Ebola Enters Active Conflict Zones in DRC

Nolan Quinn is the Africa program intern at the Council on Foreign Relations in Washington, DC. He is a master of public policy student at the University of Maryland, where he is studying international development policy and international security and economic policy.

Few modern diseases elicit the same level of fear as Ebola. Thus, observers were relieved when, in late July of this year, an Ebola outbreak in western Democratic Republic of Congo (DRC) that claimed thirty-three lives was declared over. However, this victory was brief. One week later, a new outbreak was confirmed in eastern DRC’s North Kivu province, home to around one hundred armed groups, over one million displaced persons, and the UN’s largest and most expensive peacekeeping operation, MONUSCO. As of August 28, seventy-five people have died in the latest outbreak, with more deaths expected as some areas remain inaccessible due to conflict.

Containing Ebola in eastern DRC will be more challenging than the previous outbreak, despite the logistical advantage of having a new vaccine, which was used to stop the earlier outbreak, available in-country. Since North Kivu is an active conflict zone, health workers will need armed escorts to deliver vaccines. These difficulties may have already played a part in Ebola spreading to Ituri province further north—another area where conflict recently reignited.

The Ebola virus can spread through contact with bodily fluids from an infected person, contaminated items (such as needles), and infected animals such as fruit bats and monkeys. Fruit bats, sometimes eaten as bush meat, are considered the primary reservoir for the virus since they do not experience symptoms. Ebola experts believe infected bats began the West Africa outbreak. However, other factors facilitate Ebola’s transmission among humans. Unsanitary living conditions, high levels of malnutrition, and unprotected sexual contact can quickly spread the disease. 

Movement of refugees and internally displaced persons (IDPs) complicates the emergency response. According to the most recent data from the United Nations High Commissioner for Refugees, there are almost 800,000 refugees from the DRC. More than half are located in Uganda, Rwanda, and Burundi, which border the provinces affected by the current outbreak; DRC itself hosts more than 540,000 refugees and 4.5 million IDPs. The West Africa outbreak showed that once it reaches densely populated areas, Ebola is much more difficult to control than in remote villages. With poor sanitation and medical care, as well as a $333 million funding gap, camps housing displaced Congolese—some of which shelter close to 70,000 people—could become breeding grounds for Ebola.

The West Africa outbreak, which spread to ten countries including the United States and caused 11,325 deaths, exhibited the virus’s global potential. Worryingly, there are signs this outbreak will continue to spread. On August 14, Dr. Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, said he is “more worried” about the outbreak after visiting the region. On August 29, the International Rescue Committee warned that this outbreak could be the "worst ever seen in East Africa." More than 2,000 people are feared to have come into contact with the disease, a far larger number than those vaccinated or given experimental treatment to cure the disease. If negotiations with militias to allow experts into “red zones” prove unsuccessful, completely suppressing the current outbreak could be nearly impossible.