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Work starts around 5:30 a.m. for Abdou Sebushishe. As he drinks his morning coffee, Sebushishe, who helps lead frontline emergency operations for the International Medical Corps, checks on his teams scattered across eastern Democratic Republic of Congo, where they\u2019re working on the response to the country\u2019s Ebola outbreak.<\/p>\n
By 8 a.m., he\u2019s at a treatment centre in Bunia checking on patients, staff and supplies. His afternoons disappear into meetings and operational problems, and work can continue until 9 p.m., when he finally eats what\u2019s often his only meal of the day.<\/p>\n
Sebushishe\u2019s long days point to one of the central problems in confronting Congo\u2019s Ebola response: there are only so many experienced people to go around.<\/p>\n
When cases are reported somewhere new, that location has to be staffed with a new team. Sebushishe worries about colleagues who are already exhausted, including engineers building treatment centres \u201cday and night\u201d, and healthcare workers working punishing shifts in the face of trauma and loss.<\/p>\n
Read: Ebola spreads to seventh Congo province after long-distance trip<\/p>\n
\u201cThe numbers that you are seeing being reported every day, these are real people,\u201d he said.<\/p>\n
Twenty weeks into the outbreak, health workers have managed to tamp down some of the early hotspots. But the virus is still spreading.<\/p>\n
What began in three health zones in one province has expanded to 64 across seven provinces.<\/p>\n
That widening footprint is putting further strain on a humanitarian response weakened by major aid cuts. Each new front requires surveillance, community workers, infection-control teams and treatment capacity, often in places struggling with conflict, displacement and weak health services.<\/p>\n
The longer responders take to get ahead of the virus in new locations, the greater the risk that Ebola crosses Congo\u2019s porous borders \u2013 forcing stretched teams to fight it on yet another front.<\/p>\n
\u201cYou have no impression really that we\u2019re catching up,\u201d said Johnny Falconer, who until recently ran medical care at an 80-bed Ebola treatment centre operated by M\u00e9decins Sans Fronti\u00e8res in Bunia. \u201cWe\u2019re still dramatically behind.\u201d<\/p>\n
Read: Ebola outbreak becomes Congo\u2019s deadliest as UN warns virus is \u2018winning\u2019<\/p>\n<\/p>\n
The Ebola outbreak emerged in early May. Reports of unusual deaths around Mongbwalu, a mining town in Ituri, led to an investigation. Standard field tests for the more common Ebola Zaire didn\u2019t detect anything, but samples sent more than 1 100 miles to Kinshasa showed that the virus was a rare species, Bundibugyo.<\/p>\n
By the time that was confirmed on 15 May, evidence suggested that the virus had been circulating for weeks. Later investigations indicated the outbreak may have begun months earlier.<\/p>\n
Years of conflict and inadequate healthcare in the region have eroded people\u2019s trust in authorities. The sudden arrival of medical teams taking patients into isolation \u2013 as well as an old \u201cEbola business\u201d narrative that claimed some people were profiting from the epidemic \u2013 fuelled suspicion.<\/p>\n
Frightened families hid the sick, patients fled treatment and burial teams were attacked.<\/p>\n
Read: Congo escalates Ebola response as record outbreak spreads<\/p>\n
Since then, thousands of healthcare workers have been trained, treatment and testing capacity has expanded and community teams have gone door-to-door looking for infections.<\/p>\n
Weekly reported cases have fallen by more than half in Ituri since mid-August, suggesting the response is gaining ground there. But progress is uneven: on 26 September, Mandima, a village about 100 miles from where the outbreak began, reported 25 new infections, including 20 people who had already died in the community.<\/p>\n
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Less than a week later, its confirmed caseload had climbed to 152 from 118.<\/p>\n
Ebola can reach a new community far faster than responders can react. It takes about three weeks to build an Ebola treatment centre to standard. Staffing one can require about 300 health workers, the World Health Organisation (WHO) said.<\/p>\n
Health workers queue for hot meals in a programe supported by the World Food Programme at the Mongbwalu General Hospital in Mongbwalu. Image: Michel Lunanga\/Getty Images<\/p>\n
Aid group Samaritan\u2019s Purse runs two treatment centres in Congo. In each, there are two types of patients, those with suspected Ebola and those confirmed to have the virus. It\u2019s critical to prevent cross contamination between them, so each patient is isolated in their own room, which includes piped water to shower and drink.<\/p>\n
