Frequent assaults on health workers, treatment centres threaten efforts to contain the deadly virus, WHO says.

The World Health Organization (WHO) has warned it may not be possible to contain the Democratic Republic of the Congo‘s latest Ebola outbreak to two affected provinces in the country’s east if violent attacks on health workers and treatment centres continue.

In a statement on Friday, WHO said it was “unlikely” the virus would “remain successfully contained” in North Kivu and Ituri – which combined, border Rwanda, Uganda and South Sudan – unless the targeting of response activities ended.

The current outbreak is the second-worst in recorded history and has killed 1,105 people so far, with efforts to end the nine-month-old epidemic complicated by a volatile security situation and widespread community distrust.

Tedros Adhanom Ghebreyesus, WHO director general, said he was “profoundly worried” by the outbreak’s recent trends.

“The increased transmission rates raise the risk of Ebola spreading in DRC and to surrounding countries,” Ghebreyesus said in a tweet.

“The tragedy is that we have the technical means to stop Ebola, but until all parties halt attacks on the response, it will be very difficult to end this outbreak,” he added.

Earlier this week, fighters from the armed Mai-Mai rebel group attacked a treatment centre in Butembo, a town at the epicentre of the crisis.

The assault followed a “violent attack” on a burial team on May 3 after they interred an Ebola victim in the town of Katwa, east of Butembo, WHO said, adding it was forced to halt response activities in Butembo and surrounding areas for five days due to the insecurity.

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“The ongoing violent attacks sow fear, perpetuate mistrust, and further compound the multitude of challenges already faced by front-line healthcare workers,” the WHO said in its statement.

Deepening security crisis

Eastern DRC has experienced decades of violence, with scores of armed groups operating throughout the region, which has historically been neglected by the central government in Kinshasa.

In addition to armed groups active in the area, the health workers have faced widespread community distrust over the Ebola outbreak, with segments of the local population believing it was fabricated for the financial gain of business-owning local elites or to further destabilise the area.

“The security challenges are twofold: armed groups that have been present in the region for decades, and community hostility, which has now morphed from targeting facilities to targeting response workers,” said Whitney Elmer, DRC director for US-based NGO Mercy Corps, in a statement.

“The impact of the rise in violence is clear; security incidents affect response activities. The virus does not take a break – after every interruption in activities, there is an increase in Ebola infections,” Elmer added.

More than 100 attacks on Ebola treatment centres and health workers have been recorded since the beginning of the year, according to the WHO.

In April, heavily armed assailants raided a hospital in Butembo and killed Richard Mouzoko, a Cameroonian WHO doctor working on the Ebola response.

The assault came after unidentified attackers in February torched two Doctors Without Borders (known by its French initials MSF) treatment facilities in North Kivu, prompting the organisation to suspend operations in the area.

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It warned soon after that “a climate of deepening community mistrust” was taking a grip amid “various political, social and economic grievances” and an allegedly overly militarised response by authorities to the outbreak.

‘Unprecedented challenge’

David Miliband, president of the International Rescue Committee, cautioned on Friday that, amid the violence, the outbreak now posed an “unprecedented challenge” for the DRC and the international community, warning the increasingly volatile atmosphere was “making progress against the disease impossible”.

“The situation is far more dangerous than the statistic of 1,000 deaths, itself the second-largest in history, suggests, and the suspension of key services threatens to create a lethal inflection point in the trajectory of the disease,” Miliband said in a statement after meeting health workers in the regional capital, Goma.

This Ebola outbreak, happening in an area of active conflict with widespread poverty & deep political divisions, is an unprecedented challenge for the DRC, and for world. The situation is far more dangerous than the statistic of 1000 deaths, itself the 2nd largest in history. — David Miliband (@DMiliband) May 10, 2019

In a bid to contain the virus, health workers have inoculated more than 111,000 people to date as part of a government-backed vaccination programme. The vaccine is experimental, but is estimated to be 97.5 percent effective.

But recorded cases have continued to surge amid the rising insecurity, culminating in a record 126 confirmed cases reported over a seven-day stretch ending April 28, prompting the WHO to warn of “a scenario of continued intense transmission”.

The world’s worst epidemic of Ebola, a haemorrhagic fever, killed about 11,300 people in West Africa as it raced through Guinea, Sierra Leone and Liberia from 2013 to 2016.

Additional reporting by David Child: @DavidChild90