ReliefWeb

This Emergency Appeal seeks a total of 1,630,297 Swiss francs to enable the IFRC to support the Red Cross of the Democratic Republic of the Congo (DRC RC) to respond to the ongoing Ebola Virus Disease (EVD) and deliver humanitarian assistance to 716,850 people in an emergency health intervention for 6 months. The emergency operation focuses on epidemic control with emphasis on community-based surveillance and contact tracing, safe and dignified burials (SDB), risk communication and community engagement, disinfection of households and psychosocial support. The planned response reflects the current situation and information available at this time and will be revised based on further developments and more detailed assessments. Detailed Emergency Plan of Action will be released at a later stage.

The operational strategy

Context

On the 3 May 2018, the Health Division of Equateur Province in DRC reported a cluster of 21 suspected VHF cases and 17 deaths. On 5 May, during a field investigation by the Ministry of Health (MoH) with the support of WHO and MSF, 5 samples were collected from hospitalized suspected cases of which 2 were confirmed positive of EVD serotype Zaire. On 8 May 2018, the DRC Government declared a new outbreak of EVD, which is the ninth in the country’s history.

As of 16 May, additional information on the epidemiological situation shows that the total number of cases now stand at 45 cases (including 25 deaths), of which 14 are EVD confirmed, 10 are considered as suspected cases and 21 as probable cases. Three health care workers have fallen sick from which 1 has died. 393 contacts have been identified.

At this stage of the outbreak, WHO has classified the risk to public health as high at the national level, moderate at the regional level, and low at the global level. On 18 May the WHO Emergency Committee convened to discuss the declaration of a Public Health Emergency of International Concern (PHEIC). The decision to not declare the current EVD outbreak as a PHEIC was taken. However, there was a strong message that the outbreak was serious and should be treated accordingly.

The outbreak is currently affecting the Equateur province with a population of approximately 2.5 million. 3 Health Zones of Bikoro, Iboko and Wangata in Equateur province have reported suspected cases. Wangata Health Zone, Mbandaka city, is an urban area with population over 1 million, and a transport hub of the River Congo. The spread of the disease to an urban area, with limited safe treatment and isolation facilities, brings additional risks.

Most of the cases reported were in Bikoro Health Zone. Bikoro is situated on the shores of Lake Tumba in the north-western part of the country near the Republic of the Congo. Health facilities in Bikoro have very limited functionality and rely on international organizations to provide supplies that frequently stock out. The capacity of local facilities to early detect suspected EVD cases and safely provide medical care to patients is limited, including limited diagnostics capacity.

The affected area is very remote with limited mobile telephone networks and difficult road conditions. The estimated distance from the epicentre to the capital of the Equateur province, Mbandaka, is 280km by road and can also be accessed via an airstrip that is 8km away from Bikoro, and the distance between the airstrip and Ikoko Impenge is approximately 30 km. This area of DRC has not suffered previous documented EVD outbreaks before the current outbreak.

The primary economic activity in Bikoro is fishing from Lake Ntomba; the fish are transported to Brazzaville and Kinshasa via Mbandaka. The population from the neighbouring Health Zones of Iboko and Ingendie also engage in fishing activities at Lake Ntoumba and pass through Bikoro to access the lake daily. This mixing and movement of population is a risk factor for the spread of the disease during an outbreak like EVD. An additional risk factor for possible spread of this outbreak is the fact that the exact source and trajectory of the possible first cases found on retrospective investigations are not yet fully known. The local traditional medical practices and burials with close contact to the deceased could lead to further spreading the disease. Thus, the spread could be wider than currently seen.

The major means of transportation to the epicentre of the outbreak from Mbandaka to Bikoro town is by 4 x 4 vehicles during the dry seasons; however, during rainy seasons as it is the case now, the roads become impassable and thus the only means of accessing the area is with the use of motorcycles and helicopters. The UN have re-routed their helicopter schedule to enable helicopter shuttles from Mbandaka to Bikoro until further notice. Water way transportation is also a very prominent means of movement -- the water way transport runs along the border with the Republic of Congo (Rock) and the Central African Republic (CAR) to major cities like Brazzaville in RoC, Bangui in CAR and Kinshasa in DRC. This movement too, could constitute a potential risk for spread considering the number of people who use this means of transport daily.

Vigilance against the outbreak spreading to other areas in the province, to neighbouring provinces and potentially into neighbouring countries is important due to potential population movement, limited detection and safe treatment capacity as well as existing cultural practices that may pose risks. An emphasis on contact tracing and active case finding at community level, SDB and risk communication for early detection to limit spread of the disease and ensure rapid control of the outbreak is crucial. As such, it is an extremely important and urgent task to respond very quickly to this outbreak, to contain the disease and limit its impact.

International Rapid Response Teams continue conducting emergency needs assessments to better understand the severity and magnitude of the outbreak. At present the available demographic and epidemiological information remains limited and the situation fluid; making it difficult to estimate the true extent of the outbreak.