DR Congo

DRC - Emergency Response to the Ebola and Cholera Outbreak in North Kivu Province - COD182


1.1. Context

Ebola virus

Since 1976, the date of the first cases of viral haemorrhagic fever, the DRC has been facing several episodes of Ebola virus epidemic. The Ministry of Public Health declared the 10th Ebola outbreak in August 2018. Its first confirmation was found in Mabalako health zone, Mangina locality, northwest of Beni. Within a few days, the disease spread to Beni and Butembo cities. So far, suspected cases have been reported in Musienene (N-Kivu), Mandima (Ituri) and Komanda (Ituri) health zones. At the pace by which Ebola is spreading, it is estimated that there is a great risk of Ebola spreading to other provinces of North Kivu, Ituri province and even beyond the Rwanda and Uganda borders.

Since the Ebola epidemic was declared by the Democratic Republic Congo (DRC) Ministry of Health, a response was launched to respond to Ebola Virus Disease (EVD) in collaboration with the World Health Organization (WHO) in partnership with other humanitarian agencies. As of 28-10-20182 , a total of 274 confirmed and probable EVD cases have been established (239 confirmed, 35 probable). At least 174 deaths have been reported giving a case fatality ratio (CFR) of 63.5%. According to a WHO report, the confirmed cases were reported within six health zones in North Kivu Province namely Beni (124), Mabalako (71), Butembo (24), Masereka (4), Kalunguta (2), and Oicha (2); and three health zones in Ituri Province: Mandima (9), Tchomia (2) and Komanda (1). Beni has surpassed Mabalako (the origin) in cumulative numbers of confirmed cases.

Two of the biggest hindrances to responding to EVD outbreak are insecurity, and reliance of the community on traditional healers, according to the discussions of the IASC Emergency Directors Group.

Other challenges include a very poor surveillance system, a poor system for community members to regularly contact health care centres, unsolved transmission chains, late arrival of patients in Ebola Treatment Centres (ETCs), and low notification of community alerts and deaths, among others. Other factors also include internal displacement of populations, displacement of Congolese refugees to neighbouring countries, and easy movement and contact links between affected areas and the rest of the country. The easy contact link means that there is a lot of human traffic between (a) Beni and Goma (via Kirumba, Kiwanja, Kibirizi, Bambo, Birambizo Health zones - within Rutshuru territory - and Mweso health Zone – within Masisi Territory) and between (b) Beni and Komanda- in Irumu territory - as well as in Mandima- in Mambasa territory (Ituri Province).
DRC ACT forum seeks to target about 93,000 persons to be protected against contacting the EVD.


In 2017, a total of 55,000 cholera cases including 1,190 deaths were reported in the DRC making the year 2017 one of the years with the highest Cholera cases.

According to WHO, the DRC has the largest endemic cholera outbreak in the world. Monthly rates throughout the year demonstrate an endemic and epidemic presence of the disease as compared to other countries affected by the cholera bacteria. Since 1978, cholera deaths have been recorded in the eastern provinces of Tanganyika, Haut Lomami, South Kivu, North Kivu, Ituri and Tshopo (these provinces register cholera cases each year). Some of the causes of cholera in DRC could be attributed to poor access to water and sanitation with only 31% rural population having access to safe water. In addition, only 29 % have access to improved sanitation facilities (JMP 2015) and 11.6% have access to handwashing devices with soap (EDS 2013-2014). In addition to EVD and Cholera, malaria outbreak is also a major public health concern in DRC.