Fieldset
Ebola: “Unless change happens, the outbreak isn’t going to end”

One year since the start of the ongoing Ebola outbreak in the Democratic Republic of Congo (DRC), the epidemic not only still raging, it has become the second-worst in world history. Trish Newport, deputy coordinator of MSF’s Ebola response, reflects on the epidemic and the fight to contain it...

I remember 24 July 2018 so clearly. It was the day the ninth Ebola outbreak in the Democratic Republic of the Congo was declared over.

During the outbreak in the western province of Equator, I had worked managing MSF's vaccination project. It was the first time that the currently experimental Ebola vaccine was used at the beginning of an outbreak to try and help control its spread.

It has been a long, painful, deadly year for the population living in the Ebola-affected areas in the DRC

The outbreak lasted less than three months, and I remember crying with joy and hope on 24 July when it was declared over. I naively thought that with this great vaccine the world would never have to face a large Ebola outbreak again.

As has happened so many times in my humanitarian life, I was very wrong.

North Kivu

One week after the ninth Ebola outbreak in the DRC was officially over, the start of the tenth Ebola outbreak was declared – this time in North Kivu, a province in the northeast of the country.

Today, 1 August, marks the one-year anniversary of the start of the outbreak, and it is not only still raging, but it has also become the world’s second-largest Ebola outbreak in history.

It has been a long, painful, deadly year for the population living in the Ebola-affected areas in the DRC.

Ebola treatment centres have been viciously attacked and destroyed, health workers have been murdered for working in the response, security forces "protecting" the response have killed civilians, and all the while, people continue to die of Ebola.

Trusting the response

The "Ebola response" itself is made up of the Congolese Ministry of Health, the World Health Organization and other international organisations.

However, one of the biggest problems with the outbreak is that this Ebola response has never gained the trust of the local population. This is because the outbreak is happening in an area that has been plagued in recent years by conflict and massacres of civilians.

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On 24 February 2019, an unknown group attacked an Ebola treatment centre in Katwa - forcing MSF to suspend activities in the area
On 24 February 2019, an unknown group attacked an Ebola treatment centre in Katwa - forcing MSF to suspend activities in the area

I once asked one of our local staff why there was so much anger towards the response.

She answered:

"My husband was killed in a massacre in Beni. At that time, all I wanted was some organisation to come and protect us from the killings, but no international organisation came.

"I have had three children die of malaria. But no international organisation has ever come to work in this area to make sure we have access to healthcare or clean water.

"But now Ebola arrives, and all the organisations come because Ebola gives them money.

"If you cared about us, you would ask us our priorities. My priority is security and making sure my children don't die from malaria or diarrhoea. My priority is not Ebola, that is your priority."

A public health emergency

Recently, on 17 July, the Ebola outbreak was declared a “Public Health Emergency of International Concern” by the World Health Organization.

There are still many questions about what impact this declaration will have on the actual response.

What we do see is that even more money is being directed towards the response. But, if there is no change in the way the Ebola outbreak is managed, if it doesn't gain the trust of the local people, more money on its own won't do anything. It will just create more problems.

Today, at the one-year anniversary of the outbreak, my thoughts are with all of those people that have been affected by the illness – I hope that change comes soon

One of the greatest frustrations about this whole situation is that there is not only an effective Ebola vaccine now available, there are also experimental treatments for people already suffering from Ebola.

These are tools that were much less readily available in the 2014-16 West African Ebola outbreak, but if local people don't trust the response, the tools will never be able to be used to their full potential.

Listing to the community

In February 2019, two of MSF's Ebola treatment centres in the epicentre of the outbreak were attacked.

We didn't know who attacked the centres or why. And, as we couldn't ensure the security of our staff or our patients anymore, MSF took the painful decision to stop all activities in that specific area.

We were forced to review the problems we had been facing, and how we wanted to change our response to the Ebola outbreak. We determined that we needed to work more closely with the communities and that we needed to listen to and respond to their other health priorities.

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An MSF health promotion team visiting a community to raise awareness about Ebola and build a better relationship between people and health workers
An MSF health promotion team visiting a community to raise awareness about Ebola and build a better relationship between people and health workers

We began providing access to free healthcare for all illnesses that were affecting the population, like malaria, measles and diarrhoea. Then we began building wells so that when we told the population they needed to wash their hands to prevent the spread of Ebola, they had water to do so.

We have also set up centers for suspected Ebola patients in existing local health centres,  so that patients could be cared for in their community instead of having to travel to other areas for testing and isolation.

By addressing the actual needs and health priorities of the population, we are gaining the trust of the community.

Hoping for change

Sadly, this approach has still not been adopted by the wider Ebola response, and there remains an overall mistrust of the response. In many areas, people still refuse to go to Ebola treatment centres when they are sick, while other people still refuse the vaccine.

When I see families and communities ripped apart by Ebola, it makes me so sad. It doesn’t have to be like this, and unless a drastic change happens in the management of the Ebola response, the outbreak is not going to end anytime soon.

One year into the outbreak and more than 2,600 people have gotten sick with Ebola, and more than 1,700 people have died of the disease.

Today, at the one-year anniversary of the outbreak, my thoughts are with all of those people that have been affected by the illness – I hope that change comes soon.

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Read more: Stories about Ebola

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Chapter six: The giant