Friday2 August 2019 ★ FINANCIAL TIMES 7INTERNATIONAL
TOM WILSON— BENI, DEMOCRATIC
REPUBLIC OF CONGO
Seven grave diggersin medical smocks,
surgical gloves and plastic boots lifted the
coffin from the back of a truck and began
to pick their way through more than
200 fresh burial mounds, whose simple
wooden crosses cast long shadows.
Masika Kahongya was 19 and newly
married when she died last month after
contracting the Ebola virus. She now lies
in a crowded forest clearing outside the
town of Beni, in the Democratic Repub-
lic of Congo, a few metres from the grave
of her three-month-old son, Innocent.
The mother and child are among 1,
people killed in the Ebola outbreak since
the first cases were confirmed near Beni
a year ago. Surpassed only by the epi-
demic that claimed more than 11,
lives in west Africa from 2014-16, it is the
longest and deadliest in Congo’s history.
Each of the country’s previous nine
outbreaks since 1976, when the virus
was first identified, occurred in remote
regions and were controlled within
three months. This time, thousands of
health professionals have been
deployed and more than 170,000 people
have received an effective trial vaccine.
Yet May, the tenth month, was the dead-
liest so far, and a further 349 cases were
confirmed in July. Yesterday, neigh-
bouring Rwanda, worried about the
spread of the virus, shut its border.
The accepted explanation for the fail-
ure of the international response has
been to blame the low-level conflict that
has destabilised eastern Congo for twodecades. The presence of armed groups
in North Kivu province made it difficult
to reach victims and administer vaccina-
tions, the country’s health ministry and
the World Health Organization has said.
Some members of the response
efforthave been attackedand medical
centres burnt down. But dozens of inter-
views with health professionals, aid
workers, victims and their families
paint a more complex picture of a
response that has succeeded in some
areas and failed in others.
On the red-dirt roads across the
region, tens of thousands of people are
stopped each day to have their hands
disinfected and temperatures taken. In
the new Ebola treatment centres, doc-
tors deliver expert care. The problem,
according to the health ministry, is that
up to 40 per cent of Ebola victims ignore
official advice to visit such centres, and
instead die at home and infect others.
“Community deaths are the worst sce-
nario and make itdifficult to control the
epidemic,” said Gaston Tshapenda, the
ministry’s senior official in Beni. “We
need to break this vicious circle and
establish trust with the community.”
Clovis Mutsuva, a youth group leader,
said the population had good reason to
be suspicious. Last year, the govern-
ment in Kinshasa, the capital, used the
outbreak as an excuse to cancel a presi-
dential election in opposition-voting
Beni and nearby Butembo, despite rec-
ommendations from the health minis-
trythat it would be safe to proceed.
“That’s the source of the resistance,”
Mr Mutsuva said. Health workers with
the government and WHO have treated
communities poorly, he added, issuing
ultimatums rather than advice.
There is also a perception that somepeople have profited from the response.
Hundreds of expensive off-road vehi-
cles ply the region’s bumpy roads and
“Ebola business” has become a refrain
among locals puzzled by the big inflow
of money into their region.
“Where were they when our people
were hacked to death by armed groups,
or when thousands perished from
malaria?” Mr Mutsuva asked.
That failure to build trust means
doubts linger, even in well-educated
families. “The response brings us noth-
ing... just corpses and more corpses,”
said Hussein Wabuzi, a former parlia-
mentary candidate, whose sister-in-law
died from the virus last month.
At his son’s bedside in the Beni treat-
ment centre, Fauzi Muhindo was hope-
ful. He could see and talk to eight-year-
old Kambale but they could not touch
because the boy was enclosed in a clear
plastic treatment cube.
The technology was developed after
the west African outbreak and allows
medics to care for patients without risk
of infection. “The rumours on the out-
side and the reality [inside the centre] is
very different,” said Mr Muhindo. “[It]
is so much better than I was told.”
But a breakthrough against the virus
remains elusive. Anne Marie Pegg, a
Médecins Sans Frontières doctor who
co-ordinates the aid group’s efforts in
eastern Congo, said the issue was not the
implementation of the response, but
with the strategy itself.
After the experience in west Africa
when the health services of Sierra Leone,
Guinea and Liberia collapsed under the
2014-16 outbreak, the response in
Congo has focused on creating a parallel
health system where suspected cases
are diverted into specialist facilities.
In hindsight, given that the Congolese
epidemichas so far totalled 2,593cases
versus 28,616 in west Africa, it was the
wrong approach, she said. Instead,
money should have been invested in
building up existing health centres to
test patients before sending confirmed
cases on for treatment, Ms Pegg said.
“You can have the best Ebola treat-
ment centre on the planet, but if people
never get to it, it cannot help.”
In response to pressure from aid agen-
cies and the threat that the virus could
extend into new areas, the WHO last
month declared the outbreak an inter-
national emergency, the highest level of
global health crisis and only the fifth
time the designation has been used.
Three days later, Congo’s President
Felix Tshisekedi set up a committee
headed by Jean-Jacques Muyembe, a
respected virologist, to lead the
response. Mr Muyembe, 77, was one of
two people dispatched to the Ebola river
in 1976 to investigate the first known
cases of the disease. He has previously
been critical of the response and is
expected to consider new approaches.
That could include the rollout of a sec-
ond trial Ebola vaccine being developed
by US pharmaceutical groupJohnson &
Johnson. Its use was blocked last month
by the then health minister, Oly Ilunga,
who said it would undermine commu-
nity trust in theMerckvaccine cur-
rently being delivered. He quitdays
after the Muyembe committee was
established, decrying “interference”.
For experts such as Peter Piot, direc-
tor of the London School of Hygiene &
Tropical Medicine, this approach could
help turn the tide with a vaccination
programme in areas where the virus has
not yet been detected. This would create
a “curtain” of immunised people around
the epidemic, providing a window to
bring it under control, he explained.Congo officials
desperate to
break Ebola
‘vicious circle’
Health experts call for rethink of strategy
as progress against virus remains elusive
‘Community deaths are
the worst scenario and
make itdifficult tocontrol the epidemic’
Grief: family
members view
the body of their
relative before
the safe burial in
Beni, left; health
workers tend to
a patient inside
an Ebola
treatment
centre, above;
the funeral of an
Ebola victim
John Wessels/FTRWANDAUGANDAButemboKampalaGomaBeniConflict sites* Cumulative casesConflict is complicating the response to the Ebola outbreak in DRC
Instability in the region
has made people suspicious
of authorities and is impeding
response measuresDEMOCRATIC REPUBLIC
OF CONGO*Includes violence against civilians,
riots, protests, battles, explosions,
and strategic developments.
Conflicts since Aug ,
Sources: DRC Ministry of Health, ACLED cases to July
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