Will violence Let Go of the DRC long enough to kick out Ebola virus?

The 2018/19 outbreak of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) was showing some promising signs of control earlier this week. Then the latest attacks hit. Now, who knows?

A health worker prepares to disinfect MSF’s partly burnt-out Ebola treatment centre in Katwa, North Kivu, DRC, 25 February 2019. Photo and text from MSF.[1]

This week has seen two violent attacks resulting in damage to Ebola treatment centres (ETCs) and in one instance, the death of a nurse.

The first attack came at night

The first attack occurred on an Médecins Sans Frontières (MSF) ETC on 24th of February in Katwa, North Kivu.[1] Structures were burned, equipment damaged and a carer reportedly died.[8]

The Katwa health zone is the hotzone for most current EVD activity, having surpassed the case count in the previous most active zone of Beni (now almost controlled).

There were 10 EVD patients, including 4 confirmed cases, in this ETC. All safely transported to other ETCs. (all now returned to a newly modified transit centre [6])

A second attack, a second hotspot

The second and most recent attack was on 27th February and targeted the MSF ETC in Butembo; the biggest ETC built for this outbreak so far.[2] 32 of 38 suspected cases and 4 of 12 confirmed cases fled as a result.[3]

Both Katwa and Butembo health zones are active Ebola virus transmission areas. Shortly after the second attack, MSF stated that they were leaving both sites, pending risk analyses.[7,8]

That means these health zones have active cases in their ETCs and most likely, in the surrounding community.

OCHA Map of the hotzones, via Reliefweb.[4]

There has been frequent mention of resistance to the response to this EVD outbreak, from the community in the Katwa HZ. There is resistance to vaccination, resistance to presenting early for treatment when ill and resistance to safe and dignified burials. And there’s evidence for that; the outbreak is in its 8th month. That MSF article painfully spelt out the problem.

Organisations, including MSF, have failed to gain trust from communities; approaches to people must change

Médecins Sans Frontières (MSF) [1]

Working together, anything is possible

There was overwhelming evidence from the multi-country EVD epidemic in West Africa that engaging the community could shut down EVD. This engagement hasn’t succeeded – for whatever reasons – in the DRC this time around. Without everyone on the same page, transmission will continue its cruel and relentless path through family after family.

Disrupted responses in the region of most active transmission are bound to cause problems, just as we were warned from the outset. Infected people may move away from conflict and carry the virus to new (or back to old) places. Interruption of treatment, contact tracing, data recording, reporting and vaccination could drive new flare-ups in Katwa and Butembo.

We don’t know what’s next

As with all things outbreak, it’s impossible to accurately predict what will happen next. Impossible except for knowing that the heroic and dangerous efforts of a host of foreign and local health workers of all types will keep striving to grind the virus to a standstill.

And now there are new calls by the World Health Organization for vigilance and urgent financial aid.[5] A new plan to better empower the local response and communities has also been rolled out.

The violence and community resistance seems unwilling to let go and after recent events, this outbreak has regained the upper hand. There is still much work ahead before this particular Ebola virus is kicked out of the DRC.


  1. North Kivu: Ebola centre inoperative after violent attack
  2. Unknown forces attack Butembo Ebola treatment center, CIDRAP
  3. EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI Wednesday, February 27, 2019  http://translate.google.com/translate?hl=auto&langpair=auto|en&u=https://us13.campaign-archive.com/%3Fu%3D89e5755d2cca4840b1af93176%26id%3D693337893b
  4. RD Congo – Ituri et Nord-Kivu : 3W Qui fait quoi Où – Riposte de la Maladie à Virus Ebola (Semaine 06 : du 04 au 10 février 2019)
  5. Ebola response in Democratic Republic of the Congo risks slowdown.
  7. Why Doctors Without Borders Is Suspending Work In The Ebola Epicenter In Congo
  8. Medical activities suspended after Ebola treatment centre attack

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