Militant attacks on health care personnel and members of the Congolese army have hampered the global response to the outbreak of the Ebola virus that grew in the two eastern provinces of the Democratic Republic of Congo.
Global and American health officials say at least two rebel groups are behind three separate attacks over the weekend in and around Beni, a regional trade center in North Kivu Province. Health officials who responded to the outbreak were forced to stop their efforts to track and vaccinate contacts of those infected with the virus for several hours.
"This is probably the most complex context we have ever had to fight the Ebola outbreak before," Peter Salama, deputy director general for emergency preparedness and response at the World Health Organization, told Hill in an interview. "The security situation is tense and has been around for years."
Violence and instability, in an area where ethnic conflict has displaced more than one million people, has sent American respondents out of the region. Some American personnel were withdrawn from Beni and surrounding areas after the August attack on the Congolese military base.
The Disaster Management Team, led by personnel from the Centers for Disease Control and Prevention (CDC) and the US Agency for International Development, was sent to Kinshasa, more than a thousand miles from the epicenter. Senior American officials said Wednesday that 10 to 15 DART team members were in the field in Kinshasa, and 21 others provided support from the United States.
But American respondents were on land in neighboring Uganda, Rwanda and South Sudan, monitoring border crossings in the hope of preventing the spread of the virus on the international border. The CDC has sent 94 Americans to these countries and to Geneva, where the WHO is headquartered, to help the response.
The Congo Health Ministry said Wednesday that 339 cases of the Ebola virus had been identified, making the current outbreak the worst in the nation's history. Two hundred and twelve people have died.
About half of the cases come in Beni, a city of about a quarter of a million people near the border with Uganda. Ten cases also occur in Butembo, a larger city south of Beni that has close trade relations across the border.
Salama said many cases spread through interaction in private health care facilities, which were not registered with the local government and where basic services such as running water and safe needle handling did not exist. There are several hundred such facilities in Beni alone, some of which are located in private homes.
"The majority of transmissions, we believe, occur in private health facilities," Salama said.
About 30 health workers have been infected during the outbreak, Salama said.
In a conference call on Wednesday, senior American officials will not rule out deploying US military personnel to the region, where security seems to be the responsibility of the United Nations Organization Stabilization Mission in the Democratic Republic of Congo, or MONUSCO.
But deploying American forces, such as nearly 3,000 sent to Liberia to fight the Ebola outbreak in 2014, is very unlikely. The Americans sent to Liberia operate in a capacity of support, not for security, and America has a much closer relationship with Liberia, the country it discovered in the 19th century, rather than to the DRC.
Some public health officials were worried last week when Robert Redfield, director of the CDC, suggested at a conference on Capitol Hill that the difficulties that contain the current outbreak might make the Ebola virus entrenched in the Congo River Valley for years to come. Redfield later said he voted for the worst scenario, rather than suggesting the outbreak would be out of control.
"We do not believe that the current Ebola outbreak cannot be detained. Even in many health and health zones, it is already contained, "Salama said. "We believe it can be withheld, but it depends on increasing high intensity."
The new vaccine, developed by the National Institutes of Health and produced by the pharmaceutical giant Merck, has been deployed for the third time in the North Kivu region. Vaccines have been given to more than 29,500 people, mostly health care workers and those who have come in contact with someone infected with the Ebola virus, a process known as ring vaccination.
"This outbreak will take weeks, so we need to be there for the medium term," Salama said.