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DRC: Ebola epidemic brings despair as WHO declares large outbreaks 'new normal'11:51

DRC: Ebola epidemic brings despair as WHO declares large outbreaks 'new normal'

Congo, the Democratic Republic of the, Various
December 10, 2019 at 05:43 GMT -00:00 · Published

"We live in the midst of permanent death."

Goreti Mukumira, a psychologist at a treatment centre in the Democratic Republic of the Congo's north-east, describes the harrowing impact of Ebola on local communities since a massive outbreak of the disease in August last year.

"The fact of living in a permanent situation of death doesn't make it easy for us to accept the Ebola epidemic," she says.

The second deadliest outbreak of Ebola in history was declared 'an international public health emergency' by the World Health Organization (WHO) in October. A total of 3,200 confirmed cases and 2,207 deaths have been recorded since the disease first swept through the DRC's North Kivu and Ituri provinces in 2018, according to figures from December this year.

The Ebola epidemic comes just three years after the end of the most lethal outbreak of the disease ever recorded, in West Africa in 2014-16, when 11,310 people lost their lives. Previous outbreaks since 2000 had seen death tolls reach no higher than 224. This leap in mortality rates has led WHO to declare the DRC outbreak part of a "new normal" in which large-scale flare-ups of deadly diseases are increasingly commonplace in poorer regions of the globe.

Ebola tore through the DRC's conflict-ridden northeast, with over 1,000 cases reported in the first eight months, according to Doctors Without Borders. The infection rate then doubled between April and June 2019, and despite slowing somewhat since August, the outbreak is showing few signs of coming to an end.

Weak governance, ongoing conflict and high rates of internal and cross-border migration are among the factors converging to fan the spread of lethal diseases much faster than before in some of the world's most deprived areas, where they leave behind traumatised and vulnerable survivors.

Roseline Kavira Lukando is the only survivor from her family, after her parents, husband and young son were all killed by the disease. Her father and mother contracted the virus first, and her two-month-old son fell ill soon after his grandfather's burial. After doctors told her that her baby could not be vaccinated, she refused to get the injection herself and fell ill alongside her husband. He died after six days of treatment, and her baby passed away just before she was taken to an emergency treatment clinic, where she spent three weeks in a coma.

Survivors of the disease often face lingering physical effects such as blurred vision and generalised weakness, but also stigma and phobia from members of the local community. After being transferred to a convalescence ward, Lukando says she experienced sensations of detachment and helplessness as she became the target of threats over her cooperation with Ebola workers. "I also received an anonymous letter in which they wrote that I would be killed because I work with the Ebola response groups," she says.

Conspiracy theories have grown as the disease has spread, with some reported to believe that the illness is a plot to steal organs. Other theories say the disease is fabricated entirely, while some believe it to be deliberately expedited for financial gain, such as the extortion of foreign aid. In Lukando's case, she says, members of the local community accuse her of infecting her relatives and of being paid by 'occult powers' who they say imported Ebola in order to exterminate the Congolese population.

Scepticism concerning the truth about the disease appears to be held by a sizeable minority of the local population in North Kivu. In a September 2018 survey by The Lancet, 25.50 percent of respondents from the area said they did not believe Ebola to be real.

Indeed, WHO writes, "after decades of neglect, the sudden surge of governmental and international attention towards affected communities has aroused suspicion."

Goreti Mukumira, of an Ebola Treatment Centre (ETC) in Beni, confirms that many in North Kivu deny the existence of the virus. She believes that numerous deaths could be prevented if people acknowledged the disease.

Joel Efoloko is a doctor at the Alliance for International Medical Action (ALIMA), an NGO which runs an Ebola treatment centre in Beni. He agrees that the high mortality rate is fuelled in part by a widespread refusal to acknowledge the illness among the population, resulting in patients seeking treatment only when the disease is at an advanced stage. Providing treatment when symptoms first appear improves the chances of survival, he adds.

