The fight against the Ebola virus in Congo prevents any medical hope against local chaos

The fight against Ebola in Central Africa is underway. not like the others.

This is the first time that doctors have both a promising vaccine and treatments to offer. These medical innovations are experimental, but the vaccine seems to be working well, the four new treatments have given preliminary indications on curative powers and a clinical trial of these began on Monday.

It had seemed, with the help of these new tools, that the epidemic was about to end quickly. Instead, with 419 cases and 240 deaths, it's now the second deadliest already (Although that of West Africa 2014 was of an order of magnitude higher, with more than 28,000 cases and 11,000 deaths).

Dr. Peter Salama, head of the W.H.O. emergency response, recently said that he expects the epidemic to last at least six months.

It's because it's unique in another way: this is the first time an eruption has broken out in an area devastated by armed fighting. Doctors and other experts currently working or formerly in the area have described a landscape that is not quite a war zone but in which shooting can almost burst any place for unknown reasons.

"Yes, it's stressful," said Anthony Bonhommeau, Director of Operational Development at ALIMA, the Alliance for International Medical Action. "You work all day in an Ebola unit, then you go back to the hotel and hear gunshots at night. We allow our staff to see a psychologist and take a break after three weeks. "

The violence has also cut short the work of former doctors of Centers for Disease Control and Prevention, many of whom have extensive experience with Ebola outbreaks. Two months ago, the state department ordered all US government employees to leave the region and confined them to the capital, Kinshasa, nearly 1,000 kilometers away.

Some of them have grumbled privately that it makes them ineffective and that the state department is suffering from what is called the "post-Benghazi stress syndrome", a reference to the 2012 attack in Libya that killed an American ambassador and became a crisis for Hillary Clinton. who was secretary of state at the time.

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Several experts spoke on condition of anonymity, either because they were not authorized by their organization or because they feared to offend other organizations involved in the response.

Until now, no armed group has openly targeted medical staff, but the risk of being caught between two fires is still present, even in the cities. In the most remote areas, workers risk being kidnapped and held for ransom.

Americans have been ordered to come out well before the recent major violence. In August, a convoy carrying doctors from the C.D.C. almost made a crossfire as he headed from the operations center to a peacekeeper base near the airport.

At an information meeting on November 14, officials from five government agencies defended the evacuation, saying their highest priority was to protect US personnel.

Hundreds of staff from the Congolese Ministry of Health, W.H.O. and medical charities such as ALIMA and Médecins sans frontières are still in the area; some Americans, working as private citizens, are part of it.

The processing units never closed and the itinerant operations resumed less than 48 hours after the end of the operations. November Rocket Attacksaid Jessica Ilunga, a spokeswoman for the Ministry of Health.

Each organization has its own curfew and travel limits. Some only venture into the countryside as they are escorted by the Congolese army or by US peacekeepers.

Others, like Doctors Without Borders, do without it, because they do not appreciate the image of medical care provided under the threat of firearms and that the escorts themselves may attract the flames, said Dr. Ronsse.

Another problem with travel restrictions is that the transmission chains are no longer traced. The Ebola treatment units meet many patients unrelated to previous cases and with an unusual number of babies and children.

Doctors believe that many patients are infected in private clinics or by herbal healers or religious healers. Patients seeking treatment for malaria, typhoid or even toothache find themselves lying next to an Ebola sufferer or receive an injection with an already used syringe.

And the settings in which they were infected do not keep any records, so their contacts can not be tracked.

Because of local mistrust, people with Ebola often go to treatment units only when they are about to die, too late to be saved by treatment. Nevertheless, virtually all get one of four experimental schemes. More than 36,000 health workers and contacts have been vaccinated.

Food distribution has helped to attract people for testing and vaccination, but this poses its own problems, said one expert: neighboring villages that do not receive food may be irritated, and the World Food Program can not deliver more than once a week, while tracing normally requires daily visits.

Local people can be hired to perform daily checks, but it is difficult to control by mobile phone that they are doing it properly.

"We need to find a way to reach the population in areas where we can not go," said Dr. Ronsse.

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