By Alfred Nyakinda
Recent attacks on Doctors Without Borders (MSF) Ebola treatment centers in the Democratic Republic of Congo have highlighted the need for a more humane response to Ebola outbreaks according to MSF experts at a press conference in Geneva.
There have been 944 confirmed and probable cases and 629 deaths in North Kivu and Ituri provinces making it the worst outbreak on record in DRC.
Two Ebola treatment centres (ETCs) were attacked in February in the city of Butembo and Katwa. One caretaker died in the attack in Butembo, during which gunshots were heard, property set on fire and the electricity supply disabled; forcing the staff and 57 patients, including 14 confirmed Ebola cases, to flee.
MSF operations in North Kivu province were suspended after the attack. The Butembo centre was attacked again shortly after reopening in March under the health ministry in collaboration with the World Health Organization (WHO) and Unicef. One police officer was killed in the attack.
The attacks have revealed lapses in the response measures towards Ebola. Dr. Ousmane Dede of MSF said that the use of security forces in the quarantine of suspected cases was interfering with treatment procedures. In one case he witnessed them go against protocol by bringing a relative of a suspected case, who had shown no symptoms, into the ETC.
The government’s treatment of Ebola as a security emergency, rather than a medical one, has deepened suspicions among affected communities according to the MSF.
“The community is not the enemy, Ebola is a common enemy”, said Dr. Joanne Liu, MSF international president, “Many of those with a negative view of the response feel that Ebola is being used for political maneuvers.”
The experts also highlighted the deep contradictions in the response in Northern Kivu, where common ailments are frequently deadly, but receive little attention. They suggested that seeing donors pouring millions into Ebola after years of neglect may have played a part in fuelling the resentment against the response efforts.
The outbreak has been met with a massive response that has seen nearly 100,000 vaccinated. Despite this, 40 percent of the deaths have occurred within the community with 35 to 45 percent of the cases lacking a known chain of transmission. Furthermore, there is a limited supply of vaccine available which is only given to those who have been in contact with the infected and health workers.
“To fix this response we must ensure we are looking from the patient’s perspective. Ebola is a brutal disease, it brings extremes of isolation and suffering,” noted Dr. Liu, “We must be honest, the offer from the Ebola treatment centre is not a very tempting one, away from your loved ones and surrounded by strangers in space suits.”
A solution proposed was shaping the response around patient’s concerns, not those of the response team. This would mean providing viable community based care alternatives, provision of more vaccines and training people in hard to reach areas so they can protect and care for their own families.
The MSF international president said Ebola treatment should be integrated into the wider healthcare system and cautioned against responding with increasing force, instead advising for greater attention to people’s needs.
She also stated that the organization was not pulling out of the country, but has learned that being part of the machinery of the response was counterproductive and would only return to North Kivu if the people wanted them back.
According to the WHO, no cases have been reported outside North Kivu and Ituri provinces and no cases have crossed international borders, but the risk of national and regional spread remains high, especially with violence affecting the response.
Many MSF workers in the areas where the attacks took place opted to continue working as part of the response with other organizations, but have been subjected to threats of violence should they continue to do so.