Since August of 2018, the Democratic Republic of Congo (DRC) has been facing the second deadliest outbreak of the Ebola virus since its discovery in 1976. According to resources published by the World Health Organization (WHO), 2150 deaths have been confirmed as of October 12. The rising death toll appears in spite of the development of an effective Ebola vaccine. While international efforts are currently combatting the outbreak, conditions in the Democratic Republic of Congo - ongoing armed conflicts, political protests, and local distrust of government - has hindered efforts and created ripe conditions
for future outbreaks.
The Ebola virus is thought to naturally originate from fruit bats and spread into certain animal populations such as non-human primates and antelopes. The virus is then introduced to human populations via contact with infected bodily fluids of the infected animals. Human to human transmission occurs in a similar manner and has been reported with direct contact with deceased bodies.
As the bodies of the afflicted remain infectious after death, proper care must be taken for safe disposal. The World Health Organization recommends that handling of the human remains be kept at a minimum and should be contained in body bags and coffins followed by disinfecting of the container after closing. Governments often take great measures to protect the graves of the infected in order to prevent people from uncovering the contaminated bodies and exposing
themselves to the virus.
Ebola vaccinations, however, are not welcomed by many local populations. This resistance to Ebola vaccinations makes the region especially susceptible to infection. Some reports have shown that villagers will at times violently demonstrate against Ebola vaccination teams, assaulting them with thrown stones. On April 19, in one instance of violence against health workers, a WHO epidemiologist was murdered and two other health workers were injured by gunmen. In another violent incident against Ebola responders, buildings and treatment centers associated with Ebola vaccinations were set ablaze.
Since January, local trust in health teams has decreased considerably leading to approximately 200 attacks on Ebola responders and treatment centers. These tensions are exacerbated by the fact that these teams are escorted by police or security forces who regularly and disproportionately take action beyond their jurisdiction and power of law. As multiple factions in the Democratic Republic of Congo are engaged in active conflict with human rights abuses on both sides, this association between health workers and security forces creates a public image that severely hinders Ebola response efforts.
The association between health workers and security forces damages the former's’ reputation and erodes public trust. This leads to Ebola response teams being seen as the ‘enemy’ rather than as an emergency health team. Furthermore, some local communities argue that Ebola responders and other health workers are being used as a tool for achieving political or military goals leading to calls for disentanglement between the two parties. Amongst rural populations accusations are made claiming the DRC government is responsible for the creation, or at least the deployment, of the Ebola virus for economic gain; they accuse them of using Ebola in order to secure more funding for humanitarian and government agencies. These sentiments will continue to prevent Ebola response operations from achieving health and safety objectives. However, as long as physical security remains a concern, security forces will continue to accompany health workers in their activities.
Tensions between communities, Ebola responders, and security forces are further exacerbated due to bans on traditional burial sites put in place because of the risk of contamination when the infected bodies of the deceased are disturbed. These bans contradict fundamental cultural elements of many of the peoples of the DRC. Often community members defy instructions and security protocols in order to properly honour and bury the dead, as their traditions dictate. To prevent further outbreaks, security forces are ordered to fire on those attempting to tamper with banned burial grounds resulting in further distrust.
In response to the violence against Ebola responders, the United Nations Security Council passed Resolution 2439 condemning all attacks on Ebola responders and calling for an increase in efforts to protect health workers responding to Ebola outbreaks.
Other humanitarian agencies have proposed that efforts to combat outbreaks of Ebola should be based solely on community-based approaches and not on security-based ones. It is, however, crucial that all efforts to combat Ebola be accompanied by appropriate healthcare expertise as many rural healthcare practices in the DRC still focus on untested, homegrown ‘treatments’ and traditional medicines.
Unfortunately, as violence against Ebola responders continues, the Ebola threat spreads creating more death and instability. This instability, in turn, creates a dangerous environment for further efforts to address the Ebola threat, allowing the virus to spread untreated in many regions. The result is a large region inhabited by politically isolated people further at risk of exploitation by militant groups that may be able to seize upon the government distrust and viral disruptions. Additionally, as borders in the region remain porous, opportunities for the Ebola virus to spread to nearby countries increase thus creating more risk of instability.
Ultimately the Ebola outbreaks in this region represent a very real and alarming situation. Humanitarian organizations, government agencies, health workers, the WHO, and security forces need to collaboratively draft a more coherent plan to address gaps in Ebola response planning and rebuild local trust in healthcare professionals. In this respect, they need to incorporate community-based approaches and perceptions that take into consideration local context and cultural traditions. These approaches should include the appropriate scientific and medical expertise. If they do not succeed, there are dangers that Ebola cases in the region will result in another outbreak, which will be difficult to contain and may be transmitted to other nearby, vulnerable regions.
The Counterterrorism Group (CTG) is constantly monitoring, tracking, and writing about terrorist attacks worldwide. The AFRICOM Team, in collaboration with EMH2 (Emergency Management, Health, and Hazards), will continue to work together to collect data on these attacks and how it affects travel, business, government, and societal interactions.
1. Maladie a Virus Ebola en RDC, World Health Organization Regional Office for Africa, October 2019, https://who.maps.arcgis.com/apps/opsdashboard/index.html#/e70c3804f6044652bc37cce7d8fcef6c
a. 40 Years of Ebola Virus Disease around the World, Center for Disease Control and Prevention, June 2019, https://www.cdc.gov/vhf/ebola/history/chronology.html
2. Ebola virus disease, World Health Organization, May 2019, https://www.who.int/en/news-room/fact-sheets/detail/ebola-virus-disease
3. Ebola Response in DRC Undergoes “Important Shifts” as Violence Intensifies, International Peace Institute Global Observatory, May 2019, https://theglobalobservatory.org/2019/05/ebola-response-drc-important-shifts-violence-intensifies/
b This local Red Cross team is disinfecting a body bag of an Ebola patient in Kikwit, Democratic Republic of the Congo, 1995, CDC/Ethleen Lloyd, November 2012, http://www.publicdomainfiles.com/show_file.php?id=13528688416644
4. Battle against Ebola being lost amid militarized response, MSF says, Reuters, March 2019, https://www.reuters.com/article/us-health-ebola-congo/battle-against-ebola-being-lost-amid-militarized-response-msf-says-idUSKCN1QO1F1