GOMA, Democratic Republic of the Congo (Reuters) – When medics tried to reach Ebola patients in a village in the Democratic Republic of the Congo east during a recent wave of violence, they were blocked by people holding machetes and axes.
FILE PHOTO: A medical worker wearing protective clothing as he prepares to manage the care of Ebola patients in the International Alliance for Medical Action (ALIMA) care center in Beni, North Kivu Province of the Democratic Republic of Congo September 6 2018. Image taken September 6, 2018. REUTERS / Fiston Mahamba / File Photo
Concerned about being kidnapped, they returned, the latest in a series of setbacks in their efforts to contain the worst outbreak in the central African country of the deadly virus.
As fighting worsened between warring militias seeking control of land and natural resources, vaccinations and vital care were increasingly delayed and Ebola had spread.
The situation became so dangerous in eastern Congo that humanitarian workers were temporarily evacuated last month from their base in the town of Beni in the North Kivu region close to Rwanda and Uganda.
With a vast country of more than 80 million people also suffering from political instability and facing the refugee crisis, experts at the World Health Organization see it as one of the most complex public health challenges in history today.
"Sometimes on the field we hear bullets flying from left to right and we tell ourselves that maybe it will hit one of us," said Mimi Kambere, emergency response coordinator for the non-profit group Oxfam, whose team was confronted by people with machetes .
"Sometimes insecurity encourages us not to respond to calls, and does not go to certain areas for days," he told Reuters in Goma, a city on the north coast of Lake Kivu where he and other health workers were evacuated in November. 17
The tenth rupture of the Congo since Ebola was discovered in 1976 has infected 422 people and killed 241 in the past four months. This would be the second largest outbreak if it surpassed 425 cases recorded in Uganda in 2000, according to the health ministry's Congo record.
This disease spreads through contact with body fluids and causes dengue fever with severe vomiting, diarrhea and bleeding. In a lot of turmoil, more than half of the cases are fatal. In the worst outbreak, which began in 2013, more than 11,000 people died in three years, mostly in Liberia, Guinea and Sierra Leone.
Tracking patient contacts and immunizing them with preventive vaccines quickly contains Ebola outbreaks in peaceful areas in western Congo this year. This raises hopes that new ways to fight Ebola can reduce adulthood, even in urban areas.
But in what an World Health Organization official in Geneva said was a "potential perfect storm", densely populated North Kivu is now at the center of the battle and Ebola.
A WHO emergency committee said in October that the outbreak would likely deteriorate significantly unless the response was increased. In November, the number of new cases increased, and the virus spread to previously untouched areas.
An internal record by the UN Office for the Coordination of Humanitarian Affairs (UNHCR), seen by Reuters, recorded 28 incidents of violence that affected the Ebola response team between August and November.
THREAT OF DEATH
International and Congolese health workers are not only hampered by gunfire. They often face the so-called "reluctance, refusal and resistance" by some Congolese citizens to receive treatment.
Some Congolese people believe medical personnel came to spread the disease with their vaccination needles. Others don't believe the virus exists at all. A number of medical officers, especially local staff, have received death threats verbally and have thrown rocks at their cars, they told Reuters.
The action, said the WHO, was driven by fear of Ebola and exploited by local politicians before the presidential election in December.
Those who seek medical help often find themselves in unhealthy medical facilities where the virus spreads, medical said.
The scope of humanitarian workers for action is also limited by shortening of workdays under curfew imposed by the government, Non-Governmental Organizations (NGOs) and the US because of fighting.
This delayed important services such as safe blood tests and funerals for Ebola victims to help prevent the spread of the virus.
"The armed group that attacked Beni posed a big obstacle to our staff," said Michel Yao, WHO incident manager in Beni.
In some regions, WHO must ask permission from armed groups to access new patients. Telephone negotiations to secure a safe trip can delay vital initial treatment, Yao said, and disrupt the vaccination plan.
"We never had to negotiate access to patients before. This is the specificity of this Ebola outbreak, "Yao said.
WHO staff, along with representatives of the World Food Program and UNICEF aid agency, were among dozens of people who were evacuated for psychological evaluation after fighting in Beni two weeks ago where 12 Congolese soldiers and seven UN peacekeepers were killed, WHO said.
Shots come close to the city's Ebola Emergency Center and hotel housing humanitarian workers. A shell landed in a building where the WHO staff stayed but did not explode.
"It's scary because usually violence is not that close," said a UNICEF employee who asked not to be named.
To avoid stray bullets, he followed the advice he gave in training.
"I entered my room and squatted in the bathroom. I was trapped in the bathroom for three hours, "he said.
FAST WORK IS VITAL
Effectively containing Ebola involves quick work under pressure: health workers must examine all possible new cases, take blood samples, isolate sick people and track all people who have contact with patients.
The slow international response contributed to the rapid spread of Ebola in West Africa in 2013, the outbreak that developed to be the worst so far.
In Congo, visiting potential patients often means driving for hours along pitted country roads, health workers said. In eastern Congo it can mean danger.
A laboratory in Beni received between 50 and 70 blood samples every day from health workers in the field, but testing of the sample has slowed due to time restrictions imposed by curfews, Congo Health Ministry spokesman Jessica Llunga said.
"Until we get confirmation that the patient has Ebola, we cannot move him to the center and we cannot vaccinate his contacts, which also hinders the fight against the epidemic," he said.
Additional report by Kate Kelland in London; Editing by Edward McAllister and Timothy Heritage