Chlorine is also piped throughout the facility. Families need to see that patients are not just brought to an Ebola centre to die, said Shannon Hamilton \u2013 who recently returned from Congo, where she worked with Samaritan\u2019s Purse \u2013 so rooms are fitted with windows to allow patients to see and speak with their loved ones.<\/p>\n
Read: Why Congo\u2019s record Ebola outbreak is becoming deadlier<\/p>\n
There is what\u2019s called a donning room, which is where staff go through the laborious process of putting on their personal protective equipment. Usually less than an hour later, that health care worker needs to enter the doffing or decontamination area to take their gear off.<\/p>\n
\u201cBeing in that PPE, you lose about one or two lighters of sweat an hour in these environments,\u201d Hamilton said. \u201cSo you can only safely stay in PPE for a short period of time.\u201d<\/p>\n
As important as caring for patients once they\u2019re infected\u00a0is preventing the virus\u00a0spreading, which means surveillance, fast response, and building trust in communities.<\/p>\n
\u201cAn Ebola treatment centre isn\u2019t enough,\u201d Trish Newport, emergency programme manager at MSF, who is based in Congo, said. \u201cAn Ebola treatment centre is the end of the line.\u201d<\/p>\n
Awareness Workers with UNICEF\u2019s \u2018U-Report\u2019 group at the Alanine market in Goma, in June. Image: Daniel Buuma\/Getty Images<\/p>\n
Treatment capacity has expanded from only a handful of beds early in the outbreak to more than 1,700 across 50 treatment centers, with plans to exceed 2 000, according to the WHO.<\/p>\n
Earlier in the outbreak, dozens of health workers became infected while treating patients outside specialised Ebola centres, where shortages of protective equipment, training and infection-control measures left staff exposed. About 254 health workers have since been infected and 50 have died.<\/p>\n
Responders should be able to swarm a place when its first few infections appear, tracing contacts, disinfecting homes and engaging communities before transmission takes off, Newport said. Instead, organisations stretched across dozens of hotspots often don\u2019t have the people or time.<\/p>\n
\u201cPutting out small fires isn\u2019t possible,\u201d she said. \u201cAnd you end up with massive fires everywhere.\u201d<\/p>\n
This gap is visible in North Kivu, where on 2 October only seven of 30 identified households were decontaminated, due to community resistance and shortages of teams and transport.<\/p>\n
Cases there jumped 84% last month, government reports show. MSF said on 3 October that the virus is spreading \u201clike wildfire\u201d in North Kivu.<\/p>\n
When Newport arrived\u00a0in Mongbwalu in July, inexperienced workers were faced with\u00a0patients who often sought help only when gravely ill.\u00a0As\u00a0many as 20 people were dying in the community each day.<\/p>\n
Weeks later, some 300 workers had been trained, patients were arriving earlier and deaths had fallen sharply.<\/p>\n
Read: Ebola spreads to seventh Congo province after long-distance trip<\/p>\n
Then Newport travelled to Bambu, about 15 miles to the southeast. What she found looked like Mongbwalu weeks earlier: inexperienced staff, patients arriving desperately late and as many as 15 people dying in the community each day.<\/p>\n
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\u201cEvery area is like a separate outbreak,\u201d she said. \u201cBut all connected.\u201d<\/p>\n
The response is increasingly being pushed outward from large treatment centers and closer to villages. Thousands of community workers are going door-to-door, asking families about illnesses and deaths, identifying contacts and directing suspected cases for testing.<\/p>\n
On 12 September alone, teams conducted almost 32 000 household visits in Ituri and North Kivu.<\/p>\n
Congo\u2019s response plan aims eventually to mobilise close to 71,000 community workers, according to the Africa Centres for Disease Control and Prevention.<\/p>\n
One goal is to identify at least 50 contacts for every confirmed infection, allowing exposed people to be followed before they become sick and potentially spread the virus further. The response currently remains far from that goal. Congo reached 73% of the contacts already on its lists on 2 October \u2013 and only 60% in North Kivu.<\/p>\n
Africa CDC estimates those lists contain less than a quarter of the contacts that would be expected from known cases. Almost 80% of new infections are being detected among people who weren\u2019t already being followed, the agency said on 1 October.<\/p>\n
Read: Congo Ebola responders stay on strike as Africa CDC pushes to resolve pay dispute<\/p>\n
The virus is moving through a region that has been shaped by cross-border trade, conflict and mass displacement. Millions of people have been uprooted in eastern Congo, sometimes repeatedly.<\/p>\n
