Outbreak: Ebola spreads to Congolese city of 1.2 million sparking containment fears

A surge in new Ebola cases has been reported in a densely populated Congolese city, adding a dangerous dimension to the worst outbreak of the virus in the country’s history.

Health workers have been forced to open up a new and particularly perilous front after 28 people died of Ebola in and around Butembo, a city of approximately 1.2 million people that is located in the heart of the country’s most volatile regions.

The government of the Democratic Republic of the Congo admitted this week that the country’s tenth Ebola outbreak is now officially its worst ever, after the number of confirmed infections crossed the 300 threshold. The virus has killed 211 people, the ministry of health said.

Unlike previous outbreaks, which have been restricted to fairly remote, rural areas, the present epidemic has swept through populated parts of northeastern Congo, a lawless area that is infested with rebel groups, freelance militias and armed criminal gangs.

Already struggling in conditions more challenging than previous outbreaks anywhere in Africa, health workers are now trying to deal with an outbreak that has multiple epicentres. 

But nowhere is as worrying as Butembo, where a blend of insecurity, suspicion of aid workers and a large, mobile population have created an ideal landscape for the rapid spread of the disease.

“We are worried,” said Axelle Ronse, emergency coordinator for Medicins Sans Frontieres, which runs an Ebola treatment centre in Butembo.

“It is a big area. There is a big population where people move about a lot and there are some areas which are difficult to access due to a large number of armed groups.”

As in previous outbreaks, the present Ebola crisis began in a small village — Mangina — raising hopes that the the disease could be contained and the death toll restricted to a few dozen. 

The trajectory Ebola followed in Mangina did indeed mimic the past, with aid workers saying that the situation was now more or less under control.

The outbreak, which was formally declared on August 1, would now be coming to a halt if it had not spread to the town of Beni, with an estimated population of 300,000, where over half of the confirmed Ebola cases have been recorded.

But Butembo has four times as many people as Beni, making the outbreak there potentially much more dangerous.

Although the first Ebola was reported in Butembo in early September, the disease did not seem to spread rapidly, with only one or two incidents being reported a week. 

That changed at the start of this month, with aid workers saying that the number of new cases is increasing every day and is expected to continue rising sharply.

The disease is also spreading into rural areas around the city that aid workers cannot access because they are too dangerous. As a result, programmes to teach local people methods to slow the spread of the disease — a strategy that has proved effective in the past — cannot be implemented so easily.

Hostility towards aid workers and government health officials is also more marked in Butembo than elsewhere. Much of north Kivu is suspicious of Joseph Kabila, the Congolese president, and many believe the government has done little to protect civilians from massacres by local armed groups and may even be complicit in them.

The suspicion has been extended to foreign aid workers, because of a perception that the international community places more emphasis on tackling Ebola — seen as killing comparatively few — while ignoring massacres that have devastated villages and wiped out families.

Organisations like the United Nations’ Children’s Fund (Unicef) have had success in convincing people to trust health workers elsewhere, using local radio stations and youth leaders and, most effectively, those who have recovered from Ebola, to win people over.

“We as Unicef work with Ebola survivors who can express de facto 1,000 times better than we can how effective the Ebola treatment centres can be,” said Yves Willemot, Unicef's communications chief in Congo. 

But because such sensitisation efforts were less focused on Butembo, progress has been slower. 

“We are essentially starting from scratch in Butembo,” one aid worker said.

As aid workers scramble to confront the spread of ebola in Butembo, concerns are also mounting elsewhere. This week three previously unaffected regions reported confirmed Ebola cases for the first time and there are fears that the disease is edging ever closer to the Ugandan border.

Amid the gloom, aid workers say they are hopeful that four experimental Ebola treatments — none of which have yet gone through clinical trials — are helping to save lives. 

Yet there is also a sense that the geographic footprint of the outbreak is expanding faster than health officials can cope with. Already, the response plan drawn up by Congo’s government and its international partners at the start of the outbreak has been eclipsed by the fact that the number of cases and their spread is far higher than they forecast.

A new plan is in the process of being drawn up, the Telegraph understands, and it may be based on a grim assumption: that, for the first time, it may not be possible to end an Ebola outbreak and that containment may be the most realistic strategy.

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