World Health Organization confirms a second person has died of the disease in a major transit hub in Democratic Republic of Congo

A second death linked to the Ebola virus has been confirmed in the densely populated city of Goma, located at the Democratic Republic of Congo’s porous border with Rwanda.

The first case of Ebola in Goma – an evangelical preacher – contributed to the World Health Organization decision to declare the Ebola crisis in DRC an international public health emergency.

The city, which has a population of 2 million, shares a porous land border with Rwanda and has an international airport. It is often used by international travellers as a gateway to DRC.

The Ebola outbreak in DRC began exactly a year ago on Thursday and has claimed more than 1,803 lives, according to figures published on Wednesday, making it the second deadliest outbreak of the disease on record.

'Most complex health crisis in history': Congo struggles to contain Ebola Read more

The second patient began showing symptoms of the disease on 22 July, after arriving in Goma from DRC’s northeastern Ituri province, according to Associated Press reports.

Aruna Abedi, in charge of coordinating the Ebola response in North Kivu, the worst-hit province, said the second patient had already been ill for 11 days before he sought treatment.

“His was really a hopeless case, because the illness was already at an advanced stage and he died overnight Tuesday,” Abedi said.

The case is not connected to the one previously detected in Goma.

Quick guide Ebola in the Democratic Republic of the Congo Show Hide How bad is the current outbreak? With more than 2,577 confirmed cases and more than 1,803 confirmed deaths, the outbreak in the eastern DRC is the second largest in history. It has a 67% fatality rate and 11 months after it began, the case numbers are still escalating. It is disproportionately affecting women (55% of cases) and children (28%). The WHO declared the outbreak an international public health emergency in July 2019. The same month saw the the first diagnosis of a case in Goma, a city of 2 million people, which is a transport hub on the border with Rwanda. In early August Rwanda announced that it was closing its border with DRC. The WHO has long said that the national and regional risk levels are very high and containment of the spread to North Kivu and Ituri provinces was unlikely, unless a break in the fighting made it safe for health workers. What is Ebola and how do you treat it? Ebola hemorrhagic fever is caused by a virus that has a reservoir among forest animals, including monkeys and bats. It is spread through body fluids, which is why carers – mostly female relatives and nursing staff – are particularly at risk. It causes fever, aches and diarrhoea and attacks the immune system, causing blood clotting cells to malfunction so that victims bleed extensively and die if their immune system cannot fight off the viral infection. Drugs are still experimental. Patients are isolated and treated by nurses wearing full protective body suits and masks who try to boost their immune response. Friends and relatives are quarantined for 21 days. Prevention measures include washing hands at every opportunity and safe burial practices, with no touching or washing of the body, as is traditional in some cultures. How does this compare with other outbreaks? The 2013 and 2016 outbreak in Sierra Leone, Liberia and Guinea spread for months through forest regions in west Africa where Ebola was unknown before the emergency was recognised. It escalated when it emerged in towns and cities, with 28,600 cases and 11,300 deaths. DRC successfully stamped out nine previous Ebola outbreaks in rural areas within a matter of a few months. Aid agencies, infectious disease experts and the WHO say it will be very hard to bring this outbreak under control, even though they have had vaccines and experimental drugs from the outset. What are the contributing factors to this outbreak? There is almost no functioning state in much of eastern DRC. There is an almost total lack of basic services such as power, education, roads, healthcare, and the authority of the government only extends to the edges of urban areas. Police are corrupt, predatory and violent. In rural zones, militia and armed bands provide security and employment opportunities but also steal, rape and kill at will. It is one of the most hostile environments faced by aid and health workers anywhere in the world. Mistrust of officials and foreigners is harming efforts to tackle the disease and conspiracy theories are rampant. Some believe the outbreak is fake news spread by rapacious NGOs and the UN to justify their presence in the country and allow the extraction of valuable mineral resources. Sarah Boseley and Jason Burke

The escalating crisis has led to a row within the DRC’s health ministry, which is co-ordinating national efforts to contain the spread of the virus.

Last week, DRC’s health minister Olly Ilunga resigned in protest against the country’s handling of the Ebola outbreak. Ilunga said international agencies were pressuring his government to allow the testing of a new vaccine developed by Johnson & Johnson. The row over the vaccine trials began after Ilunga banned clinical trials of the new vaccine in DRC, according to Stat News.

Ebola vaccines are difficult to develop because they have to be tested during outbreaks.

In the previous outbreak in West Africa, one vaccine, produced by Merck, was successfully trialled in Guinea. The success of that trial meant preventative Merck vaccines could be given to citizens in the DRC and potentially contain the outbreak.

But Ilunga has argued that trialling vaccines in Ebola-affected regions could erode public trust in the government.

Merck’s vaccine requires only a single shot, whereas Johnson& Johnson’s new vaccine has to be taken in two doses.

Officials and NGOs fear that discrepancies in the vaccination schedules – where some people were getting one shot, while others were getting two – could fuel rumours about the vaccines in local communities.

Ilunga also said that delivering two doses would be logistically difficult in a region where there is a high rate of displacement and where people frequently travel.

“How can you, in an environment where people are traveling a lot, where people have no identity card, how can you organise a two-dosage vaccination in rural areas?” he was reported as saying. “You vaccinate somebody today and say, ‘Come back two months later’ … even from a logistical point of view, it’s not feasible.”

Jean-Jacques Muyembe-Tamfum, who is now heading the Ebola response in DRC said Goma had been preparing for more Ebola cases for many months, and that the latest patient would receive treatment at a facility in the city.

“The response teams continue to work to decontaminate the home [of the patient] and the high-risk contacts of the case have been identified and will be vaccinated from tomorrow,” Muyembe-Tamfum said.