More than 5,000 people, mostly children, have been killed in the Democratic Republic of the Congo, in what is currently the world’s biggest measles epidemic.

Measles, which is preventable through vaccination, has spread to all 26 provinces of the country, which is also battling a 15-month-long Ebola epidemic.

About a quarter of a million people in DRC are thought to have been infected by measles this year alone, more than three times the number infected in 2018. Three-quarters of cases, and around nine in 10 deaths, involve children younger than five years old.

“The situation is very critical and very alarming,” said Xavier Crespin, Unicef’s chief of health in DRC. “All the international community are focusing on Ebola but we are seeing the number of measles cases in DRC are far more,” he added.

Since August 2018, authorities have struggled to contain the spread of Ebola, which has claimed 2,196 lives in the eastern North Kivu and Ituri provinces. The country’s weak health infrastructure, combined with political instability and widespread suspicion of health workers, have severely hampered efforts to tackle the disease. Officials have described the outbreak as the most complex public health emergency in history.

On Friday, the World Health Organization warned of escalating violence, which has is preventing health staff from reaching communities. The WHO has documented more than 300 attacks on health care facilities in the country this year, including six deaths of workers and patients.

Weak infrastructure and political instability has hampered efforts to deliver and administer treatment. Photograph: Pablo Garrigos/MSF

Health workers say the same problems, combined with a shortage of vaccines caused by funding delays, are also undermining attempts to stop measles.

“We don’t have a lot vaccines to cover all of the country. We are doing the immunisation campaign step by step: we begin with hotspot areas and then move to other group of provinces because we cannot do all of them at the same time,” said Crespin.

In some cases, families who live far from clinics make expensive and lengthy journeys to health facilities, only to find there are no jabs available. “When they come sometimes there is a stock out of vaccines, they go back [home] and they cannot come back,” said Crespin.

A lack of trust in health teams, which has also severely disrupted the Ebola response, is leading some to refuse vaccines. “In some remote areas it can take two, three or four days just for the team to do 100km, it takes a lot of time to reach the population, and when you come there people are not sensitised and some refuse the vaccine,” Crespin added.

Children require two jabs to be protected against measles, which means health teams face the additional challenge of reaching families, and convincing parents, a second time.

The disease is highly contagious and is normally passed through direct contact and through the air. The measles virus infects the respiratory tract, then spreads throughout the body.

Most measles-related deaths are caused by complications associated with the disease, which can include blindness, severe diarrhoea, ear infections and encephalitis, an infection that causes brain swelling. Patients can also experience severe respiratory infections such as pneumonia.

A lack of trust in health workers has intensified throughout the Ebola crisis. Photograph: Pablo Garrigos/MSF

The country’s weak health system has left communities highly vulnerable to such outbreaks. Unicef surveys in DRC suggest that 65% of children under five are not completely vaccinated. Among these children, one-fifth are not vaccinated at all.

So far this year 5,110 people have been killed by measles in the DRC.

“The health coverage is very weak, we think about 50% of the population have no access to basic health services,” said Crespin. “There is a big need to invest in strengthening the health system in this country to address the gap we are facing now.”