Twelve-year-old Mumbere Nixon is one such survivor. He was admitted to an emergency treatment centre after complaining of a head and stomach ache, before testing positive for Ebola. Mumbere was treated with the help of the CUBE, a biosecure emergency care unit designed to allow doctors and nurses to safely administer treatment to Ebola patients. The boy lost his mother and two siblings to the disease and while he continues to convalesce, his main thought is to raise awareness of the dangers posed by the virus as soon as he leaves the clinic.

"When I get out of here I want to tell people that they must stop saying that Ebola doesn't exist," he says.

Soldiers and security forces across the DRC's north-east guard sanitation checkpoints, set up along major transportation arteries and at all points of entry into the cities of the North Kivu and Ituri provinces. Those travelling along or through these routes have their temperature taken and are required to disinfect their hands with a solution of water and chlorine. The army is joined at the checkpoints by police and healthcare providers.

Medical workers must take extra precautions to protect themselves, since they are among the most at risk of contracting the disease. At an emergency treatment centre in Beni, the epicentre of the crisis, health workers wear hermetically sealed suits before entering the red-zone, a high risk area where they are not permitted to spend more than two hours. Once their shift is over, the workers are sprayed down with chlorinated water and must remove their personal protective equipment.

For the populace, the dangers of setting foot inside such medical facilities remain very real. Thirteen-year old Esperance Kavira Balikwisha contracted the disease at a local healthcare facility where she was seeking treatment for Malaria. She found out she had Ebola only three days before she died.

"A further four people became ill there and died. She spent three days in the treatment centre, but didn't make it and died," said her father Mapo Lekesa Bosanda. The child's burial was overseen by the army to prevent any backlash from the local population, many of whom regard healthcare workers with suspicion.

In the face of such trauma, mistrust and suffering, psychologist Goreti Mukumira spoke of the need for accepting the realities of the disease. "It is necessary to accept the Ebola disease virus, that it is a real illness, that it exists and accepting it could result in a positive mental attitude," she said.

"If it continues to be ignored, we will continue to lose our brothers and sisters."

DRC: Ebola epidemic brings despair as WHO declares large outbreaks 'new normal'11:51
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"We live in the midst of permanent death."

Goreti Mukumira, a psychologist at a treatment centre in the Democratic Republic of the Congo's north-east, describes the harrowing impact of Ebola on local communities since a massive outbreak of the disease in August last year.

"The fact of living in a permanent situation of death doesn't make it easy for us to accept the Ebola epidemic," she says.

The second deadliest outbreak of Ebola in history was declared 'an international public health emergency' by the World Health Organization (WHO) in October. A total of 3,200 confirmed cases and 2,207 deaths have been recorded since the disease first swept through the DRC's North Kivu and Ituri provinces in 2018, according to figures from December this year.

The Ebola epidemic comes just three years after the end of the most lethal outbreak of the disease ever recorded, in West Africa in 2014-16, when 11,310 people lost their lives. Previous outbreaks since 2000 had seen death tolls reach no higher than 224. This leap in mortality rates has led WHO to declare the DRC outbreak part of a "new normal" in which large-scale flare-ups of deadly diseases are increasingly commonplace in poorer regions of the globe.

Ebola tore through the DRC's conflict-ridden northeast, with over 1,000 cases reported in the first eight months, according to Doctors Without Borders. The infection rate then doubled between April and June 2019, and despite slowing somewhat since August, the outbreak is showing few signs of coming to an end.

Weak governance, ongoing conflict and high rates of internal and cross-border migration are among the factors converging to fan the spread of lethal diseases much faster than before in some of the world's most deprived areas, where they leave behind traumatised and vulnerable survivors.

Roseline Kavira Lukando is the only survivor from her family, after her parents, husband and young son were all killed by the disease. Her father and mother contracted the virus first, and her two-month-old son fell ill soon after his grandfather's burial. After doctors told her that her baby could not be vaccinated, she refused to get the injection herself and fell ill alongside her husband. He died after six days of treatment, and her baby passed away just before she was taken to an emergency treatment clinic, where she spent three weeks in a coma.

