Description of the disaster
Following the declaration of the 9th Ebola Disease Outbreak (EVD) on 8 May 2018 by the Democratic Republic of Congo (DRC) Ministry of Health, the WHO has raised the alert for neighbouring countries of the Democratic Republic of the Congo (DRC) which share extensive borders, hosting DRC refugees and are used as corridors for DRC population movement. On 1 August 2018, just one week after the declaration of the end of the Ebola outbreak in Equator province, the 10th Ebola epidemic of the DRC was declared in the provinces of North Kivu and Ituri, which are among the most populated provinces in the DRC that also share borders with Uganda and Rwanda.
The provinces have been experiencing intense insecurity and a worsening humanitarian crisis with over one million internally displaced people (IDPs) and a continuous efflux of refugees to neighbouring countries, including Uganda, Burundi and Tanzania. Population mobility, including cross-border movements, were identified as a significant risk for disease transmission in this outbreak due to the high number of traders and miners, displaced populations and insecurity caused by rebels and militias in the area (Source IOM, 15 August 2018). Additionally, the security situation in North Kivu may hinder the implementation of response activities. Based on this context, the public health risk is considered high at the national and regional levels.
Since EVD outbreak in DRC continues to spread, WHO has been sending Preparation Support Team (PST) missions to neighbouring countries of DRC to review EVD readiness and support preparedness strategies with government and other stakeholders including RC/RC National Societies. According to their risk profiles, the WHO has categorized four countries i.e. Rwanda, Uganda, South Sudan, and Burundi as Priority-1 and remaining five countries -- Angola, Congo, Central African Republic, Tanzania, and Zambia are Priority-2. The prioritization was done based on their capacity to manage EVD and viral haemorrhagic fever (VHF) outbreaks, and their connections and proximity to the areas currently reporting EVD cases.
The RC/RC National Societies have been supporting government efforts in updating EVD contingency plans and strategies in the early detection/surveillance of cross border population movement, training of volunteers to undertake typical EVD response activities related to infection, prevention and control(IPC), risk communication, social mobilization and community engagement, Safe and Dignified Burials (SDB), Psychosocial support and National Society capacity building and preparing for future outbreaks.
In view of the above, potential risk factors for a further EVD expansion into Uganda exist not only at national level, but also at regional level, among which:
Transport links between the affected areas, the rest of the country, and neighbouring countries;
Internal displacement of populations;
Low level of knowledge around Ebola modes of transmission, especially among women (according to a KAP survey done in North-Kivu).
Displacement of Congolese refugees to neighbouring countries, including Uganda.
Concerning this last point, as of 30 June 2018, 288,766 Congolese form DRC fled into Uganda, 244,858 of whom arrived between January and June 2018 as a direct consequence of inter-communal violence between Lendu and Hema ethnic groups that broke out in December 2017 in Ituri province and attacks by Mai-Mai militia in North Kivu. Beside the influx of DRC refugees into Uganda for security reasons, cross border population movements between the two countries are also common for trade, family, pilgrims, health and education related services reasons1. These population movements have to be considered in addition to those entering into Uganda through official Points of Entry (PoE) for security reasons, estimated at 210 people/day between May and August 2018.
Based on the above, there is a tangible risk of EVD transmission in Uganda, especially as the affected area of Mbalako in Beni (DRC) is approximately 100 km from the western border of Uganda, with active cross-border movements in and out of Kasese, Bundibugyo, and Ntoroko districts.
Furthermore, on 17 August, the Uganda Ministry of Health (MoH) reported five (5) suspected EVD cases, which thankfully, were not confirmed after laboratory tests. Nevertheless, the situation remains critical in country, leading the MoH to undertake a series of measures to increase surveillance and preparedness, particularly in districts located along the border with the affected areas in North Kivu and Ituri provinces.
As such the MoH, under technical guidance of WHO has undertaken the below:
Activated the Public Health Emergency Operations Centre (PHEOC);
Reviewed and activated the National Ebola preparedness plan;
Instituted Ebola Prevention and Preparedness initiatives in target at-risk districts of Kasese, Bundibugyo, Ntoroko and Kabarole.
In line with the outbreak, preparedness measures were undertaken by UN agencies among which WHO, UNHCR and UNICEF which collaborate with the MoH for conducting, directly or through operational and implementing partners, preparedness activities.
The Uganda Red Cross Society (URCS) has been participating in MoH led coordination meetings and engaging in preparedness activities such as reviewing EVD contingency plan, surveillance on cross border population movement and mobilization of people for potential response. The National Society has been coordinating with in country Movement partners including IFRC, ICRC, Netherlands Red Cross, German Red Cross, Belgium Red CrossFlanders, Austrian Red Cross and Canadian Red Cross for support in potential health, WATSAN, training of volunteers and CEA activities.
WHO, for its part, has been supporting URCS through the training of RC volunteers who have been deployed by the National Society to work in the most at risk districts. WHO and UNICEF are also supporting National Society in developing the risk communication tools and protocols for surveillance, and risks assessments.
Considering URCS`s experience and skill in EVD preparedness, it has been recognized as a key partner in community risk communication, social mobilization and community engagement, community-based surveillance and screening, Safe and Dignified Burial (SDB) and Psychosocial support (PSS). It is in line with these pillars that URCS has developed this Ebola Preparedness plan of action. As such, the proposed DREF operation seeks CHF 145,512 to support 144,300 people for 3 months.