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 Worried about being kidnapped, they turned back, the latest in a
series of setbacks in their attempts to contain the central African
country's worst outbreak of the deadly virus.
As fighting has worsened between rival militia seeking control of
land and natural resources, vaccinations and vital treatments have
increasingly been delayed and Ebola has spread.
The situation has become so dangerous in eastern Congo that
humanitarian workers were temporarily evacuated last month from
their base in the town of Beni in the North Kivu region close to
Rwanda and Uganda.
With the vast country of more than 80 million people also suffering
from political instability and facing a refugee crisis, World Health
Organization experts see it as one of the most complex public health
challenges in recent history.
"Sometimes in the field we hear bullets flying left to right and we
tell ourselves maybe it is going to hit one of us," said Mimi
Kambere, emergency response coordinator for nonprofit group Oxfam,
whose team was confronted by the men with machetes.
"Sometimes the insecurity pushes us not to respond to calls, and not
to go into certain areas for days," she told Reuters in Goma, the
town on the northern shores of Lake Kivu to which she and other
health workers were evacuated on Nov. 17.
Congo's tenth outbreak since Ebola was discovered in 1976 has
infected 422 people and killed 241 in the last four months. It will
become the second largest outbreak of the disease if it surpasses
the 425 cases recorded in Uganda in 2000, according to Congo health
ministry records.
The disease is spread through contact with bodily fluids and causes
hemorrhagic fever with severe vomiting, diarrhea and bleeding. In
many flare-ups, more than half of cases are fatal. In the worst
outbreak, which began in 2013, more than 11,000 people were killed
in three years, mostly in Liberia, Guinea and Sierra Leone.
Tracking contacts of patients and immunizing them with a
preventative vaccine swiftly contained an Ebola outbreak in a
peaceful area of western Congo this year. This raised hopes that new
ways of fighting Ebola could reduce its deadliness, even in urban
areas.
But in what a World Health Organization official in Geneva called "a
potential perfect storm", densely populated North Kivu is now at the
epicenter of both the fighting and Ebola.
A WHO emergency committee said in October that the outbreak was
likely to worsen significantly unless the response was stepped up.
In November, the number of new cases rose, and the virus spread into
previously untouched areas.
An internal note by the United Nations Office for the Coordination
of Humanitarian Affairs (UNHCR), which was seen by Reuters, recorded
28 violent incidents affecting Ebola response teams between August
and November.
GRAPHIC: https://tmsnrt.rs/2ReWwZU
DEATH THREATS
International and Congolese health workers are not only hampered by
gunfire. They often face what the WHO calls "reluctance, refusal and
resistance" by some Congolese to accept treatment.
Some Congolese believe medics come to spread the disease with their
vaccination needles. Others do not believe the virus exists at all.
A number of medics, especially local staff, have received verbal
death threats and have had rocks thrown at their cars, they told
Reuters.
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Such actions, the WHO says, are driven by fear of Ebola and are
being exploited by local politicians before a presidential election
due in December.
Those that do seek medical help often find themselves in unsanitary
medical facilities where the virus spreads, medics said.
Humanitarian workers' scope for action is also limited by the
shortening of the working day under curfews imposed by the
government, Non-Governmental Organisations (NGOs) and the U.N.
because of the fighting.
This delays crucial services such as blood tests and safe burials of
Ebola victims to help prevent the virus spreading.
"Armed groups that attack Beni pose an enormous obstacle for our
staff," said Michel Yao, the WHO's incident manager in Beni.
In some areas, the WHO must seek permission from armed groups to
access new patients. Negotiations via phone to secure safe passage
can delay vital early care, Yao said, and interrupt vaccination
plans.
"We never had to negotiate access to patients before. It's a
specificity of this Ebola outbreak," Yao said.
WHO staff, along with representatives of the World Food Programme
and aid agency UNICEF, were among dozens of people evacuated for
psychological evaluation after fighting in Beni two weeks ago in
which 12 Congolese soldiers and seven U.N. peacekeepers were killed,
the WHO said.
Gunfire came close to the town's Ebola Emergency Center and a hotel
housing humanitarian workers. A shell landed on a building where WHO
staff were staying but did not explode.
"It was scary because normally violence is not that close," said a
UNICEF employee who asked not to be named.
To avoid stray bullets, he followed advice he was given in training.
"I entered my room and crouched in the shower. I was stuck in the
shower for three hours," he said.
FAST WORK IS VITAL
Effectively containing Ebola involves fast work under pressure:
health workers must check all possible new cases, take blood
samples, isolate the sick and track everyone a patient has been in
contact with.
A slow international response contributed to the rapid spread of
Ebola in West Africa in 2013, the outbreak that developed into the
worst so far.
In Congo, visiting potential patients often means driving for many
hours along pitted country roads, health workers said. In eastern
Congo that can mean danger.
A laboratory in Beni receives between 50 and 70 blood samples each
day from health workers in the field, but testing those samples has
slowed because of the time restrictions imposed by the curfews, said
Congo health ministry spokeswoman Jessica Llunga.
"Until we have confirmation that the patient has Ebola, we cannot
transfer him to a center and we cannot vaccinate his contacts, which
also hampers the fight against the epidemic," she said.
(Additional reporting by Kate Kelland in London.; Editing by Edward
McAllister and Timothy Heritage)
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