DR Congo: managing Ebola virus in war

The Lancet
Oct 13, 2018 Volume 392 Number 10155 p1279-1368  e11

DR Congo: managing Ebola virus in war
The Lancet
The latest Ebola virus outbreak across DR Congo is testing international and local health responses under conditions of extreme stress. The country is deep in a protracted conflict, and efforts to control Ebola virus in the conflict zone are hampered by conditions of war, which have led to a fractured society, a weakened health system, and widespread poverty and hunger.
Against this backdrop, WHO’s Director-General Dr Tedros Adhanom Ghebreyesus, last week, in his speech at a UN Security Council meeting, raised the risk assessment of regional spread of Ebola virus disease from high to very high, and highlighted concern of spread into Uganda, Rwanda, South Sudan, and Burundi.

The current violence in DR Congo has its origins in the refugee crisis that arose from the 1994 Rwanda genocide, and there are now at least 70 armed groups fighting in the eastern region of the country. The Ebola response, led by the Government of DR Congo with support from WHO and other partners, is being carried out in the shadow of this deadly warfare. Although these teams have the tools and experience to respond to and control Ebola virus, attacks on health workers and local mistrust are seriously hampering efforts.

Violence and war are, and have always been, a risk factor in public health emergencies. Cholera, a treatable disease, reached record levels in Yemen last year, and is on the rise this year. Neglected diseases, such as leishmaniasis, and diseases that should be on the way to eradication, such as polio, are resurging in conflict areas. What has changed is the nature of war. Wars are no longer ending, and new wars are being declared. The complexity of the geopolitical scene makes the UN Security Council’s mandate to maintain international peace and security ever more challenging—and important.

This situation is not isolated—it is our present and our future. Long and protracted wars are common-place, and are a threat to us all. Violence and conflict are compounders of public health crises. What is happening in DR Congo means that a fragile political situation, a complex virus, and a raging conflict puts the whole world under threat.