The second-worst Ebola outbreak in history is proving difficult to contain.
An Ebola treatment center that shut down in response to an arson attack last month was again stormed by armed assailants on Saturday, leaving one police officer dead, health workers injured, and patients fearful for their safety, according to the AP.
The violence broke out hours before the World Health Organization chief, Tedros Adhanom Ghebreyesus, was set to visit the facility, part of the response to the Democratic Republic of Congo Ebola outbreak that’s been ongoing since August. At least 921 people have contracted the virus and 582 have died. It’s the first known Ebola epidemic in a war zone (DRC’s eastern North Kivu and Ituri provinces).
“It breaks my heart to think of the health workers injured and police officer who died in today’s attack, as we continue to mourn those who died in previous attacks, while defending the right to health,” said Dr. Tedros, as he’s known, said in a statement Saturday. “But we have no choice except to continue serving the people here, who are among the most vulnerable in the world.”
This is the third attack on facilities treating Ebola patients in the last month. They’ve happened in the most active hot spots in the outbreak, neighboring cities called Katwa and Butembo.
The first setback came on February 24 in Katwa. Late at night, assailants threw stones at a Doctors Without Borders building and then proceeded to set it on fire, forcing workers to evacuate and to move patients to other hospitals.
“This attack has crippled our ability to respond to what is now the epicenter of the outbreak,” said Emmanuel Massart, MSF’s emergency coordinator in Katwa, in a statement after the outbreak.
Four days later, on February 27, arsonists set MSF’s Butembo operation on fire. “The blazes were contained and no staff or patients were harmed, but the teams were forced to immediately cease patient care,” according to a second MSF statement. “In light of these two violent incidents,” MSF emergency desk manager Hugues Robert added, “we have no choice but to suspend our activities until further notice.”
The facility was rapidly rehabilitated, and reopened on March 2, operated now by DRC’s Ministry of Health, WHO and UNICEF. But less than a week later, on Saturday March 9, it was attacked again.
Butembo and Katwa are the two areas in DRC where the virus is most active, with a combined 342 confirmed cases to date, according to the health ministry’s latest count. These interruptions in the Ebola response are disturbing for two reasons. First, they mean fewer workers will be available to identify, isolate, and treat Ebola patients. And in an Ebola response, when people with the virus remain in the community, they can spread it to others. “We can expect a significant increase in cases in the health zones of Katwa and Butembo in the coming days,” DRC’s health ministry warned after the February 27 attack.
But even worse, the attacks suggest that at least some community members are resisting the humanitarian work to help stop the outbreak. They may be a minority, but they pose a significant threat to the Ebola response. Instead of cooperating with aid workers, they’re burning down the medical units set up to protect them. That’s a major setback for DRC and its Ebola responders.
The success of this Ebola response hinges on trust. The arson attacks suggest there’s a trust problem.
Stamping out an Ebola outbreak requires a very high level of community buy-in. The virus is spread through direct contact with the bodily fluids, like vomit, urine, or blood, of someone who is already sick and has symptoms. The sicker people get, and the closer to the death, the more contagious they become. (That’s why caring for the very ill and attending funerals is especially dangerous.)
Because we have no cure for Ebola, health workers rely on traditional public health measures: finding, treating, and isolating the sick, and breaking the chains of transmission so the virus stops spreading.
They mount vigorous public health awareness campaigns to remind people to wash their hands; that touching and kissing friends and neighbors is a potential health risk; and that burial practices need to be modified. (Again, funerals can act as Ebola super-spreaders since people who die of the virus are extremely contagious, and families prepare, touch, and kiss corpses as part of traditional funerary rituals.)
Responders also employ a strategy called “contact tracing”: finding all the contacts of people who are sick and following up with them for 21 days — the period during which Ebola incubates.
Every one of these measures can only succeed if community members trust and cooperate with Ebola responders.
They need to let aid workers into their home to test for the virus and agree to be followed up with for 21 days. They need to accept the painful reality of sending family members with the virus to treatment centers for isolation, so they can’t infect others around them.
They need to follow basic public health measures such as hand washing, and safe burial practices, which can mean putting aside centuries of family tradition and personal beliefs to stop the spread of the virus.
In this case, responders also have an effective vaccine at their disposal — and to date, more than 86,000 people have been vaccinated, including in Katwa and Butembo.
But that doesn’t necessarily mean people are cooperating with the other parts of the Ebola response. A recent Lancet survey of locals’ attitudes toward the Ebola response in DRC suggested that people’s willingness to get the Ebola vaccine was really high (82 percent said they’d take the vaccine for their family members) — but many respondents said they would not send their family to treatment centers (17 percent) and would actively hide family members with Ebola from the authorities (17 percent).
“To overcome [an Ebola] outbreak, we need to gain the hearts of the population,” Michel Yao, the World Health Organization’s incident manager in Butembo, told Vox. “We need to have them fully on board.” Yao believes community resistance has been improving overall, but the attacks on the treatment centers suggest there may be more trouble ahead.
Clarification: We’ve updated the story to add the figures from the Lancet study clarifying DRC attitudes toward the Ebola response.
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Breaking News: Arsonists attacked 2 facilities treating Ebola patients in Congo. That’s a major setback. - News Paper
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