By Sonia RolleyPatient LigodiPosted on 31-07-2019Modified on 31-07-2019 at 22:52
It has been a year to the day that the Democratic Republic of Congo (DRC) is facing its tenth Ebola outbreak, recently described as a global health emergency by the World Health Organization (WHO).
It is 10 am in Kanzuli, the health area that has recorded the highest number of new cases in recent days in Beni. The teams of the response land on board two brand new jeeps. They are looking for a young person whose five family members have already been diagnosed with the Ebola virus , a Zaire stereotype. " We learned that he began to develop symptoms and we came to talk with him for possible treatment, " said an official of the Congolese Ministry of Health.
The case looks difficult. This "high-risk contact", a young man in his twenties, swears he is doing well and refuses to listen to the response team. His denials attract his friends, his relatives, a small group is formed around him. In a few minutes, the tone rises, clubs and machetes appear in the hands of onlookers. They even improvise a barricade.
The hostility of communities, "our daily life"
The intervention team is forced to turn back. " We limit the intervention of the police as much as possible, we prefer to come back later, " explains the doctor responsible for supervising the intervention. The teams of the response will not even have access to the home of this suspect case to disinfect. Disgruntled by the hostility of the population, the practitioner admits: " It's almost our daily life ."
One year after the official proclamation, the number of cases is increasing in the territory of Beni , the focus of the epidemic in North Kivu, and threatens to spread to the rest of the country as in neighboring countries. On July 18, 2019, the World Health Organization (WHO) placed the tenth Ebola outbreak in the DRC as a "global health emergency" , much to the chagrin of civil society in Beni. For its president, Kizito Bin Hangi, WHO has " waited too long ". It took an evangelical pastor who was infected with the virus to die when he had just stayed in the provincial capital, Goma, bordering Rwanda, and a Congolese fish merchant had gone to a Ugandan market before dying At her place.
Since then, the capital of North Kivu has recorded a second case , rekindling the fear of contagion beyond its initial zone of propagation which was limited until now in the north-east of the country, around the cities of Beni , Butembo in North Kivu and Bunia in Ituri, all of whom have already been regularly bereaved by armed violence. In one year, at least 1,800 people have died of Ebola, hundreds more have been killed by bullets or machetes.
"You can not wash your hands to protect yourself from insecurity"
In the territory of Beni, there are even massacres almost every week for five years, it is another sad anniversary for this region of the Congo which had been relatively preserved during the two great wars that shook the country between 1996 and 2002. At the moment the epidemic is declared on August 1, 2018, several thousand civilians died in this unprecedented violence, attributed by the Congolese authorities to the Ugandan rebels ADF , a politico-religious group which, after thirty years of presence in Congo , has decided to pledge allegiance to the Islamic State (IS).
For the inhabitants of the territory, this chronic insecurity is a curse as sudden and brutal as Ebola, mysterious too. Many see in each other a black hand, accusing security forces like the international community, the neighboring countries in the lead, of the worst evils, even blaming them for "genocidal intentions" against the Nande community, the majority ethnic group in this part of the Congo.
Although Ebola is endemic in some parts of the country, Beni has so far been spared. The president of the civil society of this locality does not deviate. The government must " do more ", the WHO " support ", the " neighboring states " commit themselves to put an end to this double scourge that has become consubstantial insecurity and the Ebola epidemic.
Before this epidemic and the massacres of recent years, Beni's bus station was still very busy. Since, conveyors and drivers prefer to take the road early and in convoy for more security. Around 15h, three last trucks line up before departure to Kasindi, border post with Uganda. Among dozens of anxious passengers, a seasoned shopkeeper, but worried like the others.
For fourteen years, Jeanine has bought shoes and sandals in Uganda to sell them in Beni. With her six-month-old baby on her back, she is preparing to embark on an already crowded bus, on this road where convoys are attacked almost every week. " The military decided that there would be no traffic after 16h, but we will still take the road. We have nothing to lose, "says Jeanine. Next to her, Sophie, a few years older than her, vociferates rubbing her hands in chlorinated water made available by the coordination of the response: " You can not wash your hands to protect yourself from insecurity " .
Ebola, "a political battleground"
When Ebola officially emerges in North Kivu, WHO has just four days earlier declared the end of an epidemic on the other side of the country, in the northwest, in Equateur province. There, it took the actors of the riposte barely three months to stop the virus, so much this forest region of Congo, certainly bordering the very fragile Central African Republic, remains isolated, isolated from the rest of the country. With eastern Congo, the threat is quite different. This region is full of armed groups that for nearly 25 years, hamper humanitarian action as development and move civilians to neighboring countries. Its roads, though often impracticable, serve both commerce and traffic. Nevertheless, almost miraculously, neither Rwanda nor Uganda has been contaminated so far.
