Ebola and conflict: the best partners in crime?

By Lise Carlier, Key Correspondent for the Irish Forum for Global Health

On the 1^st of August 2018, the Democratic Republic of Congo (DRC) declared an outbreak of Ebola in North Kivu. Dr Michael Ryan, the WHO’s Assistant Director General of Emergency Preparedness and Response joined us today all the way from DRC, via Skype, for the Global Health Exchange Conference. He reported what is currently being done on the ground and the challenges they face. He stressed that, “This epidemic is not driven by a virus; it’s driven by behaviour and human systems,” referring to the current conflicts happening in the same region.

Dr Ryan is currently based in Beni, North Kivu, and at the current epicentre of the outbreak. He shared with us the unfortunate news that the number of cases had just passed 300 the previous day, with 135 confirmed deaths to date. Currently, there are 91 inpatients in three different clinics provided by Médecins Sans Frontières (MSF) and Alima. Patients treated so far number 133, receiving novel antiviral and antibodies. ZEBOV, an experimental vaccine for protection against Ebola, has been provided for 24000 people.

North Kivu is not only the epicentre of the epidemic. It’s also the epicentre of current conflicts and has been for almost 20 years. Attacks, with frequent killings and kidnappings. Communities have been left traumatized and distrustful of the government, with street protests and sometimes complete shutdown of civic work. This severely disrupts operations and makes it difficult to effectively deliver risk communications, vaccine management, and inpatient treatment. Community engagement has been hard to maintain due to lack of trust in the government and general faith in more traditional medical approaches. This approach has deeply impacted disease transmission and limits the ability to successfully detect and deal with new Ebola cases.

For Dr Ryan, despite the unstable environment they are, “Getting the job done,” effectively containing the spread of the virus in several regions. They rely heavily on partners such as UNICEF, MSF, and the Red Cross. He also acknowledged the significant government response. According to Dr Ryan, the best form of epidemic prevention is the ability of health systems to deliver essential health education to its population and creating effective public health services that can detect and respond to epidemics quickly. Additionally, he mentioned that the only way to get rid of Ebola is through a community-based approach that allows for better community surveillance in times of conflict. Their engagement promotes better understanding of Ebola and what they need to do.

Containing an Ebola outbreak is always complicated, but in North Kivu, when conflict is added to the equation, the job is made a whole lot harder. It’s essential that health systems educate and prepare populations for quick and effective responses to epidemics. Furthermore, community-based approaches are vital for Ebola eradication in conflict regions.

7th November 2018