Violent attacks on caregivers and other factors are contributing to the spread of Ebola virus in an outbreak in the Democratic Republic of Congo. The number of healthcare workers infected has risen to 81 (7% of total cases), including 27 who have died of Ebola, the World Health Organization (WHO) reports.1

A WHO epidemiologist was killed on April 19 in the latest in a series of attacks on care centers by armed militia in the warring region. In the lead-up to that incident, an Ebola care center established by the Doctors Without Borders volunteer group was destroyed. The CDC — the healthcare agency that has the greatest Ebola expertise in the world — was previously pulled from the DRC due to the security concerns.

As of April 2, 2019, a total of 1,100 confirmed and probable Ebola cases have been reported, of which 690 died — a case fatality rate of 63%.

At a WHO Committee meeting on April 12, officials decided not to declare a Public Health Emergency of International Concern (PHEIC). This follows similar inaction earlier in the outbreak, and some U.S. experts have strongly questioned what they perceive as “political” decisions.2

“It’s definitely getting worse,” says Lawrence Gostin, JD, a professor of global health law at Georgetown University in Washington, DC.

In what is likely to be a seen in future outbreaks, the DRC is suffering co-epidemics of disease and violence, he says. Rather than withdraw, the world must step in to secure the region and stop Ebola before it gets into more urban, mobile populations, Gostin argues. “Job one is to protect health and humanitarian workers,” he says.

“We should never be in a situation where people have to put their life on the line to provide care,” he says. “We should also quell the violence so the CDC can be back on the ground in the hot zone providing their expertise.”

An ongoing UN mission preceded the Ebola outbreak, and they are there for general peacekeeping. They are not trained, nor do they have a specific mandate to protect healthcare workers, he explains.

“The potential for global spread is ever-present,” Gostin says. “Certainly, the greater danger is to the region. Imagine if it gets across the border to Somalia or Uganda or to major cities — it would spread like wildfire. If it carries on the way it is, it will only be a matter of time before it appears in a major global city in the U.S. or Europe.”

REFERENCES

  1. World Health Organization. Ebola virus disease – Democratic Republic of the Congo. Disease outbreak news: Update April 4, 2019. Available at: https://bit.ly/2VpuQDM.
  2. Gostin L, Phelan A, Coutinho AF, et al. Ebola in the Democratic Republic of the Congo: Time to sound a global alert? Lancet. Feb. 04, 2019. DOI: https://doi.org/10.1016/S0140-6736(19)30243-0.