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DRC Ebola Outbreak Fighting Misinformation

On November 8, 2019, USAID published their “Ebola Outbreak Fact Sheet” . The report indicates that insufficient community engagement has exacerbated community mistrust of Ebola response teams which is hindering efforts to halt transmission. Porous borders, and misinformation is complicating the response.

Only 50 percent of the patients who contracted the disease were isolated within three days of symptom onset; early isolation decreases the risk of onward transmission to community members. Communications and community engagement is essential for dispelling misinformation. The United States Agency for International Development (USAID) Office of U.S. Foreign Disaster Assistance (OFDA) and Translators without Borders are working to counter misinformation. source

The following report contains information on language and communication challenges, aid agencies responding and their social media accounts. You can download our situation at the following link

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Personnel from Combined Joint Task Force-Horn of Africa (CJTF-HOA) and the Kamenge Military Hospital practice doffing hazardous material suits at the Kamenge Military Hospital, Bujumbura, Burundi, June 20, 2019. The 403rd Civil Affairs Battalion, CJTF-HOA, and military personnel and doctors from the Kamenge Military Hospital conducted an Ebola preparedness subject matter expert exchange as a precautionary measure for personnel near the border of the Democratic Republic of Congo. (BUJUMBURA, Burundi June 18, 2019 U.S. Navy photo by Mass Communication Specialist 1st Class Nick Scott/Released)

There are significant challenges to controlling this outbreak since it is occurring within a very densely-populated region, subject to a long-term humanitarian and security crisis, with limited prevention control practices at numerous health facilities and persistent reluctance in the community to accept Ebola responses activities. The adverse impact of security incidents and the ongoing community reluctance are hindering the implementation of Ebola prevention and control measures

Country Context and History

The Democratic Republic of Congo (DRC), the second largest country in Africa, is faced with a precarious health situation that requires medical and humanitarian support. Rich in natural resources, the DRC has been center stage for conflicts since the early 1990s. This gave rise to the substantial displacement of people and led to the destruction of health care facilities and public services. Cholera, measles and malaria epidemics are common throughout the entire country. The infant mortality rate of the country – 71 deaths per 1,000 – is one of the highest in the world. source

History: The Ebola virus was identified for the first time in 1976 in Zaire (now Democratic Republic of Congo). A fever hit in a village bordering the Ebola River. This first epidemic killed 318 people in Zaire and 284 in Sudan. Doctors sent on the spot have been identified by a virus, until now unknown. Outbreaks of hemorrhagic fever caused by Ebola occur mainly in Africa with a mortality rate of 55% to 60%, according to the CDC (Centers for Disease Prevention and Control). According to the WHO, this figure can reach up to 90%.

Since June 2019, six confirmed EVD cases have been reported in previously unaffected areas or countries. On 12 June 2019, the Ugandan Ministry of Health reported three imported confirmed EVD cases in Kasese district of Uganda; two died in Uganda and one died following repatriation to DRC. On 30 June 2019, one confirmed EVD case, listed as a close contact in Beni, was reported in Ariwara Health Zone, which is close to the borders of Uganda and South Sudan. On 14 July 2019, a confirmed EVD case, infected in Butembo, was reported in Goma. The case was admitted to the Ebola Treatment Centre (ETC) in Goma and died during transfer back to an ETC in Butembo. Source

On 11 July 2019, a Congolese trader, displaying symptoms consistent with Ebola, visited Uganda. The patient was symptomatic in Uganda, travelled back to Beni in DRC, tested positive for Ebola in an ETC in Beni and died there. To date, viral circulation in the community has been persistent in previously affected areas, but the epidemiological situation varies in the affected health zones and neighboring countries at a significant distance from the epicentre demonstrate the potential of the current EVD outbreak for regional spread. Source

The Ebola outbreak in the DRC has been declared a Public Health Emergency of International Concern (PHEIC) by the Director General of the World Health Organization (WHO) following the recommendations of the International Health Regulations (IHR 2005) Emergency Committee on 17 July 2019. The introduction of Ebola virus disease (EVD) is expected to continue. The Committee recognized the potential increase of national and regional risks and the need for intensified and coordinated action to manage these risks. source

