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Ebola in a war zone

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Global health officials have warned that combating Ebola in the northeastern Congo outbreak is complicated by multiple armed groups in the mineral-rich region and a restless population that includes one million displaced people and scores of refugees leaving for nearby Uganda every week.

The Associated Press reports that insecurity means health workers might have to change a vaccination strategy that proved successful in Congo’s previous Ebola outbreak.

The ‘ring vaccination’ approach of first vaccinating health workers, contacts of Ebola victims, and their contacts might have to give way to the approach of vaccinating everyone in a certain geographic area such as a village or neighbourhood. That would require a larger number of vaccine doses.

Vaccinations began in early August in the current outbreak, which was declared on August 1 and has killed 11 people in the densely populated region. The World Health Organisation (WHO) has said more than 3,000 Ebola vaccine doses are available in Congo.

While Congo’s previous Ebola outbreak, declared over barely a week before the current one began, set off alarm by spreading to a city of more than one million people on the other side of the country, the current outbreak comes with the threat of armed attack.

An assault that killed seven people in Mayi-Moya, about 40 kilometres from Beni city, was likely carried out by rebels with the Allied Democratic Forces, the administrator of Beni territory, Donat Kibwana, told The Associated Press.

The rebels have killed more than 1500 people in and around Beni in less than two years.

The rebels sent the local population fleeing, Kibwana said.

Beni residents already had been shaken by the discovery last week of 14 bodies of civilians who had been seized by suspected ADF rebels.

The latest attack occurred as the WHO Director-General, Tedros Adhanom Ghebreyesus, was visiting the area to see the response to the Ebola outbreak, which is being carried out in some cases under armed escort.

“The active conflict in the area is a barrier to control Ebola,” Tedros said.

“I call on all warring parties to provide secure access to all responders serving affected populations and saving lives.”

United Nations peacekeepers, Congolese police, and, at times, Congolese troops have been travelling with convoys of health workers as they fan out to contain the outbreak. Hospitals are guarded by Congolese police and military police.

So far, Congo’s health ministry has said 48 cases of hemorrhagic fever have been reported in this outbreak, 21 of them confirmed as Ebola.

Nearly 1000 people are being monitored. Screenings for the virus are being carried out at the heavily travelled border; officials have said travel restrictions are not necessary.

This is Congo’s tenth outbreak of Ebola, which is spread via contact with bodily fluids of those infected, including the dead. There is no licensed treatment, and the virus can be fatal in up to 90 per cent of cases, depending on the strain.