Attacks by militants against health workers and members of the Congolese army have prevented a global response to the growing outbreak of the Ebola virus in two eastern provinces of the Democratic Republic of Congo.
Global and US health officials said at least two rebel groups are behind three separate attacks over the weekend in Beni, a regional trading center in North Kivu province. Health officials who responded to the outbreak were forced to discontinue their efforts to track and vaccinate contacts of people infected with the virus for several hours.
"This is probably the most complex context we have ever had to combat an Ebola outbreak before," said Peter Salama, deputy director-general for emergency preparedness and response at the World Health Organization, in an interview with The Hill. "The security situation is really tense and has been there for many years."
Violence and instability, in a region where ethnic conflict displaced more than a million people, kept US attendants out of the region. Several American officials were removed from Beni and surrounding areas after an August attack on a Congolese military base.
A disaster relief response team, led by staff from the Centers for Disease Control and Prevention (CDC) and the US Agency for International Development, was sent to Kinshasa more than 1,000 miles from the epicenter of the epidemic. US officials said Wednesday that 10 to 15 members of the DART team were in Kinshasa, and another 21 are providing support from the United States.
But the US military is in neighboring Uganda, Rwanda and South Sudan, monitoring border crossings in hopes of preventing the spread of the virus across international borders. The CDC sent 94 Americans to those countries and to Geneva, where WHO headquarters is located, to assist in the response.
The Congolese Ministry of Health said on Wednesday that 339 cases of the Ebola virus had been identified, making the current outbreak the worst in the country's history. Two hundred and twelve people died.
About half of the cases occurred in Beni, a city of about a quarter of a million near the border with Uganda. Ten cases also occurred in Butembo, a larger city south of Beni that has close commercial ties at the border.
Salama said many of the cases are spreading through interactions in private health facilities, which are not recorded in local government and where basic services such as running water and safe needle handling do not exist. There are several hundred such facilities only in Beni, some of which are located in private homes.
"Most of the broadcasts, we believe, are occurring in private health facilities," Salama said.
About 30 health workers were infected during the outbreak, Salama said.
In a teleconference on Wednesday, senior US officials would not rule out sending US troops to the region, where security is ostensibly the responsibility of the United Nations Stabilization Mission in the Democratic Republic of Congo (MONUSCO).
But the mobilization of US troops, like the nearly 3,000 sent to Liberia to fight an Ebola outbreak in 2014, is highly unlikely. The Americans sent to Liberia operated in a supportive capacity, rather than security, and America has much closer ties with Liberia, a country it helped to found in the nineteenth century, than with the DRC.
Some public health officials were alarmed last week when Robert Redfield, the CDC director, suggested at a conference at the Capitol that the difficulty in containing the current outbreak could make the Ebola virus entrenched in the Congo River Basin for many years. Redfield later said he was giving voice to the worst-case scenario, rather than suggesting that the outbreak would get out of control.
"We do not believe that the Ebola outbreak is uncontainable," Salama said. "We believe it is a container, but it depends on the high-intensity expansion."
A new vaccine, developed by the National Institutes of Health and produced by pharmaceutical giant Merck, was implanted for the third time in the North Kivu region. The vaccine was administered to more than 29,500 people, mostly health professionals and those who came in contact with someone infected with the Ebola virus, a process known as ring vaccination.
"This outbreak will take many weeks to contain, so we need to be in it for the medium term," Salama said.