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A wave of violence in the Congo is threatening efforts to contain a serious outbreak of the Ebola virus in the African Republic, according to the Irish Head of the World Health Organization's response to the emergency.
Dr. Mike Ryan, an Assistant Director General of WHO, is based in North Kivu province, where growing conflict is undermining efforts to bring about the three-month-old outbreak under control.
"This is probably the first Ebola outbreak to happen in an active conflict zone," he says on the phone from the town of Beni. "North Kivu is one of the most dangerous places in Congo, with constant attacks on security forces from various groups."
Last week, Ryan's team was forced to go to gunmen killed 15 people in Beni, sparking a subsequent riot by frightened townspeople.
"I was reminded of Belfast in 1972. We were driving back to town, the post office had been burned down, there were burning tyres in the street, stones and rocks everywhere in the aftermath of the riot.
"The city shut down and you can not move. But every day we're in the field tracking, you're falling behind. "
The current outbreak has gone to 266 cases and 168 deaths. Stemming the spread of the disease in a race against time. They trace people who have been in contact with those infected and then look for the contacts of these contacts.
Ethnic killing
In September, a similar attack in Beni forced a two-day suspension of tracking activities and a result of Ebola cases doubled.
North Kivu has been wracked by armed rebellion and ethnic killing since two civil wars in the late 1990s. The Allied Democratic Forces, an Islamist group based in Uganda, active in eastern Congo, has clashed with Congolese troops in Beni in recent weeks. May-May militia, which were originally formed to resist Rwandan invasions in the 1990s, are also present in the region.
Ryan's team have tracked down 5,700 contact cases so far, but they can not operate when the security situation deteriorates.
Ryan's team have tracked down 5,700 contact boxes so far, but they can not operate when security deteriorates
They also have to overcome distress in communities, and Ryan says there are "pockets of resistance" to medical intervention.
The strategy is to create "social networks" centred on original cases, in which every contact will be vaccinated. So far, 127 of these networks have been created and vaccines are running at 97 per cent.
"The problem is that it's not what you get, it's what you miss. The virus spreads along the cracks, "says Ryan, who likens his work to" a detective story, the way you link all the evidence. Then you get cases you can not fit into an existing transmission chain. That's really bad news. "
Traditional healers
WHO staff have taken to work with traditional healers, who often enjoy greater trust in communities than mainstream health services, to improve their immunization rates.
From Curry on the Sligo / Mayo border, Ryan studied in Galway and has been with the WHO since 1996. He says he has been one of the most sought after.
He has most of the time since college 'chasing various viruses'
The development of a vaccine in recent years. Some 21 healthcare workers have been infected with the disease.
The other major development since the massive Ebola outbreak in West Africa between 2014 and 2016 has been the development of drugs, which are still in the experimental phase, to treat the disease.
Ebola's symptoms include fever, muscle pain and, sometimes, haemorrhaging from orifices. The disease can be spread through contact with the body fluids of both living and dead victims. In Beni alone, 350 burials have taken place.
For now, Ryan believes the situation in Beni is under control. "I'm happy we've brought it under control. We're doing well but need to remain vigilant. Hopefully, the security situation will remain calm. "
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