► See also: Ebola: the story of a killer virus, an infographic
As in all Ebola outbreaks, the agents engaged in the struggle met from the first weeks to a resistance of the population that the WHO has long called modestly "reticence". The political crisis in Congo has turned them into a real revolt. " The responsibilities are shared, there has been a diversion of public attention on political issues ," said Butembo's vice president of civil society and Congolese researcher Elie Kwiravusa.
On the one hand, there is the government that " uses the excuse " of Ebola to cancel the presidential election and postpone the elections to Beni-Butembo, an opposition stronghold, and on the other, politicians who are transforming the issue. Ebola " in a political battlefield " to attract the electoral favors of an increasingly mistrustful population to coordinate the response, the security forces and its political class.
The first attack on an Ebola treatment center took place on December 28, 2018, the day after the announcement of the postponement of elections in Beni-Butembo. At the time, community leaders managed to contain the anger of the population. While two months later, seven since the beginning of the epidemic, the WHO says " optimistic ", the attacks become almost weekly. Dozens of medical staff and structures are targeted. As of February 5, 2018, according to official figures, 789 cases of Ebola virus disease (735 confirmed and 54 probable) had been reported in seven months, including 488 deaths. In the next five months, this balance sheet will almost quadruple. One year after the officialization of the epidemic, nearly 1,800 Congolese died from this virus in 2,700 cases.
"We do not even have the right to have a headache"
In West Africa, for Ebola outbreaks between 2013 and 2015, there were also acts of violence, misinformation campaigns against attacks on health facilities or even personnel " in areas where there was people's distrust of the government, "recalls American anthropologist Adia Benton. In Sierra Leone and Liberia, she says, " some people really believed that the information that was given about Ebola was false or part of a conspiracy that targeted them personally ."
Despite millions of dollars invested, the coordination of the response struggles to control the chain of contamination and deploy enough resources everywhere to cope with the influx of new cases. When the epidemic exploded around Butembo, the teams had to leave Beni. With the resurgence of cases in the territory of the same name, reinforcements are now needed and sent from Goma and Butembo. When they are not in Kanzuli, they must also deploy to other health areas just as difficult to access as Butili. The track is so rugged that the three jeeps of the riposte are struggling to make their way under the anxious look of the people. When the vehicles manage to park, some inhabitants are already fleeing.
An old woman reacts badly to a question from a health worker formulated in a bad Swahili and gets carried away: " We are all vaccinated here, we must believe that we do not even have the right to have pain in the head or vomit . In her fifties, she no longer supports the clinical vocabulary of the riposte: " They speak of a 'confirmed case' for the sick, it is this French word that we can not stand anymore ". A little further, a group of young people is watching the scene with a lot of bitterness. " These people are all in upscale hotels, they will not want the epidemic to stop, " a Swahili mumbled in a young man wearing a jersey in the colors of the popular Chelsea team.
The hostility is all the stronger whether confirmed or not, the inhabitants of the affected areas report that receiving a visit from a team of the response changes the eyes of the community. Many people still share the same water points and sanitary facilities, which facilitates the spread of the virus.
The emergence of Ebola in the north-east of the DRC has reinforced the mistrust of a community with a social fabric already weakened by conflict. In the territory of Beni, for the last five years, the apolitical personalities closest to the population, the customary chiefs, the priests, the members of the civil society are targeted, victims of assassinations, kidnappings or even sometimes arrests, human rights violations attributed by the UN mainly to alleged ADF and other armed groups (55%) but also very largely to security forces (45%).
"With each new epidemic, they undertake reforms and do not finish them"
Despite the deployment of anthropologists, the WHO and its Congolese partner were continually accused, during this first year, of not sufficiently involving local communities and their legitimate representatives in the strategy of the response. Here too, it is a recurring criticism made to international actors. " With each new epidemic, they regret not having quickly associated local communities, undertake reforms, do not finish and especially difficult to adapt to the new context in which they are, " laments the American anthropologist Adia Benton.
Back at the Kanzuli treatment center, patients wait for the results of their tests. The face of Kahindo, 32, is already marked by the disease. The young woman has vomited about ten times since morning, she also has headaches. Hospitalized for four days, she is fluent in Kanda and swindles in Swahili, not enough to understand what is happening to her and the questions of the experts of the response too often from other provinces of the Congo.
