Ebola Threat Heightens Surveillance in Congo's Eastern Neighbors

(Bloomberg) -- Rwanda and Uganda increased surveillance at their borders with the Democratic Republic of Congo, where instability is heightening the risk of an Ebola outbreak spreading.

The virus killed at least 113 people since it was identified near Beni in east Congo in August, the highest toll since an Ebola epidemic killed more than 11,000 people in West Africa between 2014 and 2016. Insecurity and the spread of the virus toward the Ugandan frontier led the World Health Organization to say last month there’s a “very high” risk of it crossing Congo’s borders.

“We have intensified our systems for health surveillance on our borders,” Ugandan Health Minister Sarah Achieng Opendi said by phone from the capital, Kampala. Anyone arriving from Congo is being screened and blood samples are being taken from those suspected of carrying the virus, she said. “Fortunately, all have tested negative.”

Rwanda has placed screening machines at its border posts with Congo and Uganda and urged its citizens not to travel to affected areas, said Fulgence Kamali, a spokesman for Rwanda’s Health Ministry.

Second Outbreak

It’s the second time this year Ebola has occurred in Congo -- 33 people died in a flare-up in northwest Congo in April -- and the 10th in the country since the disease was first discovered there in 1976.

Tackling the current crisis in the eastern Congolese provinces of North Kivu and Ituri is “arguably the most difficult context we have ever faced in terms of responding to an Ebola outbreak,” Peter Salama, the WHO’s deputy director-general of emergency preparedness and response, said last month. Local mistrust of health workers and escalating violence threaten to create “a potential perfect storm,” he said.

Eastern Congo has been blighted by armed groups for more than two decades and in excess of 120 militia groups are currently active in the region. Around Beni alone, at least 1,000 civilians have been killed in the past four years. The United Nations estimates that about a million people are currently displaced by conflict in North Kivu.

‘Insecurity, Attacks’

“There is a lot of insecurity, a lot of attacks happening right up against the Ugandan border and people are regularly and routinely fleeing in all directions from those attacks and that includes across borders,” Sarah Terlouw, Congo country director at the International Rescue Committee, said in a phone interview.

A rebel assault on Beni on Sept. 22, which left 21 people dead, resulted in Congo’s Health Ministry and its partners suspending their activities in the town.

“We weren’t able to do any prevention work for six days,” Terlouw said. “We weren’t able to track cases, or refer suspected cases for testing for confirmation or for treatment.”

A vaccination program, deployed successfully for the first time this year during the earlier outbreak in Congo, was also put on hold during the lockdown.

“It’s safe to say there are unidentified cases and contacts of cases out there,” Terlouw said.

Volunteers Attacked

Hostility from some communities is also complicating the response, requiring the government and its partners to simultaneously perform rapid interventions and education campaigns. Last week, three Red Cross volunteers were attacked and seriously injured in the city of Butembo, a major hub for trade with Uganda, while carrying out a safe burial.

Mistrust of health workers has been concentrated around Ndindi, a district in Beni, which has been responsible for a large proportion of recent cases, according to the WHO.

“Small numbers, but still significant numbers, of people are refusing active follow-up, refusing to be cared for in the Ebola-treatment unit, and actively fleeing from the responders into the forests, and for hundreds of kilometers in some cases,” Salama said on Sept. 25. A family from Ndindi was responsible for spreading Ebola to Tchomia on the shores of Lake Albert on the border with Uganda and Butembo, according to the Health Ministry.

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