Bunia, 22 July  

More than 1,000 people have died in the Ebola outbreak in Congo, according to Africa's top health body, a grim toll in the fastest Ebola outbreak in history, as conflict, community resistance and an uneven response fuel its spread.

Speaking at a health summit in Ghana on Wednesday, Dr Jean Kaseya, director-general of the Africa Centres for Disease Control and Prevention, said 1,031 deaths have been confirmed. “These are people dying. They are dying because we don't have vaccines, we don't have medicine, we don't have funding,” he added.

The latest update from Congo's Ministry of Health showed that as of Monday, 2,473 cases had been recorded in the latest outbreak. At least 737 patients were in isolation or hospitalised, it said. The outbreak, which was declared on May 15, is unlike most previous Ebola outbreaks because the Bundibugyo virus responsible for it has no approved vaccines or treatments.

It has also killed more people at a faster rate than any outbreak on record, including the 2013-2016 outbreak that is considered the worst on record with over 11,000 deaths out of at least 28,000 cases. That outbreak took about eight months from the first case to reach 1,000 deaths.

The World Health Organisation has said the true scale of the outbreak could be two to four times larger than official figures indicate. Some communities at its epicentre also remain difficult to reach, mainly because of fighting involving rebel groups. Ebola is rare, but highly contagious and can be contracted through contact with bodily fluids such as vomit, blood or semen. It can cause severe illness and is often fatal.

Officials have warned that 80% of new cases have emerged outside known chains of transmission, a sign the outbreak is spreading faster than health officials can track it even as they step up their response in Ituri province, the epicentre of the outbreak, and four other provinces where cases have been recorded.

Community resistance to Ebola teams, particularly those carrying out safe burials, has also hampered the response. Robert Ndjalonga, head of civil protection in Ituri province, said some communities have refused to allow burial teams to operate because they prefer traditional burials, increasing the risk of further transmission.

Shortages of burial supplies have delayed responses to reported deaths, while some affected health zones still lack operational burial teams, Ndjalonga said.

Attacks on health facilities and response teams have also forced front-line workers and aid groups out of some areas. Some health workers have gone on strike, saying they haven't been paid since the outbreak started. A member of a team carrying out safe Ebola burials was recently injured when assailants threw stones at the team's vehicle following a burial in Bunia last week, according to provincial civil protection authorities.

The attack highlighted the challenges facing the response in eastern Congo. In Ituri's Irumu territory, the local military administrator recently described Ebola as a greater threat than the Islamic State-affiliated Allied Democratic Forces insurgency and urged residents to support, rather than attack, health workers.

Less than 9% of the contacts of confirmed patients who are expected to be traced are currently being monitored, far below the level needed to contain the outbreak, according to Africa CDC. More than 60% of deaths are occurring in the community before patients can receive care.

Pierre Akilimali, the Ebola response incident manager at the National Public Health Institute of the Democratic Republic of the Congo, said the high number of community deaths suggests many infections are not being detected or isolated in time, allowing the virus to continue spreading.

Last month, researchers at the US Centres for Disease Control and Prevention used computer modelling to estimate how the outbreak could evolve. In a worst-case scenario, they said it could approach the scale of the 2014-2016 West Africa epidemic.

“There's never been an Ebola outbreak that started with so many cases because it was so late to be identified,” said Trish Newport, emergency program manager for Doctors Without Borders, who has been working in Congo.

“It's like the outbreak is outrunning the response,” Newport said.

University of Pittsburgh epidemiologist Dr Jean Nachega, who is advising African health authorities, said he does not expect the outbreak to reach the CDC's worst-case scenario but cautioned that the challenges remain “huge”.