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The humanitarian agency Doctors Without Borders has been forced to suspend operations in two areas where it responds to the Ebola epidemic in the Democratic Republic of Congo, following the arson attacks this week in its health care facilities.
"More than six months after the start of the Ebola outbreak in North Kivu and Ituri, the epidemic is not under control," warned the MSF agency. . At least 885 people have contracted the virus and 555 have died in an epidemic that has been raging since August – the first known cases of Ebola in a war zone (eastern provinces of North Kivu and Ituri in the DRC) .
The attacks took place in MSF treatment centers in the most active areas of the epidemic, the neighboring towns of Katwa and Butembo. The first failure occurred on February 24 in Katwa. Late in the night, assailants – who were not identified – threw stones at the MSF building and burned it, forcing the workers to evacuate and transfer patients to other hospitals.
"This attack paralyzed our ability to cope with the current epicenter of the epidemic," said Emmanuel Massart, MSF emergency coordinator in Katwa, in a statement.
Four days later, on February 27, arsonists set fire to MSF's Butembo operation. "The flames were controlled and no staff or patient was injured, but the teams were forced to immediately stop patient care," according to a second statement from MSF. "In the light of these two violent incidents," said Hugues Robert, head of MSF's emergency room, "we have no choice but to suspend our activities until further notice" .
Butembo and Katwa are the two areas in the DRC where the virus is most active, with a combined total of 317 confirmed cases to date and 40 other suspected infections. This pause in MSF operations in these cities is disturbing for two reasons. First, it means fewer workers will be available to identify, isolate and treat Ebola patients. And in an Ebola response, when people with the virus stay in the community, they can pass it on to others. "We can expect a significant increase in the number of cases in health areas of Katwa and Butembo in the coming days," warned Thursday the DRC Ministry of Health.
Even worse, the arson suggests that at least some members of the community resist humanitarian work to help stop the epidemic. They may be a minority, but they pose a significant threat to the Ebola response. Instead of cooperating with aid workers, they burn medical units set up to protect them. This is a major setback for the DRC and its stakeholders.
The success of this response to Ebola is based on trust. The arson suggests a problem of trust.
Eradicating an Ebola outbreak requires a very strong commitment on the part of the community. The virus is spread through direct contact with bodily fluids, such as vomit, urine or blood, from an already sick person with symptoms. The sicker people get closer and the closer they are to death, the more they become contagious. (This is why it is particularly dangerous to take care of very sick people and attend funerals.)
Since we can not cure Ebola, health workers rely on traditional public health measures: to seek, treat and isolate the sick and break down the chains of transmission so that the virus stops spreading. .
They organize vigorous public health awareness campaigns to remind people to wash their hands; touching and kissing friends and neighbors is a potential health risk; and that burial practices should be changed. (Again, funerals can play the role of Ebola super-propagators as people who die of the virus are extremely contagious and families prepare, touch and kiss corpses as part of traditional funeral rituals.)
Respondents also use a strategy called "contact search": search all contacts of sick people and follow them for 21 days – period during which the incubation of Ebola.
Each of these measures can only succeed if community members trust and cooperate with Ebola co-workers.
They must let humanitarian workers go home to test the virus and agree to be followed for 21 days. They must accept the painful reality of sending HIV-infected family members to treatment centers to isolate them to prevent infecting others.
They must follow basic public health measures such as hand washing and safe funeral practices, which may involve putting aside centuries of family tradition and personal convictions to stop the spread of the virus.
In this case, respondents also have an effective vaccine – and to date, more than 84,000 people have been vaccinated, including 21,662 in Katwa and 10,512 in Butembo.
But that does not necessarily mean that people are cooperating with other parts of the Ebola response. A recent Lancet A survey of DRC residents' attitudes towards the Ebola response in the DRC showed that people were really willing to be vaccinated against the Ebola virus – but most respondents said they do not send their families to treatment centers and actively hide from Ebola family members.
"Surpass [an Ebola] we must win the hearts of the people, "Vox told Michel Yao, Incident Manager at Butembo, World Health Organization. "We have to integrate them fully." Yao thinks that community resistance has improved overall, but attacks on MSF suggest there may be more problems.
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