Without waiting for the results of the tests, they try to trace their course from their village of residence to be ready to intervene in case of confirmation. " It takes patience. Me, I just arrived and my Swahili is not fluent, "admits one of the investigators. He pleads for the accompaniment of " community relays " who act as translators and help integrate the agents of the response and psychologists who continue to be sorely missed.
The opponent Jules Vahikehya has long worked for the response, before embarking on the election campaign for the legislative elections of December 2018. He is one of those candidates whose mandate was invalidated by the Constitutional Court " in the pay of the regime of Kabila ". The deposed deputy from Beni is less upset against the state than against Congo's partners like the WHO, accused of " bypassing " the national health system to create a parallel system that engulfs millions.
This son of the country insists on " better management " of local health personnel, those without whom " nothing can be done " and who would be " almost forgotten " in the strategy of coordinating the response. Since the beginning of the epidemic, several strikes broke out, employees of the centers concerned demanding the payment of wages or bonuses.
Raise awareness to "get a better feedback"
For a year now, the response team has set up its permanent headquarters a few meters from the Beni Reference General Hospital. To get there, you have to be not only controlled by the security teams, but also to wash your hands with chlorine and have your temperature checked. Nothing gleaming, two buildings and a hut are used to bring together the teams of coordination of the response, agents of the Ministry of Health, WHO experts and medical NGOs.
This is also where journalists are obliged to target their reporting authorizations issued upstream by the Congolese Ministry of Health. Two Italian journalists come from Butembo and have to go to the grill. The proposed agent wants to know everything: courses, topics addressed, interlocutors to interview. Controlling information is also a concern for coordinating the response.
In one office, Dr. Gaston Tshapenda, one of the local coordinators in Beni, has only one obsession: to reduce the number of Ebola deaths in communities, which means a higher risk of spread. " All our message of awareness aims to obtain a better feedback of information between households and community relays ," he says. But he also recognizes training problems. " Some health centers do not use the protocol we gave them, " he says.
In the health area of Kanzuli, there is not only bad news. A young lady has been in bed for two days, is vomiting and is suffering from severe headaches. Her husband, worried, brought her at the first symptoms. Her test is negative, the young woman is simply pregnant and asks " some tablets to relieve her headache ". She will still be kept 24 hours for observation, but leaves without drugs.
Elsewhere, medical NGOs in the response, such as MSF and Alima, are increasingly trying to provide primary health care within their Ebola facilities to facilitate community relations. As civil society recommended in the early stages of the epidemic, the coordination of the response and associated UN agencies such as WFP are beginning to address the other needs of those communities left behind by government services.
"Harmful confusion and cacophony" to the riposte
At the same time in Kinshasa, a few days before the first anniversary of the epidemic in North Kivu, the Congolese Minister of Health resigned . In a letter addressed to the new head of state on July 22, 2018, Dr. Oly Ilunga unveils disagreements in the coordination of the response. He says he has resisted various types of interference since February and the explosion of confirmed cases in the east of the country.
Félix Tshisekedi has repeatedly tried to regain control of the Ebola device. The former personal doctor Etienne Tshisekedi, the father of the new president, " failed to make the presence of the state on the ground, " said a close friend of his son Felix. The Minister, coming from the outgoing regime, speaks of a decree signed without his knowledge, the importance of maintaining " clearly identified lines of command " and the risk of " confusion and a cacophony harmful " to the response.
The former minister is gone, disappointed to have lost control of the coordination of the response for the benefit of his successor, Professor Jean-Jacques Muyembe, one of the discoverers of Ebola in Congo and patron of the National Institute biomedical research (INRB). Oly Ilunga also did not like the fact that WHO is making this tenth Ebola outbreak a "global health emergency" and said he fears " the establishment of a parallel system that will never strengthen the existing health system " .
The outgoing minister did not make himself heard by Felix Tshisekedi, who welcomed the announcement. But the remarks of the Minister hit the public spot and particularly his fears about the introduction of a new experimental vaccine. "In recent weeks, pressures from all sides have tended to make it a humanitarian crisis, " writes Dr. Oly Ilunga. " It is a public health crisis that is taking place in an environment characterized by problems of safety, development and shortcomings of the health system ". In the Democratic Republic of Congo, the measles epidemic has killed more people in six months than Ebola in one year.
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