An outbreak in two eastern provinces of the Democratic Republic of Congo has become the worst known epidemic of the fatal Ebola virus in the history of the country.
The Congolese Ministry of Health said in a statement Saturday that 326 people were infected with the Ebola virus in the provinces of North Kivu and Ituri.
This makes this epidemic worse than a 1976 epidemic in Yambuku, which infects 318 people and left 280 dead. This outbreak was the first time scientists found what is now known to be the deadliest strain of the Ebola virus. An outbreak in Kikwit city in 1995 infected 315 people, 250 of whom died.
The current outbreak is now the third worst epidemic of Ebola in modern history. An outbreak in West Africa from 2013 to 2015 infects more than 28,600 people, mainly in Liberia, Guinea and Sierra Leone. An outbreak in Uganda in 2000 of the Sudanese virus of the Ebola virus infects more than 400 people.
After its first appearance, the number of cases in the province of North Kivu rose in September and October, worrying about public health officials around the world. In an update on Capitol Hill last week, Robert Redfield, director of the Centers for Disease Control and Prevention, warned that the outbreak could spread so widely that the Ebola virus became endemic in Central Africa.
The Congolese Ministry of Health, the World Health Organization and non-governmental groups such as the Red Cross and Médecins Sans Frontières have sent hundreds of people at the heart of the epidemic. They have vaccinated more than 28,000 people, including those who have been in contact with Ebola victims and healthcare workers who would be most vulnerable to the virus.
But the reaction has been confused in part by an unstable security situation in which dozens of armed groups opposed to the government have threatened or attacked health officials.
A bombing at the end of August, accused of Islamist fighters from the border in Uganda, ended the response to Benny for several days, allowing the virus to spread further. Last month, two health workers employed by Congolese soldiers were killed in an ambush.
"No other epidemic in the world has been as complex as the one we are experiencing today." From their arrival in the region, the response groups faced threats, physical attacks, repeated destruction of their equipment, and kidnapping, "said Oly Ilunga Kalenga, of the Congo, said in a statement.
The current outbreak began in late July, most likely when the virus spread to a funeral through the family of a sick woman. The virus later spread to Benny, a regional trading center of around a quarter of a million inhabitants. From there, it spread to Butembo, an international hub on the border with Uganda.
About half of the incidents that have so far been detected, 159, were reported in Beni. A further 36 people were identified in Butembo. The World Health Organization sent assistance to Uganda, Rwanda, Burundi and South Sudan, awaiting the possibility of crossing international borders.
"It remains a provocative way forward to control the heavy traffic in Beni and the emerging hotspots in the villages around Beni and Butembo," the World Health Organization said in a weekly assessment of the situation in the region.
North Kivu hosts about eight million people, about one million of whom are internally displaced after years of ethnic conflict. It is the largest province in the Congo outside the capital, Kinshasa.
Oliver Johnson, a visiting lecturer on global health at King's College in London and the co-author of Getting To Zero, a book on the Ebola epidemic 2014-2015 in West Africa, said the conflict in eastern Congo has diverted disbelief from the government in Kinshasa and any international groups that could get to the scene to help.
"There are many suspicions that Ebola and the outbreak messages are false and are part of a conspiracy, making it very difficult to persuade people to seek treatment or change behavior to protect themselves," Johnson said in an e-mail Sunday. "There is a real challenge for respondents to gain physical access to the affected communities – to collect a sick ambulance patient to take them to a treatment center, to work with communities to prevent further spread or to distribute the vaccine."
Violence in North Kivu has limited the American response to the event. After an attack on the Congolese army base in August, the State Department ordered to respond from the US Department of International Development and the Centers for Disease Control and Prevention from the region, first to the regional capital of Goma and then to Kinshasa, 1,700 miles away the epicenter.
The move of the CDC's personal field back to the capital "puts the response at risk of failure at a crunch," Johnson said.
The World Health Organization said 29 new cases occurred in the area just last week. Three health workers were among the young victims.
WHO said the risk of spreading the virus at national or international borders "remains very high". The Ministry of Health has developed preparedness experts in ten provinces around North Kivu.
Healthcare staff monitor over 5,400 people who have been in contact with Ebola victims, a practice known as contact follow-up, aiming at new cases being treated at the first sign of infection.
"The epidemic remains dangerous and unpredictable and we should not let our guard down," said Health Minister Ilunga Kalenga. "We must continue to pursue a very dynamic response that requires permanent adjustments and real ownership at Community level."