Significant Updates

  • The current EVD outbreak is the first to occur in Ituri and North Kivu, conflict-affected provinces with high density population areas, highly transient populations, significant insecurity-related access constraints, and porous borders to adjacent countries. source Daily updates from the DRC's Ebola technical committee (CMRE) show that the latest cases are all from the current main hot spots, which are rural and pose a host of access and security problems. In its last three daily updates, the CMRE said the latest new cases are in Mabalako in North Kivu province and Mandima in Ituri province. The main epicenter in Mandima has been the Biakato Mines area, the source of about half of the recently reported cases. source.
  • Nov 8 UNOCHA press release reports that Ebola cases are declining. It also stated that “300 attacks against health workers and 6 deaths documented in the DRC since January 2019" 05 November 2019” source
  • Nov 8 USAID Report indicates Insufficient community engagement has exacerbated community mistrust of EVD response teams in Mandima, hindering efforts to halt transmission. Communications and community engagement is essential for dispelling misinformation about EVD source
  • Nov 5 The DRC Ministry of Health (MoH) is leading the outbreak response, with support from WHO. source
  • Nov 5 MSF has been involved in the outbreak response, working with the Ministry of Health, since the declaration of the epidemic on 1 August 2018. source
  • Nov 5 As part of the response, ALIMA nongovernmental organizations which has been responding since the outbreak, manages two Ebola Treatment Centers (ETCs) that receive a large number of confirmed cases. Since August 2018, ALIMA has cared for 5,284 patients (suspected and confirmed) within its centers. Of the 569 patients confirmed to have the Ebola virus in our ETCs, 277 were discharged as cured. source
  • 28 October to 3 November 2019, 10 new confirmed Ebola virus disease (EVD) cases were reported from five health zones in two affected provinces in the Democratic Republic of the Congo. Though the number of new confirmed EVD cases reported is lower this week, compared to the 20 cases reported last week, security issues and poor access continue to slow response activities in certain health zones. This can prevent the detection of cases in these hard to reach areas. source
  • Sept 30 USAID is responding to an Ebola outbreak in the DRC’s North Kivu region and Ituri provinces, working with partners to boost infection prevention and control, upgrade water, sanitation, and hygiene infrastructure at health facilities, raise awareness about Ebola in communities, and provide other life-saving assistance. source
  • On 12 June 2019, the Ugandan Ministry of Health reported three imported confirmed EVD cases in Kasese district of Uganda. Onset of disease was 7–8 June and they crossed the border on 9 June and sought medical care on 10 June. Two cases died in Uganda and the third case died on repatriation to DRC. One hundred and eight contacts were followed up for 21-days, all of them were asymptomatic source.
  • On 30 June 2019, Ariwara Health Zone reported its first confirmed EVD case. This person had been listed as a close contact in Beni but travelled to visit a relative in Ariwara, where the diagnosis was made. Ariwara is a health zone located in the northern part of Ituri Province, close to the borders with Uganda and South Sudan. source
  • On 9 July 2019, Mambasa Health Zone reported its first confirmed EVD case. In December 2018, a confirmed EVD case was initially reported in Mambasa health zone, but was relocated to Mandima health zone. source
  • On 11 July 2019, a Congolese fishmonger displaying symptoms consistent with Ebola visited Uganda. The case was symptomatic while in Uganda, and travelled back to Beni, DRC, on 12 July, before being admitted to an ETC on 13 July. The case tested positive for Ebola and died in the ETC on 15 July. No formal points of entry were passed to cross the border with Uganda source.
  • On 14 July 2019, Goma Health Zone reported its first confirmed EVD case. The case was in close contact with EVD cases and was infected in Butembo and travelled by bus to Goma. The case was admitted to the Ebola Treatment Centre (ETC) in Goma but died during transfer to an ETC in Butembo. source
  • Jul 18 2019 The most affected health zone since the beginning of the outbreak is Katwa, with 621 confirmed and 16 probable cases. In the last 21 days (26 June–16 July 2019), Beni, Mabalako and Katwa have reported the highest number of cases: 73% of the 245 confirmed cases reported. Within this same time period, Mandima reported 10 new confirmed cases and Butembo reported nine new confirmed cases. source
  • Dec 7, 2018 An experimental vaccine has been developed and is currently being offered for the DRC 2018–2019 outbreak under the Expanded Access framework, with informed consent and in compliance with good clinical practice. WHO had hoped to contain the epidemic, including through the vaccine, but in recent weeks, senior WHO officials have admitted that insecurity, lack of financial resources and manipulation of local policies to train the population against health agencies fighting Ebola have seriously undermined these efforts. source

Aid Agencies responding

For a complete list with phone numbers, please download our PDF at the link above.

