Contributors include Erikas Mwisi reporting from Butembo, North Kivu; Margaret Basheer from the United Nations; and Eddy Isango, James Butty and Carol Guensburg from Washington.

Armed attacks, misinformation and a growing funding gap continue to impede the response to the Ebola outbreak in northeastern Democratic Republic of Congo, with the World Health Organization warning that the situation could spiral out of control.

Insecurity leaves response teams “unable to perform robust surveillance nor deliver much needed treatment and immunizations,” the WHO reported Friday in its latest update on the outbreak confirmed last August. The health organization warned that “without commitment from all groups to cease these attacks, it is unlikely that this EVD [Ebola virus disease] outbreak can remain successfully contained in North Kivu and Ituri provinces.”

The disease could spill into other parts of the country and across the borders of neighboring Uganda, Rwanda and South Sudan, the health organization suggested.

This month alone has brought setbacks such as a violent assault on a burial team in the town of Katwa and a gunfight between at least 50 armed militia and security forces in the city of Butembo, WHO reported. Mourners also buried Richard Valery Mouzoko Kiboung, a 41-year-old Cameroonian doctor killed April 19 while working for WHO and meeting with other front-line workers at Butembo University Hospital.

The threats continue.

A letter warns against collaborating with Ebola re A letter warns against collaborating with Ebola responders or treatment centers in the Democratic Republic of Congo. Copies of the letter, allegedly written by a Mai-Mai fighter, appeared on the street in Butembo and in other communities in the region. A letter warns against collaborating with Ebola responders or treatment centers in the Democratic Republic of Congo. Copies of the letter, allegedly written by a Mai-Mai fighter, appeared on the street in Butembo and in other communities in the region.

On Thursday, a VOA correspondent in Butembo spotted copies of a letter – anchored with pebbles on streets and posted on buildings in that city and other North Kivu communities. Handwritten in Swahili and attributed to Mai-Mai fighters, the letter warned police, soldiers and the general public against showing any support for Ebola responders or treatment centers.



Anderson Djumah, whose 10-year-old son is being treated for Ebola at the Butembo general hospital, complained that “the lack of security has just added more suffering.”

“Even Ebola treatment centers are targeted by the assailants. We’re afraid. Ebola is killing so many people. We’re still expecting that the government would be able to protect us,” he said. “… [But] some people who are sick with Ebola are fleeing to other places for their lives and are meanwhile spreading the sickness.”

Complications for care

Violence sends people into hiding and disrupts response operations such as contact tracing, vaccination and safe burials, giving “time and space to the virus to spread within the community and make more victims,” Jessica Ilunga, spokeswoman for the DRC’s health ministry, told VOA.

“Every time we have a security incident, the number of cases and deaths obviously increases,” Ilunga said.

The health ministry, leading the response with WHO’s help, reported 1,600 total cases as of Wednesday, with 1,534 confirmed and 66 likely. This second-worst Ebola outbreak already has claimed 1,069 lives. The 2014-15 West African outbreak killed more than 11,000.

🚨#Ebola - Situation au mercredi 8/05/19- Au total, 1.600 cas (1.534 confirmés & 66 probables), 1.069 décès et 442 personnes guéries- 15 nouveaux cas confirmés- 14 nouveaux décès de cas confirmés- 1 nouveau guéri- 267 cas suspectsLe bulletin complet sera envoyé jeudi matin pic.twitter.com/OFCNtsn61M — Ministère de la Santé RDC (@MinSanteRDC) May 8, 2019

Many of the victims have died at home, potentially exposing others to the disease and leaving gaps in how — and to whom — the virus may have been transmitted.

“You don’t know who those contacts are,” said epidemiologist Jennifer Nuzzo, an epidemiologist and principal investigator for the Outbreak Observatory, a project of the Johns Hopkins Center for Health Security. “… Chances are you can’t offer them vaccines or treatment.”

Funding for the Ebola response has fallen far short of need, WHO spokesman Tarik Jasarevic said in an email to VOA Wednesday. As of May 2, WHO had received $32.5 million of the $87 million it estimated needing for six months ending in July.

“If the funds are not received,” Jasarevic wrote, “WHO will be unable to sustain the response at the current scale.”

FILE - Police shelter behind a hospital sign as th FILE - Police shelter behind a hospital sign as they guard a hospital in Butembo, Congo, April 20, 2019, after militia members attacked an Ebola treatment center in the city’s Katwa district overnight. FILE - Police shelter behind a hospital sign as they guard a hospital in Butembo, Congo, April 20, 2019, after militia members attacked an Ebola treatment center in the city’s Katwa district overnight.

