The Democratic Republic of Congo (DRC) is dealing with the world’s second largest outbreak of Ebola. As of end August 2019, more than 3,000 cases of Ebola had been recorded, including over 2,000 deaths.
The DRC shares its borders with nine countries and there is regular cross-border movement of people, goods and services in the region. Combined with weaknesses in national health systems, the nine neighbouring countries are at very high risk for an Ebola outbreak.
This risk has become evident in recent months. In June 2019, three members of a family from the DRC crossed the border into Uganda; all three subsequently died of Ebola.
In July 2019, an Ebola case was reported in the DRC near the border with South Sudan and another was confirmed in Goma, after arriving from Butembo, a previous epicentre.
In August 2019, cases were confirmed in a third province of DRC, South Kivu, near the border with Burundi.
In reflection of the growing risks and based on the advice of the International Health Regulations Emergency Committee, the World Health Organization (WHO) declared the Ebola outbreak in the DRC a Public Health Emergency of International Concern (PHEIC) on 17 July 2019.
To assist the DRC’s nine neighbours with advancing critical preparedness measures, the United Nations has developed this Regional Ebola Preparedness: Overview of Needs and Requirements July - December 2019. The Regional Overview serves as a complement to the Integrated Strategy to Respond to Ebola Virus: Ituri and North Kivu Provinces for the DRC, covering the same period.
Together, the two documents present the full scope of actions and funding required to respond to the current Ebola outbreak in the DRC, to prevent it from spreading further, and to drive the response towards zero cases. The generous financial and in-kind contributions provided by national and international partners to the many actors working in support of Ebola preparedness has been a key factor in the progress made thus far.
The nine countries included in this Regional Overview are categorized into two groups, based on risk level:
• Priority 1 (based on proximity to areas where cases have been reported and large-scale movement of goods and people across borders): Burundi, Rwanda, South Sudan and Uganda.
• Priority 2 (all other countries neighbouring the DRC): Angola, Central African Republic.
Republic of Congo (RoC), Tanzania and Zambia.
This document presents a consolidated summary of urgent activities required to advance preparedness, as elaborated in each country’s national plan, with a particular focus on Priority 1 countries. It presents the estimated requirements, needs and gaps for each of the Priority 1 countries, and a summary for Priority 2 countries, as aligned for the period of July to December 2019.
The Democratic Republic of the Congo (DRC) is experiencing its tenth outbreak of Ebola, epicentered in the North Kivu and Ituri Provinces. Since the declaration of the outbreak on 1 August 2018, over 3,000 Ebola cases, including 2,931 confirmed and 105 probable cases, had been registered by 1 September 2019. This includes 2,035 deaths, with a case fatality rate of 67 per cent.
Twenty-nine health zones are affected by the outbreak, with the health zones of Mabalako, Katwa and Beni being particular hotspots.
The efforts of the DRC Government, frontline medical workers and the people of the DRC in responding to the Ebola outbreak have been commendable and have largely contained this yearlong outbreak from spreading outside the affected areas. Nevertheless, the risk of spread to other areas inside the DRC and across borders to neighbouring countries remains very high. In June 2019, the first cases crossed the border to Uganda; three members of a family from the DRC subsequently died from Ebola. On 1 July 2019, a new health zone inside the DRC, Ariwara in Ituri Province, located several hundred kilometres north of the epicentre near the border with South Sudan, reported a new confirmed case. On 14 July, the first case was registered in Goma, the capital city of North Kivu Province and adjacent to the border with Rwanda, after a symptomatic man travelled there from Butembo; the case was later transferred to the Butembo ETC. On 15 August, two cases were confirmed in Mwenga in South Kivu Province, near the border with Burundi, after returning from Beni.
Significant challenges to breaking the chain of transmission and ending the outbreak remain. Unlike other areas in the DRC where Ebola has been successfully contained, the current outbreak is occurring in an extremely fragile environment marked by active conflict and the presence of both foreign and domestic armed groups. The area is also a traditional opposition stronghold characterized by a deep mistrust of outsiders and a perception of historical neglect and persecution. This context makes key activities such as surveillance, contract tracing, and infection prevention and control difficult.
Ongoing armed conflict and lack of access to vulnerable communities hamper implementation of infection prevention and control measures and increase the risk of human-to-human transmission.
A significant proportion of people with Ebola are dying outside health facilities, of whom some do not receive a safe and dignified burial, and the average time from onset of illness to reporting remains high. The concurrence of several outbreaks of diseases with similar non-specific clinical signs has also challenged the initial clinical diagnosis. Specifically, the recent spread of Ebola in cholera-affected health zones of the DRC (Kayna, Alimbongo) might complicate response activities.
The increased risk of geographical spread remains. The risks are particularly acute for countries bordering the affected provinces of the DRC. These countries are exposed to large cross-border population movements (due to usual travel, trade or ongoing insecurity) and concurrently have health systems weaknesses. Confirmed cases and individuals who have come into contact with Ebola-affected people (referred to as ‘contacts’) are known to move long distances.
Citing concerns over worrying signs of possible extension of the epidemic in the DRC, the resurgence and ongoing transmission in Beni and the risk of further spread, the International Health Regulations Emergency Committee recommended on 17 July 2019 that the World Health Organization declare a Public Health Emergency of International Concern (PHEIC). The Committee’s recommendations for preparedness were:
• At-risk countries should work urgently with partners to improve their preparedness for detecting and managing imported cases, including the mapping of health facilities and active surveillance with zero reporting.
• Countries should continue to map population movements and sociological patterns that can predict risk of disease spread.
• Risk communications and community engagement, especially at points of entry, should be increased.
• At-risk countries should put in place approvals for investigational medicines and vaccines as an immediate priority for preparedness.