Alima

Suisse Cooperation SDC Great Lakes Africa Humanitarian Aid and SHA Division

Global Facility for Disaster Reduction and Recovery (GFDRR)

Red Cross of the Democratic Republic of the Congo

Medair

USAID

UNICEF

Humanity Road

Translators Without Borders

Health and Hospitals

  • Nov 5 ALIMA manages two Ebola Treatment Centers (ETCs) that receive a large number of confirmed cases. Since August 2018, ALIMA has cared for 5,284 patients (suspected and confirmed) within its centers. Of the 569 patients confirmed to have the Ebola virus in their ETCs, 277 were discharged as cured. source
  • Nov 3 WHO Situation Report #66: There are 10 field laboratories with Ebola virus diagnostic capacity operational in the Democratic Republic of the Congo, located in Beni, Butembo, Bukavu, Bunia, Goma, Kasindi, Katwa, Komanda, Mambasa, and Mangina. All the laboratories are using GeneXpert as the primary diagnostic tool. Central laboratory support is provided by the Institute of Biomedical Research (INRB) laboratory in Kinshasa. source

Special needs populations

  • The infant mortality rate of the country – 71 deaths per 1,000 – is one of the highest in the world. source Only 1 pediatric 300 bed hospital in the DRC source
  • Messaging in Language Needs: Translators without Borders (TWB) found that people in Goma, Democratic Republic of Congo (DRC) do not fully understand Ebola-prevention messages in French and standard Swahili. Responders should use the local form of Swahili in their Ebola-related communications in Goma to ensure people have the information they need to keep themselves and their families safe source See more information in our Communications section below.
  • Local volunteers are needed to improve information and translation products Skilled in the local languages of the DRC? Volunteer to be a translator https://kato.translatorswb.org/signup.html

Communications

  • Nov 8 USAID Fact Sheet Reports Misinformation is contributing to the inability to properly contain the outbreak. The UN agency continues to note persistent delays in case detection and isolation. Only approximately 50 percent of the EVD patients were isolated within three days of symptom onset; early isolation increases patients’ chances of survival and decreases the risk of onward transmission to community members. Insufficient community engagement has exacerbated community mistrust of EVD response teams in Mandima, hindering efforts to halt transmission. Community engagement is essential for dispelling misinformation about EVD. In support of this goal, Translators without Borders (TWB) is actively responding to improve communications. TWB published the results of a study which included 7 ways to communicate more effectively about Ebola Source
  • Visual Communication - Democratic Republic of the Congo according to UNESCO, an adult literacy rate of 77.04%. While the male literacy rate is 88.52%, for females is 66.5%. Literacy level is low making oral and visual communication essential. source
  • Translation Support - The Integrated Research Institute (IRI) established at the Bilingual Christian University of Congo is a research institute that has expressed its willingness to help translate printed or social media content into a link with the intervention. They have already been involved in conflict mapping and mediation projects. Please contact https://www.anthrologica.com/contact-us for more details.
  • Social Networks - Social networks are widely used in the Far North, especially WhatsApp and Facebook. The GIF with key information on prevention, transmission, symptoms, care and immunization Ebola viruses must be created and disseminated on these platforms. GIFs (Graphic Image Formats) are compressed images shown quickly to give the effect of a video but only require a minimum bandwidth.
  • Local Radios - Local radios have significant coverage and are broadcast throughout the province. A study conducted in 2017 indicates 72% penetration on Radio versus 48% on TV – radio is the simplest and most popular way to disseminate and receive information. The potential of networks of community radios must be fully utilized; RTR, Radio Moto and Radio Graben stations must be mobilized.
  • Local Swahili - Although meetings with leaders may be conducted in French, local Swahili must be the language of work for all community mobilization and information materials. Local Swahili differs from Swahili "classical" (Tanzanian or Kenyan). In the past, many international agencies have produced content in Swahili "classical" and these have therefore not been favorably received by the communities of the Far North, which wondered about certain expressions used. It is important to translate all the information into a Swahili that can be understood at Community level. Other local languages ​​should not be ignored in the context of exchange of information with affected populations. The kinande can thus for example be used in Butembo

Maps and Reports

Pictures and Videos

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