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MSF Update on Ebola Frontline Response

Personnel helping others put on masks and full body protective suits
The dressing process is complex but will allow hygienists who work in high-risk areas not to put themselves at risk by protecting every part of the body that may come into contact with the virus. Credit: Alexis Huguet

Medical facilities, personnel and patients have continued to be the targets of violent attacks, with an increase in attacks and violence over November and December as anti-Ebola response sentiment resurfaced, Doctors Without Borders (MSF) Southern Africa reports in a Jan 20 Situation Update. There have been more than 300 attacks on Ebola health workers recorded in 2019, leaving six dead and 70 wounded.

Ongoing Violence Against Health Workers

An intensification of military operations and a series of violent attacks by armed groups across the northeast of Democratic Republic of Congo (DRC) have been the catalyst of protests across several towns in North Kivu, including Beni and Goma. These protests were directed against armed forces and the United Nations peacekeeping force (blue helmets) and at times turned very violent. Daily anti-UN demonstrations which began on 20 November turned into violent confrontations that lasted 10 days. Dozens of people have died during the protests and approximately 250 succumbed to violent attacks. Health workers in the Ebola response have also been targeted. Three people were killed, and several Ebola responders were injured in a separate violent attack against a Ministry of Health (MOH)/WHO base in Biakato Mine on 27 November. Simultaneously the riposte base in Mangina was also targeted. This violence directed at response workers in Biakato caused the majority of the health personnel to be either evacuated or to flee.

On 4 December, after receiving multiple threats, MSF staff was evacuated from Biakato area and the management of the Biakato Ebola Treatment Centre (ETC) was handed over to the Ministry of Health (MOH). In the end of December, following the deployment of armed forces around and within the health structures, MSF decided to stop activities in Biakato.

Containment Challenges in a Volatile Security Situation

Efforts to contain the Ebola outbreak in eastern DRC, which so far claimed over 2200 lives, have also been affected by the volatile security situation . While the number of new cases had been steadily declining in the previous months, the recent violence in North Kivu and Ituri which disrupted the provision of care, surveillance, vaccination, contact tracing and other activities of the Ebola response, forces MSF to remain extremely vigilant about the resurgence of the disease. A sharp increase in the weekly number of new cases was observed in the first half of December, rising from 11 cases to 24 cases in the following week. In the second half of December, the number of cases stabilised and decreased to 14 cases per week. Out of 13 health areas currently reporting active transmission, the health area of Aloya (health zone of Mabalako) has notified more than half of the total confirmed patients during December. In the last two weeks of 2019 and the first week of 2020, new cases were reported in five health zones that were not considered places of active transmission anymore (which means 42 days without cases), namely Biena, Butembo, Katwa, Kalunguta, and Mambasa. By 5th January, the origin of the chains of transmission of the cases in Kalunguta, Katwa, and Mambasa was not known.

Following the recent deterioration in security conditions, the movement of population has risen, with thousands now displaced across North Kivu. Similarly, the increase in military operations in the Kalehe region, in South Kivu mainly FARDC [Armed Forces of the Democratic Republic of the Congo] against local armed groups caused the displacement of thousands of people. The growing movement of the population increases the risk of a geographic spread of the disease, especially as health controls along the roads are not effective because of insecurity and unrest. For example, following the November 28 attack and the evacuation of most Ebola responders, some points of entry and points of control surrounding Biakato, one of the main hotspots, were reactivated days later, but others remained closed due to threats or destruction for more time.

Reinforcing Security for Responders

In response to the surge in violence at this critical juncture of the outbreak, while the Ministry of Health/WHO’s strategy has not been finalized yet, reinforcing the security apparatus seems to be a recurring topic. Plans include the deployment of teams made out of military medics, armed escorts for responders (particularly for surveillance and vaccination), reinforcement of the presence of the national army and a more active role for MONUSCO in the vicinity of medical facilities. In the past similar measures, as well as forced transfers to the ETCs, have resulted in an increase in anti-Ebola response feelings and made the Ebola intervention more difficult.

Vaccine Waiver Agreement

The Ministry of Health and WHO obtained a waiver from Merck to use 30,000 doses of the Ebola vaccine “out of the investigational protocol” which will reduce the paperwork and the size of the vaccination teams while expanding target. This will allow the population greater access to the vaccine and will enable teams to vaccinate people faster. So far, there have been delays in both bringing the additional stocks into the country as well as to define and communicate the microplanning for the targeted areas by the MoH/WHO.

MSF’s Position and Acitivities

MSF is supporting the Ebola response through patient care in two Ebola Treatment Centres in Beni and Goma, numerous decentralized isolation/transit zones and infection prevention and control activities (IPC) community-based surveillance and support to vaccination activities. MSF’s main priorities are to provide timely healthcare to Ebola patients, ensure appropriate IPC standards in healthcare facilities and improve access and quality of non-Ebola health care based on the assessment of the local community health care needs. Some of our activities have been affected by the recent surge in violence, which forced full or partial evacuation decisions.

In all our projects, MSF states it is striving to put patients and communities first, engaging with the local community and working with existing health centres to identify needs and prioritize activities. In addition to integrated isolation and treatment facilities for suspect Ebola patients, MSF strengthens health care capacities, builds infrastructure for clean water, sanitation and hygiene, and invests in community outreach and health messaging in health centres all over the region.

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