Fear and distrust are fueling the Ebola outbreak

Crossing the border on foot from Rwanda to the Democratic Republic of Congo, it was immediately apparent that we were entering a place at war. War has been a part of the landscape of Eastern Congo for decades, and it is the home of the largest U.N. peacekeeping operation in the world. But at the border there were no guns or peacekeepers. This border was at war with an invisible but potentially even more deadly foe: Ebola

August marks the one-year milestone for this Ebola outbreak — and the end is not yet in sight. Just last month, the World Health Organization (WHO) declared it a Public Health Emergency of International Concern, a designation for “an extraordinary event that poses a public health risk to other countries through international spread and that potentially requires a coordinated international response.” It is a tool rarely used by the WHO, this being only the fifth such declaration since 2009, and it sends a strong signal that the disease is out of control and has overwhelmed the country’s ability to respond.

Ebola is not new to the Democratic Republic of Congo. It was first identified in 1976 in what was then Zaire, and periodic outbreaks are a part of the landscape in this vast country about one-quarter of the size of the U.S. 

Years of conflict have eroded social cohesion and trust within communities. The sense that the central government and the rest of the world have forsaken the people of Eastern Congo until the Ebola outbreak started has led to more fear and distrust of outsiders, including anyone engaged in the Ebola response. Fear and distrust are the fuel driving this outbreak into its second year. 

Goma, a city of 2 million people that hugs the north end of Lake Kivu and the border with Rwanda, hosts the Emergency Operations Center, a kind of mission control for the Ebola response. There is a well-attended daily briefing each morning at 8:30 a.m. that serves to coordinate the work of several U.N. agencies, the Congo’s Ministry of Health, U.S. government agencies, and numerous international nongovernmental organizations. 

Everyone’s temperature is taken on the way into the U.N. compound where it is held, and everyone is administered two pumps of hand sanitizer. People greet each other with an elbow bump rather than a handshake, practicing the same infection-prevention techniques they spend their days promoting to communities. 

On the day I attended, we learned that there were seven cases of Ebola confirmed the previous day. We collectively reviewed each case. It’s clear why it is so difficult to contain this outbreak. One case involved a 2-year-old boy who had been in and out of hospital facilities for almost two weeks due to a series of misdiagnoses. He died the day he was confirmed to have contracted Ebola. Another case died at home and was diagnosed only posthumously. Despite an enormous and robust response by the international community, half of all Ebola cases are dying at home, never having sought medical treatment. Despite an effective vaccine and effective treatment protocols at Ebola Treatment Centers, some people are still refusing the vaccination, hiding from health care workers or running away from isolation facilities.

We are at a critical juncture. Ebola is spreading, with cases recently reported near the border with South Sudan and in Goma. Uganda, a country that has been preparing for months for Ebola, saw four cases in June when a family fled an isolation facility in Democratic Republic of Congo on foot to seek care there. 

This Ebola response requires the continuing — and increasing — support of the international community. It should have the world’s attention. The WHO’s declaration warns us that this outbreak has the potential to be as bad or worse than the West Africa outbreak of 2014 that killed more than 11,300 people.  The U.S. government played a lead role in bringing that outbreak under control and rebuilding the affected countries’ decimated health systems in its aftermath. 

In the Democratic Republic of Congo, the U.S. government’s emergency funding to the Ebola response is saving lives, but more is needed. Just like in West Africa, the health system has turned its focus exclusively to Ebola prevention and control. Routine primary health care, including immunizations, malaria treatment and maternity care, has all but ceased in the Ebola zone.

Furthermore, U.S. assistance to support these life saving measures is being withheld because of an Executive Order issued in late 2018 barring aid to countries not doing enough to combat human trafficking. Holding governments accountable is a good thing, but ordinary people shouldn’t suffer as a result. As in the past, exceptions should be made, and especially in this crisis, which has proven difficult to contain. 

As we mark the first anniversary of the Democratic Republic of Congo’s Ebola outbreak, let us resolve there won’t be a second.

Allyson Bear is the vice president for health programs at IMA World Health and Lutheran World Relief, an international humanitarian organization based in Baltimore, Md. and Washington, D.C.