Security Concerns Are Threatening the Ebola Response in the DRC. Here’s What to Know

Continuing security issues in the Democratic Republic of the Congo (DRC) are impeding efforts to control the country’s worsening Ebola outbreak, according to a statement from the World Health Organization (WHO).

Protests, unrest and attacks on healthcare workers in the country, which is in the midst of a humanitarian crisis, are making it difficult for responders to administer vaccines, address possible new cases and identify individuals who may have been exposed to the deadly virus, threatening containment progress, the WHO says.

“These gains could be lost if we suffer a period of prolonged insecurity, resulting in increased transmission,” the statement says. “That would be a tragedy for the local population, who have already suffered too much.”

The DRC outbreak is still far less sweeping than a West African outbreak that killed 11,000 people between 2014 and 2016, but the WHO has called it the second worst ever. Continuing spread of the disease, and the fact that it has reached a populous city in the DRC’s North Kivu province, has health officials concerned, and national and regional risk associated with the disease is considered “very high.” Global risk remains low.

Here’s what to know about the Ebola outbreak in the DRC.

How severe is the Ebola outbreak?

The DRC’s current Ebola outbreak, its 10th in 40 years, was officially declared on Aug. 1, shortly after the end of another outbreak in the country that claimed 33 lives. As of Dec. 27, the WHO had recorded 543 confirmed cases of Ebola, as well as 48 suspected cases. More than 350 deaths have been reported, including 309 confirmed to be the result of Ebola. The most confirmed cases have been reported in the Beni health zone, located in the country’s populous North Kivu Province, but new cases there are slowing, according to a recent WHO case report. Meanwhile, the outbreak is intensifying in Butembo — a North Kivu city with more than 1 million residents — and Katwa.

Women and children have been disproportionately affected by the outbreak. As of early December, women accounted for about 62% of cases where sex was reported; at least 18 of these women were pregnant, and additional seven were either breastfeeding or had recently given birth. Another cause for concern, according to the WHO, is the high rate of infection among children. Nearly a quarter of cases have been in children younger than 15, including 27 infants not even a year old. Women and children may be exposed to Ebola in health facilities, when attending funerals or through family care, according to the WHO. They may also be more likely to seek medical attention if they do become sick.

As of Dec. 25, 201 people had been successfully treated for Ebola and discharged from health facilities.

Is Ebola spreading?

Ebola — a rare and severe virus that causes fatigue, muscle and stomach pain, vomiting, diarrhea and unexplained bleeding — can be quite contagious and is spread through direct contact with infected people or their bodily fluids, according to the Centers for Disease Control and Prevention (CDC). While no cases of the virus have been confirmed outside the DRC, one was confirmed near the Ugandan border in late September, and health officials have deemed the risk of national and regional spread “very high.” The WHO and the Ministry of Health are keeping a close eye on countries that share borders with the DRC, including Uganda, Rwanda and South Sudan.

A number of factors could allow disease transmission to extend beyond the DRC’s borders, raising red flags. In a recent case report, the WHO cited “the volatile security situation, sporadic incidents of community reluctance, refusal or resistance, continued reporting of confirmed cases, and the risk of spread to neighbouring countries” as reasons for concern.

One of the primary issues is a long-standing humanitarian crisis in the DRC that has worsened over the past year, forcing millions of people to flee their homes, according to the UN. More than 4 million people in the DRC are considered displaced — including more than a million in North Kivu Province alone — leading to “continuous movement of refugees to neighboring countries,” the WHO says. This movement, along with travel within the DRC, could increase the disease’s chances of spreading, the WHO says. Plus, security concerns and community resistance in North Kivu and Ituri provinces have stifled response and monitoring efforts in these areas, and made it more difficult to carry out “safe and dignified burials” that can curb disease spread. Recent political turmoil has also caused hundreds of Congolese refugees to enter Uganda, raising concerns about further spread.

In the U.S., health officials are closely monitoring an American who may have been exposed to Ebola while treating patients in the DRC. The individual has not shown symptoms of Ebola, but is under observation at the University of Nebraska Medical Center.

What’s being done about the Ebola outbreak?

The WHO continues to closely monitor and respond to affected and at-risk areas. Multiple hospitals in the DRC now have the capacity to confirm diagnoses of Ebola with laboratory testing, and procedures are in place for treating and isolating patients suspected or known to have the virus. (Nonetheless, the WHO says some hospital visitors still show “resistance” to containment procedures, another risk factor for disease transmission.)

Health workers have also been using a new, experimental Ebola vaccine to help stop the virus’ spread, inoculating almost 40,000 people so far. Health workers have been using a vaccine made Merck, which has been shown in field testing to potentially reduce infection rates, and showed some success during the last outbreak in the DRC. Merck has provided thousands of the vaccines to health authorities for emergency use, but it’s still considered experimental since ethical concerns have barred scientists from performing the types of controlled clinical trials usually used to test new drugs. Health workers and at-risk individuals have also been vaccinated in South Sudan and Uganda.

About 160 people have also been treated with other experimental drugs, under a WHO policy that allows for the emergency use of investigational therapies. And in a significant step, the WHO announced that the DRC will begin a randomized control trial to test the efficacy of new therapeutics.

The U.S. withdrew its presence in the region in August and has not redeployed anyone in the face of significant security concerns. Some employees from the CDC and the U.S. Agency for International Development are in the DRC capital of Kinshasa, miles away from the heart of the outbreak, the Washington Post reports.