Summary of major revisions made to emergency plan of action:
Following the confirmation of Ebola cases in Kashenyi at the shores of lake albert in DRC, 40km from thee landing site in Uganda about 3 weeks ago; and the continued conflict in Beni which has hampered the Ebola control efforts, the WHO risk level of the outbreak spreading to Uganda has been increased from high to very high nationally and regionally, but still seen low globally. This calls for strengthening and scaling up of current interventions.
At the national level in Uganda, it has been noted that it is a matter of when and not if the outbreak will occur, with WHO initiating preparations for safe and dignified burial (SDB) by training teams. However, it is not yet clear who will take a lead in managing SDB services in the country. Harnessing on the expertise and experiences of the Red Cross Movement in previous Ebola outbreaks in west Africa, URCS is positioning herself to lead SDB services in Uganda. There is therefore a need for additional surge capacity to support the development of a clear SDB strategy and plan that will guide interventions. An additional allocation of CHF 17,040 is being requested through this Operations Update to enable the deployment of an SDB expert and to support the ongoing mission of the CEA expert.
In addition, a strategy and Planning expert will be deployed for 1 month, funded by the Norwegian Red Cross, to support the SDB strategy and plan.
A. SITUATION ANALYSIS
Description of the disaster
Following the declaration of the 9th Ebola Virus Disease (EVD) outbreak on 8th May 2018 by the Democratic Republic of Congo (DRC) Ministry of Health, the WHO raised the alert for neighbouring countries, 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 of North Kivu and Ituri 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 has hindered the implementation of response activities to control the EVD outbreak.
Based on this context, the public health risk is considered very high at the national and regional levels.
Since the 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- Rwanda, Uganda, South Sudan, and Burundi as Priority-1 for which EVD preparedness DREFs have all been approved for, and remaining five countries -- Angola, Congo, Central African Republic, Tanzania, and Zambia as Priority2. 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.
In the last week of September, WHO increased the risk level for DRC EVD spread into Uganda from HIGH to VERY HIGH, due to the increased insecurity situation, which is hampering response activities. Cross-border activities have continued unabated with people from both sides of the borders participating in communal activities. There are some known Ugandans from Ntoroko district who were identified to have participated in the burial of a confirmed EVD case who died in Kasenyi in the DRC, one of whom was discovered at a construction site in Entebbe while two others remained untraced. This therefore requires extra vigilance in all activities, especially through heightened Points of Entry (PoE) screening and intensified community engagement.
The Uganda Red Cross has been supporting government preparedness efforts, coordinated through the national and district level Task Forces, in partnership with the Ministry of Health (MoH), UNICEF, IFRC and other partners, with the objective to prevent the importation of EVD into Uganda, building community resilience and building capacity to respond to a possible outbreak. URCS has been implementing preparedness activities with funding from UNICEF, WFP, IFRC (DREF and the epidemic preparedness program funded by USAID). The interventions are being implemented in the following 7 districts, which are identified as High-risk districts for a possible Ebola outbreak in the country: Kisoro, Kanungu, Kasese, Bundibugyo, Kabarole, Ntoroko and Bunyangabu.
Key URCS intervention activities include:
- Risk communication, community engagements and sensitization about potential risk of an EVD outbreak in Uganda.
- Support to EVD screening at 18 ground Points of Entry (PoEs).
- Psychosocial support implementation though training for volunteers.
- Infection, prevention and control (IPC) activities implementation, including Safe and Dignified Burials (SDB) if deaths from Ebola are reported.
- Transportation of suspected cases identified at community level and at PoE to the designated health facilities, and provision of discharge kits.
URCS, with support of partners 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 EVD response activities such as IPC through training volunteers and health workers on preparing water, chlorine and jik solutions, disinfection and decontamination; risk communication; social mobilization and community engagement (CEA); Safe and Dignified Burials (SDB); Psychosocial support (PSS); and National Society capacity building and preparing for future outbreaks.
Potential risk factors for further EVD spread continue to exist not only at national level, but also at regional level including Uganda. The following factors are increasing the risk
- 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.
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 Cross-Flanders, 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 the National Society in developing risk communication tools and protocols for surveillance to be adopted both at community and PoE level and risks assessments for PoE.
The elevation of the EVD outbreak risk from high to very high calls for strengthening and scaling up of the current interventions. WHO initiated preparations for safe and dignified burial (SDB) by training of teams. Harnessing on the expertise and experiences of the Red Cross movement in previous Ebola outbreaks in West Africa and DRC, URCS is positioning itself to lead SDB services in Uganda. Two additional surge staff will be deployed to support URCS in the development of a clear strategy and plan, and to strengthen URCS SDB capacity. A revision of the DREF is expected after finalization of this SDB strategy and plan