torti, emergency coordinator for Action Against Hunger in the DRC.

At the same time, bed occupancy rates in Ebola treatment centres (ETCs) stand at 90 per cent, reflecting a lack of resources despite efforts to control the outbreak.

“Health centres systematically refer symptomatic patients to the ETCs, leading to overcrowding in the ETCs, isolation centres and transit centres,” explains Michele Torti.

Concerns are also growing over the geographical spread of the outbreak. The outbreak is now spreading to the neighbouring provinces of Haut-Uélé and Tshopo.

“Cases are rising, mortality rates are increasing and the number of affected areas is growing. The rate of spread shows no signs of slowing down,” he continues.

This development is of particular concern in Kisangani, the capital of Tshopo Province.

“Kisangani is a large city situated on the banks of the Congo River, at the heart of a major river and trade network. There is significant population movement there, which increases the risk of the virus spreading and complicates efforts to control the outbreak,” emphasises Michele Torti.

Given this situation, the needs remain considerable. “We are engaged in a long-term battle, and the resources currently available are not sufficient to bring this outbreak to an end,” he concludes.

Ebola against a backdrop of food crisis

The outbreak is striking a region that is already severely vulnerable. Persistent insecurity linked to the activities of numerous armed groups, repeated population displacements and the decline in humanitarian aid in recent years have undermined households’ livelihoods. Today, according to the United Nations, more than 1.15 million people are facing acute food insecurity in the affected provinces. As the lean season approaches – a critical period between harvests during which food stocks dwindle and food prices often rise – concerns are growing that the food and nutrition situation will deteriorate further.

Whilst conflict remains the main cause of acute food insecurity, the Ebola outbreak is an aggravating factor in the affected areas.  The border restrictions put in place with Rwanda and Uganda have severely disrupted cross-border trade, affecting household incomes and their purchasing power. Furthermore, quarantine measures applied to people who have been in contact with confirmed cases restrict their movement and temporarily deprive them of their sources of income. These difficulties could be long-lasting, particularly in Ituri, where many households depend on mobility and cross-border work to meet their needs.

“We cannot neglect the treatment of malnutrition and the continuity of healthcare in this region, where needs are immense. Despite the ongoing epidemic, our work must continue,” emphasises Michele Torti.

In Mongbwalu, Action Against Hunger is providing emergency health and nutrition support to pregnant and breastfeeding women, as well as to children under the age of five. The teams have set up a home-based monitoring programme for cases of severe acute malnutrition, carried out by community health workers. This programme aims to ensure continuity of care for children suffering from severe acute malnutrition, whilst facilitating their referral to health services where necessary. To date, 104 children suffering from severe acute malnutrition (SAM) – 42 girls and 62 boys – have benefited from this support. In addition, the provision of 15,000 mid-upper arm circumference (MUAC) measuring tapes has helped to strengthen this programme.

In Drodro and Lita, food aid in the form of cash transfers has been introduced to cover the basic needs of the most vulnerable communities for a period of three months.

Prevention, protection and training to contain the outbreak

From the very first weeks of the outbreak, Action Against Hunger teams stepped up infection prevention and control measures in 13 health facilities within the Mongbwalu health zone. Handwashing stations were installed to reduce the risk of virus transmission, and IPC-WASH kits were distributed to health centres and the Mongbwalu General Referral Hospital. These kits are designed to strengthen healthcare facilities’ capacity for infection prevention and control, in particular by providing essential supplies for hygiene, disinfection and the protection of healthcare staff and patients.

In recent weeks, a water supply service using tanker lorries has been set up at four health centres in Mongbwalu, thereby supporting preparedness and response efforts to Ebola virus disease. ly, Action Against Hunger has supported the establishment of triage systems and temporary isolation areas designed to identify and treat suspected cases more quickly and prevent any risk of transmission. To date, eleven healthcare facilities have been equipped with these systems.

The organisation is also investing in community capacity-building. In early June, community health workers were trained in epidemiological surveillance, the identification of suspected cases, alert mechanisms, infection prevention and control, as well as risk communication and community engagement. This work is essential for promoting the early detection of cases and strengthening public confidence in the response to the outbreak.

Fear and mistrust at the heart of the fight against the outbreak

On the ground, teams are observing a very significant drop in attendance at health centres, particularly in Mongbwalu. Fear of the disease is driving many people to avoid healthcare facilities, for fear of contracting the virus there, and patients showing symptoms of Ebola are arriving at health centres very late. These delays in diagnosing and treating patients are fuelling the spread of the the outbreak and contributing to a high mortality rate. In some health centres, the shortage of healthcare staff is even leading to a reduction in, or even the suspension of, healthcare services.

Sister Charlotte Vive, a senior nurse at the Notre-Dame de la Charité Maternelle health centre, describes the situation:

“A mother arrived at our health centre showing all the symptoms of Ebola. We started by washing our hands, then took her temperature in the triage area. So we said to her: ‘You have all the symptoms; can you go to hospital?’ She started crying and said: ‘No, I don’t like hospitals. ‘In hospital, people go there to die.’ We advised her: ‘No, as you’ve arrived in time, you’ll recover.’ And we called an ambulance. But there are other people who flatly refuse.”

“What worries us is that we’re afraid of the disease too. We’re afraid of the disease because many nurses have died from it – lots of them – and even doctors have died.”

Francine Mave, a nurse in the paediatric ward at the same centre, adds:

“Before, when our work with Action Against Hunger began, there were lots of children; all the beds were full. But during the epidemic, since April, there have been no patients here because parents are afraid to bring their children. They’re afraid because people are spreading rumours in the community. They say that people are being killed in hospital.”

*ACF’s Ebola response is currently funded by the donors Start Fund, SIDA, DOS and ACF.