An escalating Ebola epidemic in conflict-wracked eastern DR Congo has surpassed the 2,000 cases mark, two-thirds of which have been fatal, according to government figures.

Since August last year, there have been 2,008 confirmed and probable cases with a death toll of 1,346, the Democratic Republic of Congo health ministry said late Monday.

Read more: Conflict, superstition and inadequate funds hinder Ebola fight in DR Congo

The world's second-largest Ebola outbreak began in North Kivu province and then spread into Ituri province, although it has not yet spread to neighboring Rwanda and Uganda.

Ebola: Fight against the deadly virus Protective clothing Proper protective clothing for doctors and nurses is critical. All exposed skin must be covered with a material that cannot be penetrated by the virus. But the suit alone isn't enough: Proper procedure is also important.

Ebola: Fight against the deadly virus Suiting up Health care workers must practice correctly putting on a protective suit, as seen here at the special isolation unit in Dusseldorf. New suits are used every time, so there is no risk of infection when getting dressed. Unprotected workers are therefore able to help.

Ebola: Fight against the deadly virus Completely separate The patient rooms in the Dusseldorf isolation unit are completely shielded from the outside world. Air is filtered, and wastewater must go through a separate treatment process. The protective suits, used at all times in the ward, are kept at positive pressure. These measures go further than is necessary: While Ebola can be transmitted by contaminated objects, the virus is not airborne.

Ebola: Fight against the deadly virus Disinfectant shower After the patient is treated, the entire suit is sprayed from the outside with a disinfectant to kill off any potential viruses. Only after this shower can the suit be removed - cautiously.

Ebola: Fight against the deadly virus Outside help When removing the protective suit, health care workers must exercise extreme caution. Using permanently installed protective gloves, outside assistance can be provided without coming into direct contact with the suit. After use, the suit is immediately disposed of and burned.

Ebola: Fight against the deadly virus Infected nurses Despite the high safety standards, a total of three nurses in Spain and the United States have contracted the disease. The circumstances surrounding the infection have not yet been clarified. The nurses' homes (as seen here in Texas) were sealed off and disinfected after the discovery of the transmission.

Ebola: Fight against the deadly virus Protection in Africa Doctors and nurses in West Africa have now also been outfitted with protective suits. However, these do not always meet the standards deemed necessary for effective protection. Sometimes, small areas of skin are left unprotected, or the material used in the suit is permeable. In addition, putting the suit on and removing it can be risky.

Ebola: Fight against the deadly virus Isolating the dead Extreme caution is also necessary at the funerals of people who have died of Ebola. A West African tradition, which sees the family of the deceased wash the body has led to many new infections. For mourning friends and family, these strict isolation measures are often hard to understand.

Ebola: Fight against the deadly virus Tent as isolation units In a region where medical care is extremely underdeveloped, such an outbreak provides a daunting challenge. Infected people, like here in Liberia, are cared for in hastily constructed tents. But even a country like Germany would probably be overwhelmed by such an epidemic. At the moment, the country only has around 50 beds set up in isolation units.

Ebola: Fight against the deadly virus Incineration instead of sunlight In some of the affected West African regions, contaminated suits are hung out in the sun in an attempt to disinfect them for further use. But it's much safer to burn the clothing immediately after use, as seen here in Guinea. However, supply shortages and the high prices of suits make such advice difficult to follow. Protective clothing can cost between €30 and €200 ($40-$250).

Ebola: Fight against the deadly virus Airport controls Air travelers represent the biggest threat when it comes to transmission of the virus over long distances. For this reason, travelers' temperatures are now being monitored at some airports. However, this method does not provide absolute security: Ebola's incubation period is up to 21 days. Author: Marcus Lütticke / cmk



Struggle to respond

Response efforts have been hampered by distrustful communities and a plethora of armed groups regularly threatening and attacking health workers and treatment centers.

Without access to communities, health workers struggle to vaccinate those at risk, treat those infected, or trace contacts to halt the spread of the highly contagious hemorrhagic fever.

Decades of conflict in the eastern Congo has made local communities fearful of the army and even UN peacekeepers accompanying health workers.

Read more: Top 10 most dangerous viruses in the world

Some locals don't believe Ebola is a disease and have hidden cases from health workers, meaning that the true number of infections and deaths may be higher than reported, the International Rescue Committee said.

"As violence and insecurity continue to hamper daily operations and mistrust prevents people from seeking care, these numbers are likely an underestimate and not a realistic picture of the number of cases out there," the aid organization said in a statement.

The International Federation of Red Cross and Red Crescent Societies (IFRC) said that in recent weeks there has a significant increase of between 15-20 new cases per day.

"This escalation is at least in part due to the precarious security situation in the affected area," it said in a statement. "IFRC is concerned that partners limit their use of security or military support as much as possible. Increasing armed protection for Ebola responders may aggravate the tensions that already exist between communities and responders."

On a positive note, more than 129,000 people, mostly health workers, have received an experimental but effective Ebola vaccine.

An Ebola outbreak that started in December 2013 in West Africa killed more than 11,300 people by 2016 before being eliminated.

cw/se (AP, AFP, Reuters)

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