14 August 2019

The Ebola crisis - between beliefs and reality

The Democratic Republic of Congo's Ebola outbreak is spreading out of control, mainly due to popular beliefs and mythic terror. And whether it can be contained depends more on people than on medical advances, with restoring public confidence as a crucial imperative.

By Anna Morin

The Democratic Republic of Congo (DRC) is currently facing the second-largest Ebola outbreak in history, which has been declared a "public health emergency of international concern" by the World Health Organisation (WHO). Since August 2018, at least 2,701 cases and 1,813 associated deaths were reported across Ituri and North Kivu provinces, and the virus continues to spread: around twelve cases, including two fatal ones, were reported in Goma, a city of over one million inhabitants, in July-August.

Since the previous Ebola outbreak that struck the DRC's Mbandaka area in Équateur Province in May-July 2018, scientists developed a safer and more effective vaccine with a success rate of around 97 percent. But the trouble of containment does not lie so much in science and rationality. Hemorrhagic fever viruses inspire an almost mythic terror, and their control depends on people more than on medical advancements. Just like a virus, information is contamination. And an insidious and conceivably fatal rumour cloud made up of folklore, conspiracy theories and paranoia surrounds this Ebola outbreak, m. Health aid workers find themselves fighting on two fronts: against the real thing, and concurrently, the outbreak of fake news. But modern medicine is not only about doctors, pills and vaccines: it is about information management, scientifically-backed facts and dissipating false beliefs.

Rumours that the government created the Ebola virus in an attempt to prosper on Western aid, or that the bodies of those killed by the virus are being sold to practitioners of witchcraft have been circulating. As a result, the Ebola response has been met with resistance and treatment centres have repeatedly come under attack, forcing medical groups to close down treatment units and curtail vaccination programs. The consequence has been a rise in infections, which may lead to a vicious cycle where people become harder to treat, causing more infections in turn. Combating Ebola requires dealing with those attacks — and that requires understanding the negative perceptions and motivations fueling them.

What complicates the Ebola response in the Democratic Republic of Congo is a violent struggle over political power mixed with deep distrust toward the national government and its security forces. The region around the cities of Beni and Butembo, where the current Ebola outbreak is concentrated, is a stronghold for opposition to the government in Kinshasa. Such distrust was amplified when the central government cancelled the gubernatorial elections in Grand Nord areas last March, citing Ebola as a reason. Furthermore, local populations are questioning the sudden interest of international humanitarian actors that have been relatively unconcerned with tuberculosis and malaria, two major and long standing scourges. There is a rising belief that there are hidden political and economic agendas at play in the Ebola response.

Emergency teams are also impeded by the complex and divided geopolitical context of eastern Congo. During the 2018 Mbandaka Ebola outbreak, geography played an important role. Mbandaka, also one of the largest cities in the DRC, is located in a relatively peaceful area with an ethnically homogeneous population and good relations with the government in Kinshasa. By contrast, Ituri and North Kivu provinces, located along the country's eastern borders with Uganda, Rwanda, Burundi and South Sudan, are entrenched in a complex turmoil, involving violent clashes between dozens of ethnic groups speaking different languages and who tend to have their own militias, creating a fertile ground for the disease.

What the Congolese government needs to keep in mind is that Ebola outbreaks are not only detrimental to the battered local populations but can also bring consequential damage to the national economy. The Ebola outbreak that ravaged Sierra Leone, Guinea and Liberia in 2014 cost those nations an estimated $53 billion. Further interest, funding and efforts must be allocated by local authorities, placing communities and patients at the centre of the response as active participants. With the WHO's recent declaration, additional resources and field analysis are likely to be allocated to controlling the outbreak, while the risk of neighbouring countries closing their borders and suspending trades is also possible. This would only harm local populations and the regional economy further, without effectively curtailing the outbreak. Rumour is, as William Shakespeare put it, a “many-headed monster”, with no equivalent to a vaccine as yet.

Anna Morin is a Paris-based political and security risk analyst covering Sub-Saharan Africa.