?New challenges in 10th DRC outbreak

This is the DRC’s 10th reported outbreak since the virus’ discovery near the Ebola River in 1976. The country has proved adept at snuffing out past outbreaks of Ebola, which has been found in bats, monkeys and other animals sometimes consumed as “bush meat.” The virus spreads through contact with an infected person’s body fluids.

Ebola was unfamiliar in the northeast, a region already destabilized by at least two decades of conflict. More than 100 armed groups roam the area, displacing hundreds of thousands of people.

High mobility and population density also raise the potential that the virus could cross into Uganda, Rwanda and South Sudan. (The U.S. Centers for Disease Control and Prevention has been providing technical guidance to the DRC and its neighbors, for instance, helping them ramp up surveillance and vaccination tracking.)

Wary public

Skepticism also factors into the Ebola equation. The northeast is an opposition stronghold, and its residents were angered to be kept from voting in December’s general elections, as former U.S. diplomat John Campbell pointed out in a Council on Foreign Relations blog post.

A study published in The Lancet medical journal in March found low public trust in local authorities and broad acceptance of misinformation about Ebola. Just a third of the 961 respondents — adults surveyed in North Kivu’s Beni and Butembo last fall — said they had confidence that local authorities acted in the public interest. A fourth indicated they didn’t believe Ebola exists.

Mistrust and misinformation make it less likely that individuals will heed public safety directives, such as accepting Ebola vaccines, seeking formal medical care or supporting safe burial practices, the researchers noted.

A woman looks at burned equipement in an Ebola tre A woman looks at burned equipement in an Ebola treatment center, which was attacked early on March 9, 2019, in Butembo, Democratic Republic of the Congo. A woman looks at burned equipement in an Ebola treatment center, which was attacked early on March 9, 2019, in Butembo, Democratic Republic of the Congo.

That mistrust can be weaponized, as Medecins Sans Frontieres/Doctors Without Borders experienced. Two of the international aid group’s Ebola treatment centers, in Katwa and Butembo, were attacked in February. MSF suspended services there, saying its ability to respond in the outbreak’s epicenter had been “crippled.”

Anne-Marie Pegg, MSF’s clinical lead for epidemic response, said some Congolese look critically at the disparity between local clinics, which, if they exist, might lack basics such as running water and electricity, and the better-equipped Ebola treatment centers set up by international aid groups.

“Very little investment has gone into the existing health structures and the existing health system, and people notice this,” Pegg said. She said MSF, in “numerous interactions,” has heard complaints that international groups are involved “‘only because we [locals] are contagious and we’re a threat to you.’

“It’s not surprising that something like Ebola can be manipulated for any variety of reasons,” Pegg added. “… Absolutely, there are interest groups from all sides that are trying to use this.”

MSF continues to work in the region while pressing for “better integration of Ebola treatment into the health care system,” Pegg said. The virus’ early symptoms, such as headaches and muscle pain, are indistinguishable from those of malaria or other more common ailments, so “it’s difficult for someone who’s sick to think, ‘I have Ebola.’ So the capacity to isolate someone who may have an Ebola infection and test for that … needs to happen at a local level” rather than sending patients to a treatment center. “It would be nice if those people could be treated closer to home” and started on treatment while awaiting test results. If the virus is confirmed, then transfer the patient to an Ebola treatment center, “which is the best place.”

But, she said, MSF’s goal is to treat whatever ailment a patient might have.

FILE - A Congolese health worker administers Ebola FILE - A Congolese health worker administers Ebola vaccine to a boy who had contact with an Ebola sufferer in the village of Mangina, in North Kivu province of the Democratic Republic of Congo, Aug. 18, 2018. FILE - A Congolese health worker administers Ebola vaccine to a boy who had contact with an Ebola sufferer in the village of Mangina, in North Kivu province of the Democratic Republic of Congo, Aug. 18, 2018.

?Vaccine plans revised

As Ebola infections rise, a WHO advisory group this week recommended that an approved vaccine be distributed more widely in smaller doses and that an experimental vaccine, developed by Johnson & Johnson, also be offered. More than 100,000 doses of the approved Merck vaccine have been distributed since August, but supplies are running low. The dosage would be halved from the current 1 milliliter for the primary and secondary “ring vaccination,” which prescribes inoculation for anyone in contact with an infected person. Eligibility would be expanded through “pop-up and targeted geographic approaches” in high-risk areas.

“We know that vaccination is saving lives in this outbreak,” WHO Director-General Tedros Adhanom Ghebreyesus said in a statement.

The advisory group also recommended more training for local health workers.