Authorities in north eastern Congo banned funeral wakes and gatherings of more than 50 people on Friday in an effort to curb a rapidly spreading Ebola outbreak in a region where medical workers have struggled with a lack of resources and pushback from angry residents.
The World Health Organisation said that the outbreak now poses a “very high" risk for Congo — up from a previous categorisation of “high” — but that the risk of the disease spreading globally remains low.
WHO Director-General Tedros Adhanom Ghebreyesus said 82 cases and seven deaths have been confirmed in Congo, but that the outbreak is believed to be “much larger."
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There is no available vaccine for the Bundibugyo virus, which spread undetected for weeks in Congo's Ituri Province following the first known death while authorities tested for another, more common, Ebola virus and came up negative.
There are now 750 suspected cases and 177 suspected deaths, though more are expected as surveillance expands.
“We are trying to catch up,” Congo Foreign Minister Thérèse Kayikwamba Wagner told the AP. “It is a race against the clock."
Efforts ramping up in Ituri Province
Supplies were being rushed to Ituri in the north eastern corner of the country, where nearly a million people have been displaced by armed conflicts over mineral resources. Ramping up contact tracing is a priority, Kayikwamba Wagner said.
In the provincial capital of Bunia, AP reporters saw empty emergency treatment centres, and doctors in the nearby town of Bambu using expired medical masks while tending to suspected Ebola patients.
The provincial government said on Friday it was temporarily banning wakes and gatherings of more than 50 people.
It said funerals must be conducted in strict compliance with health protocols.
The authorities also required journalists to obtain a permit to report on the outbreak, impeding their work.
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Illness spreads in rebel-held areas
The illness also has been reported in two Congolese provinces to the south of Ituri — North Kivu and South Kivu, where the Rwanda-backed M23 rebel group controls many key cities, including Goma and Bukavu, where the rebels reported two cases.
The group said on Friday it was creating a crisis team to fight the outbreak.
Kayikwamba Wagner said having the illness in rebel-held areas was alarming because “M23 is, despite whatever ambitions they may have, thoroughly ill equipped" to fight the disease.
She said the Congo government and rebels were not communicating on the outbreak.
Response clashes with local customs
The efforts of health officials and aid groups have met with pushback from communities due to misinformation or situations where medical policy has clashed with local customs such as burial rites.
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On Thursday, an Ebola treatment centre in Rwampara was set on fire by youths who were angered when they were blocked from retrieving the body of a friend who apparently had died of Ebola, according to witnesses and police.
The dangerous work of burying suspected victims is being managed wherever possible by authorities, because the bodies can be highly contagious and lead to further spread when they are prepared for burial or when people gather for funerals.
Julienne Lusenge, president of Women’s Solidarity for Inclusive Peace and Development, a local aid group, said the population’s anger is mostly due to misinformation.
“We have lived through years and years of conflict and hardship so rumours spread easily,” she said.
She said some churches have told their congregations the outbreak is fake and that divine protection makes medical care unnecessary.
Grief and the lack of a proper goodbye
In the Ituri province mining town of Mongbwalu where the outbreak is believed to have originated, Lokana Moro Faustin lost his 16-year-old daughter to the disease and bemoaned the fact that he was not able to give her a proper goodbye because of Ebola restrictions.
“At first, we thought it was malaria. But then came vomiting, a high fever, nosebleeds, and bloody diarrhoea,” he said, grief-stricken.
The teenager died on May 15 and her body was taken from the hospital by specialised teams and taken directly to the cemetery for a secure burial.
Faustin was not able to say goodbye because he was in self-isolation, and it pained him to have his daughter buried by people who were not family.
In Bunia, coffin workshop manager Christian Djakisa said demand has soared since the outbreak began. “We're here every hour making coffins,” he said.
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Aid is being flown in, but front line staff lacks resources
The United Nations said on Friday it released $84 million from its Central Emergency Response Fund to accelerate the response in Congo and in the region.
The US has pledged $32 million in funding to bolster the response in Congo and Uganda, and said it would also fund the establishment of up to 50 Ebola treatment clinics in the affected regions.
Lusenge said her group’s small hospital near in Bunia lacks basic protective equipment, exposing nurses and doctors to possible infection, she said.
“We only have hand sanitiser and a few masks for the nurses, but we need much more than that," Lusenge said.
Public health officials say that a person infected with Ebola generally passes the virus along to one to two other people — which is less contagious than measles, whooping cough and chickenpox, in which one person can infect around a dozen others.
But researchers note that transmission rates have varied in past Ebola outbreaks, and they are still trying to determine how contagious the Bundibugyo virus is.
The outbreak is bigger than official figures show, WHO says
Both the WHO and Africa Centres for Disease Control and Prevention believe the outbreak is larger than the cases reported so far.
The region’s already-weak health infrastructure and surveillance capacity has been further weakened by international aid cuts, experts say.
The International Rescue Committee said it had to stop its surveillance activities in three out of five areas in Ituri over the last year because of funding cuts.
Armed conflict in the region further complicates efforts to handle the crisis. To get from Bunia to Mongbwalu, aid groups have to brace for potential attacks from armed groups.
“The outbreak can still be contained but the window for action is narrow,” Gabriela Arenas from the International Federation of Red Cross and Red Crescent Societies said Friday.