Survivors of the disease often face lingering physical effects such as blurred vision and generalised weakness, but also stigma and phobia from members of the local community. After being transferred to a convalescence ward, Lukando says she experienced sensations of detachment and helplessness as she became the target of threats over her cooperation with Ebola workers. "I also received an anonymous letter in which they wrote that I would be killed because I work with the Ebola response groups," she says.

Conspiracy theories have grown as the disease has spread, with some reported to believe that the illness is a plot to steal organs. Other theories say the disease is fabricated entirely, while some believe it to be deliberately expedited for financial gain, such as the extortion of foreign aid. In Lukando's case, she says, members of the local community accuse her of infecting her relatives and of being paid by 'occult powers' who they say imported Ebola in order to exterminate the Congolese population.

Scepticism concerning the truth about the disease appears to be held by a sizeable minority of the local population in North Kivu. In a September 2018 survey by The Lancet, 25.50 percent of respondents from the area said they did not believe Ebola to be real.

Indeed, WHO writes, "after decades of neglect, the sudden surge of governmental and international attention towards affected communities has aroused suspicion."

Goreti Mukumira, of an Ebola Treatment Centre (ETC) in Beni, confirms that many in North Kivu deny the existence of the virus. She believes that numerous deaths could be prevented if people acknowledged the disease.

Joel Efoloko is a doctor at the Alliance for International Medical Action (ALIMA), an NGO which runs an Ebola treatment centre in Beni. He agrees that the high mortality rate is fuelled in part by a widespread refusal to acknowledge the illness among the population, resulting in patients seeking treatment only when the disease is at an advanced stage. Providing treatment when symptoms first appear improves the chances of survival, he adds.

Twelve-year-old Mumbere Nixon is one such survivor. He was admitted to an emergency treatment centre after complaining of a head and stomach ache, before testing positive for Ebola. Mumbere was treated with the help of the CUBE, a biosecure emergency care unit designed to allow doctors and nurses to safely administer treatment to Ebola patients. The boy lost his mother and two siblings to the disease and while he continues to convalesce, his main thought is to raise awareness of the dangers posed by the virus as soon as he leaves the clinic.

"When I get out of here I want to tell people that they must stop saying that Ebola doesn't exist," he says.

Soldiers and security forces across the DRC's north-east guard sanitation checkpoints, set up along major transportation arteries and at all points of entry into the cities of the North Kivu and Ituri provinces. Those travelling along or through these routes have their temperature taken and are required to disinfect their hands with a solution of water and chlorine. The army is joined at the checkpoints by police and healthcare providers.

Medical workers must take extra precautions to protect themselves, since they are among the most at risk of contracting the disease. At an emergency treatment centre in Beni, the epicentre of the crisis, health workers wear hermetically sealed suits before entering the red-zone, a high risk area where they are not permitted to spend more than two hours. Once their shift is over, the workers are sprayed down with chlorinated water and must remove their personal protective equipment.

For the populace, the dangers of setting foot inside such medical facilities remain very real. Thirteen-year old Esperance Kavira Balikwisha contracted the disease at a local healthcare facility where she was seeking treatment for Malaria. She found out she had Ebola only three days before she died.

"A further four people became ill there and died. She spent three days in the treatment centre, but didn't make it and died," said her father Mapo Lekesa Bosanda. The child's burial was overseen by the army to prevent any backlash from the local population, many of whom regard healthcare workers with suspicion.

In the face of such trauma, mistrust and suffering, psychologist Goreti Mukumira spoke of the need for accepting the realities of the disease. "It is necessary to accept the Ebola disease virus, that it is a real illness, that it exists and accepting it could result in a positive mental attitude," she said.

"If it continues to be ignored, we will continue to lose our brothers and sisters."

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