Attacks that badly damaged two Ebola treatment centers in the Democratic Republic of the Congo this week have left the World Health Organization, the country’s Health Ministry, and some other partners scrambling to find ways to care for Ebola patients in the area where the outbreak continues to rage.
Both Doctors Without Borders and ALIMA, the medical organizations that were running the operations, have withdrawn their personnel because of the danger they faced.
The WHO will remain, but is drawing up contingency plans for reducing or withdrawing staff if the violence continues, Dr. Michel Yao, head of the agency’s Ebola response in the DRC, told STAT on Friday.
“For the time being, we are not withdrawing,” Yao said. “But of course we are working on different contingency plans. If the situation worsens, we would not put at risk our staff. We would have to at least reduce or withdraw.”
The current outbreak is now in its eighth month. To date, 885 people have been infected and 555 have died, making this the second largest on record.
The epidemic has been highly challenging to contain because it is occurring in what is effectively a war zone. Progress has been slow, with small gains generally followed by setbacks that have occurred when violence has broken out in the affected provinces of North Kivu and Ituri.
For months, the violence was mainly directed at DRC army forces or at the United Nations peacekeeping operation that has been in the region for years. Recently, however, Ebola response workers and facilities have been targeted at Katwa and Butembo, the transmission hot spots.
Workers administering vaccine, who trace the contacts of known cases and others who disinfect homes of known cases, have been attacked. “The teams are now scared,” Yao said, acknowledging the violence is affecting morale.
On Sunday, unknown attackers set fire to an Ebola treatment center at Katwa operated by Doctors Without Borders, destroying all the facility’s generators in the process. On Wednesday, armed attackers torched the treatment center at Butembo, destroying the equipment used to store Ebola medications at the proper temperature.
Both treatment centers are now unusable, though the WHO and others are trying to see if they can be rebuilt.
Eleven patients who were confirmed to have Ebola and who were being treated in the facilities have been transferred to a 40-bed transit center within a Katwa hospital where people suspected of having Ebola are cared for while they await test results.
Part of that facility has now been cordoned off for the care of the Ebola patients, Yao said. But ALIMA, which operated the transit center, has also withdrawn its workers, leaving WHO and others to struggle to provide enough medical staff to care for them.
Yao said there aren’t enough trained staff to complete a day shift. “Without the involvement of … these partners, it will be quite difficult to give appropriate care,” he said.
WHO has asked the Congolese government to bolster the security it provides the Ebola response workers in the hopes that ALIMA and Doctors Without Borders can be persuaded to return. The remaining response teams need to be kept safe so that they can resume work to control the outbreak. Yao acknowledged, though, that a “militarization” of the response could further undermine community acceptance of the Ebola response teams and their methods.
He said it’s not clear why the response is being targeted.
“This kind of violence we cannot understand. We think maybe it’s a kind of manipulation to achieve some other objective. But we don’t really understand why these teams were attacked,” he said.
There has been grumbling on social media about the region being “invaded by foreigners,” he said. “But in our team we have more nationals, more locals, than internationals. Internationals were actually to coach national colleagues who don’t have the experience.”
Earlier in the outbreak community resistance was intense in Beni, which was a hot spot in October and November. Cooperation improved markedly after people began to understand the threat posed by Ebola. Yao said health workers were starting to see that kind of shift in Katwa and Butembo before the recent attacks.
He said it will be critical to understand what is driving the violence. Failure to control the outbreak is unthinkable.
“If the disease spreads further and most of the partners withdraw, it will be a major disaster,” Yao said. “With Ebola, we have no option but to control it….We have to find the means.”