Congo is facing the worst outbreak of Ebola in its history. While that nation has experience battling the deadly disease, experts fear that a “perfect storm” of fighting, national elections and a mobile population will make containment impossible.
This outbreak — the second of the year — began five months ago in North Kivu province. When the disease first began to appear, the World Health Organization predicted an early end. It has since spread to Ituri province and the death toll has mounted, claiming more than 200 lives since August, another 330 cases are confirmed or probable, and it is estimated that there are 30 new infections each week. Last month, however, the WHO ruled that the outbreak did not meet the criteria for “a public health emergency of international concern.”
That assessment may have reflected Congo’s success in battling previous outbreaks. Its government has contained nine Ebola epidemics since 1976, including one in May of this year. Congo has developed a health infrastructure that allows it to monitor the disease, respond in real time to its appearance, treat victims, and safely and humanely deal with the dead. A new vaccine has been provided to over 27,000 high-risk individuals and experimental therapies are available to those who have been infected.
This is the first Ebola outbreak in northeastern Congo, however, and the political circumstances in that region are more precarious than those of previous epidemics. The area is wracked by violence as armed groups struggle for control of its rich mineral reserves. Fighting has endangered health workers, explained Health Minister Oly Ilunga Kalenga: “The response teams have faced threats, physical assaults, repeated destruction of their equipment and kidnapping.” Health workers have been attacked three or four times a week on average. Several have been killed.
The fighting uproots civilians and potentially infected individuals are not being isolated. Instead, they are likely spreading the disease. The WHO estimates that there are more than 1 million refugees and internally displaced people in North Kivu and Ituri. The movement of these groups compounds issues of trust and communication, making health management even more difficult.
Finally, Congo is scheduled to hold an election in December and the attempt to create order prior to the vote — and the violence that may follow the ballot — will likely make the situation worse. The capital is a long distance from the two Ebola-stricken provinces, and that distance has meant that the government has often failed to exercise control over the area. The struggle between the military and local militia groups — by some counts over 40 — has contributed to the perceived illegitimacy of the national authority. The army is accused of taking the lives of more than 100 civilians since 2017.
A United Nations peacekeeping force in the country — the U.N. Organization Mission in Democratic Republic of the Congo (MONUSCO) — can provide protection to health care providers as well as some stability during the elections. There is no guarantee, however, that the force can tamp down the violence. Earlier in November, seven peacekeepers were killed and 10 wounded during a joint operation with the army against a rebel group in the area. A more aggressive posture by U.N. forces will encourage militia groups to see them as partisan, rather than neutral, and encourage attacks upon them.
While the outbreak is half a world away, Japan is not indifferent to its progress. In addition to donations that the Japanese government has made to organizations to help fight the outbreak, the National Institute of Infectious Diseases has announced that it will for the first time import strains of five types of hemorrhagic fever, one of them Ebola, to study ways to improve detection as the country braces for an influx of tourists for the 2020 Tokyo Olympic Games. The pathogens will be studied at the country’s only biosafety level four (BSL-4) laboratory.
Experts believe it might take a year to halt and contain the outbreak; the most optimistic assessments are that six months are needed. Last month, the U.N. Security Council voiced “serious concern” over the deteriorating security situation in eastern Congo, “demanded” that all armed groups respect international humanitarian law and called for heightened international engagement, including an expanded U.N. response. Japan should back all U.N. efforts to bring peace to Congo, while providing more support to medical and humanitarian efforts to combat this horrific disease.