Ebola outbreak in Democratic Republic of Congo

The Ebola outbreak declared in August 2018 was the worst ever documented in Democratic Republic of Congo (DRC)—and the second-largest Ebola outbreak recorded anywhere. Efforts to stop the spread of the disease were challenged on many fronts, including by the realities of fighting an epidemic in a conflict zone. It was the country's tenth outbreak of the deadly virus in 40 years.

On July 17, 2019, the World Health Organization declared the Ebola outbreak in Democratic Republic of Congo to be a public health emergency of international concern.  At the request of the Ministry of Health (MoH), Doctors Without Borders/Médecins Sans Frontières (MSF) was part of the national task force coordinating the intervention based on several pillars of the Ebola response. 

Violence and political unrest

The epicenter of the tenth Ebola outbreak was in North Kivu, a densely populated area in the country’s northeast. North Kivu shares a border with Uganda and is a hub for travel and trade, as well as human trafficking. North Kivu has also been an area of conflict for over 25 years, with more than 100 armed groups active in the region.

Violence and political unrest in the affected areas added additional barriers to accessing health care. Security constraints hindered the Ebola response, made it difficult to identify new cases, trace contacts, and conduct vital community outreach activities. Some health centers were also damaged or temporarily closed.

On February 24, 2019, unidentified assailants attacked the MSF-managed Ebola treatment center in Katwa, setting the structure on fire and destroying medical wards and equipment. Three days later MSF's Butembo treatment center was also attacked and burned. All medical activities at the two sites have been suspended.

MSF responds

At the start of 2019, MSF received 3,292 people at its Ebola treatment centers and transit centers in the affected region. We treated 321 patients confirmed with Ebola. MSF has also vaccinated more than 4,800 frontline health workers, who are among those at greatest risk of contracting the disease. On June 25, 2020, the tenth outbreak was officially declared over. There were 3,470 cases, 2,287 deaths, and 1,171 survivors. This outbreak severely destabilized DRC’s already fragile health care system. People's medical needs extended well beyond Ebola, as demonstrated by the measles epidemic that claimed many more lives.

Just as this outbreak was winding down, DRC's 11th Ebola outbreak was declared in Equateur province, on the opposite end of a vast country. MSF sent teams to help curb the spread of the disease, supported community surveillance, and provided rapid treatment to patients living in remote areas. Some health zones were very hard to reach and only accessible by river using canoes or after hours of difficult transport by rough roads through the forest.

Additional challenges

The response to the 11th Ebola outbreak did not face the kinds of security challenges that affected the response to the tenth Ebola outbreak. There were other significant logistical challenges though.

MSF sent teams to the health zones of Bolomba, Bikoro, Monieka, Ingende, and Lotombe in order to curb the spread of the disease, to support community surveillance, and to provide rapid treatment to patients living in remote areas. Equateur province is four times the size of Belgium, with some health zones very hard to reach and only accessible by river using canoes or after hours of difficult transport by rough roads through the forest. Only one helicopter was available for some 15 humanitarian organizations trying to move around the region.

Little information was circulating on Ebola in the province, and the epidemic affected some health zones for the first time ever. That’s why our health promotion teams were working with the DRC Ministry of Health to strengthen awareness and community-based surveillance. In Bolomba, Bikoro, and Monieka, this is one of the key activities done by MSF.

Lessons learned

These decentralized and community-based approaches to responding to the outbreak were also complemented by a vaccination program supported by other partners in the response. Since the start of the vaccination efforts in June of 2020, the ZEBOV-GP vaccine—which was also used in DRC’s northeastern provinces during the last epidemic—has been administered to at least 26,500 people.

This outbreak was declared over on November 18, 2020. It spread at a slower rate and mainly affected less populated, difficult-to-access areas. This helped to contain the virus and prevent it from reaching more populated urban areas where it could have caused a major spike in the number of cases. By the end, 130 cases were confirmed and there were 55 deaths.

At our Ebola treatment centers, MSF teams worked to increase the level of supportive care—ensuring proper hydration, providing treatment for malaria and other co-infections, as well as treatment of the symptoms of Ebola. Our clinicians also now have the ability to use experimental therapeutics under various mechanisms, including compassionate care protocols and participation in a randomized controlled trial. The four experimental therapeutics being used in the trial are Remdesivir (GS5734), REGN3470-3471-3479, ZMapp, and mAb114. These treatments are given only with the informed consent of the patient (or a family member, if the patient is too young or too sick) and are provided in addition to supportive care.

At our Ebola treatment centers, MSF teams worked to increase the level of supportive care—ensuring proper hydration, providing treatment for malaria and other co-infections, as well as treatment of the symptoms of Ebola. Our clinicians also now have the ability to use experimental therapeutics under various mechanisms, including compassionate care protocols and participation in a randomized controlled trial. The four experimental therapeutics being used in the trial are Remdesivir (GS5734), REGN3470-3471-3479, ZMapp, and mAb114. These treatments are given only with the informed consent of the patient (or a family member, if the patient is too young or too sick) and are provided in addition to supportive care.

The Latest on Ebola in DRC

A new case of Ebola virus disease was confirmed in North Kivu on February 7, 2021, marking the start of the country’s twelfth outbreak. After three months and twelve reported cases, that outbreak ended in May 2021. On October 8, DRC declared the country’s thirteenth recorded outbreak of Ebola. This latest outbreak, which is located in DRC’s northeast, in North Kivu province, is so far small and under control. However the outbreak is not over yet, and there is a continued need for vigilance. The World Health Organization (WHO) recommends waiting two full incubation periods—42 days—after the last person tests negative a second time before declaring the end of the outbreak.

MSF’s team will ensure the rehabilitation and structural improvements of the two health centers and help supply medicines and food for patients admitted to the isolation center and their companions. In addition, we will provide technical support to monitor community activities in order to locate and identify contact cases in the community. The team is also assisting with the social monitoring of all high-risk contacts. We are distributing kits, including mobile phones and food, to make it easier for people with suspected cases of Ebola to self-isolate and limit viral transmission. People at high risk, including contacts of confirmed cases and first responders, will be vaccinated to contain the spread of the virus.

In all our projects, we put patients and communities first and engage with local people and existing health centers to identify needs and prioritize activities. In addition to integrated isolation and treatment facilities for patients with suspected Ebola, MSF also strengthens health care capacities; builds infrastructure for clean water, sanitation, and hygiene; and invests in community outreach and health messaging in health centers across the region.