In late September, fighting in Ituri caused thousands of people to leave their homes, including more than 3 000 who fled a camp housing displaced people. An Ebola transit center at the abandoned camp later burned down.<\/p>\n
Aid organisations suspended movements in some areas, and the violence delayed laboratory samples and disrupted transfers of confirmed patients for treatment. Two people involved in the Ebola response were killed in North Kivu last month, according to the UN.<\/p>\n
The outbreak has already crossed international borders. Uganda recorded imported infections and subsequent cases among contacts and health workers, while an infected traveller was diagnosed in France.<\/p>\n
Aid workers who contracted Ebola in Congo have been medically evacuated to Germany and the Netherlands for treatment.<\/p>\n
Continued transmission near Congo\u2019s borders raises the risk of further spread into neighbouring countries, including the Central African Republic, Republic of Congo and South Sudan, Africa CDC has warned.<\/p>\n
Neighboring countries are strengthening surveillance and laboratory capacity, but some start from a much weaker base. South Sudan\u2019s health infrastructure, battered by decades of conflict, is \u201camong the lowest on earth,\u201d said Samantha Nutt, founder of the humanitarian organisation War Child Canada.<\/p>\n
\u201cOnce it hits South Sudan, then it\u2019s going to be really, really challenging.\u201d<\/p>\n
Ebola response faces funding shortfalls<\/p>\n
Congo\u2019s new six-month response plan calls for $1.3 billion. International commitments to fight Ebola have now reached about $2.9 billion following a pledging meeting in New York on 23 September .<\/p>\n
The challenge is turning those pledges into work on the ground: Africa CDC said they need to be rapidly converted into disbursements, implementation and results. Some workers have gone unpaid, contributing to strikes that have hindered parts of the response.<\/p>\n
Before the outbreak, US aid cuts had already disrupted programmes supporting community surveillance, specimen transport and health facilities in eastern Congo.<\/p>\n
The International Rescue Committee, for example, had cut 60% of its health sites in Congo; in Bunia, where Sebushishe now works, only two of five primary-care sites it had supported remained open. WHO, meanwhile, froze hiring, laid off staff and cut emergency spending after losing US funding.<\/p>\n
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The Trump administration disputes that its restructuring weakened the Ebola response, and has mounted a major emergency effort since the outbreak was detected.\u00a0 The US announced a new $267 million commitment on 23 September, bringing its health and humanitarian support for the outbreak to $887 million.<\/p>\n
Read: Ebola deaths double in two weeks as WHO warns virus is outrunning response<\/p>\n
That money will expand treatment units, surveillance, contact tracing and burial teams. But emergency funding can\u2019t instantly rebuild lost capacity or produce the experienced workers needed to turn those dollars into an effective response.<\/p>\n
\u201cYou can pour money to get some of the commodities, but actually having trained teams to go and do this, who can use the equipment and be safe and do it in an effective way is a big limiter,\u201d MSF\u2019s Falconer said.<\/p>\n
Billboards warning about Ebola near a treatment center in Monigi, in June. Image: Daniel Buuma\/Getty Images<\/p>\n
There are signs of progress. Africa CDC said October 1 that seven affected health zones had gone more than 42 days without new cases.<\/p>\n
Ebola\u2019s maximum incubation period is 21 days, making each three-week stretch without a new infection an important marker of progress.<\/p>\n
But 45 health zones have reported infections within the past three weeks.<\/p>\n
Deaths fall but surveillance gaps remain<\/p>\n
Deaths are beginning to fall. Reported deaths declined 29% in September from August. But determining to what extent transmission has really declined remains difficult. Insecurity and community resistance have disrupted surveillance in several hotspots, Africa CDC said.<\/p>\n
Deborah Birx, who led the US government\u2019s global AIDS programme and later coordinated the White House\u2019s Covid response, said she is optimistic the epidemic is declining, but would watch deaths closely because case counts can be distorted by delays in detecting and reporting infections.<\/p>\n
\u201cThe one thing that usually is constant is death and the date of death,\u201d Birx said. If the epidemic really is receding, she said, the slope of deaths should begin falling substantially over the next several weeks.<\/p>\n
Rwampara, on the outskirts of Bunia, became one of the outbreak\u2019s biggest early hotspots, recording more than 1,000 infections. Its experience also shows how rebuilding trust can change the trajectory of the response.<\/p>\n
In May, fear and misinformation were so intense that two Ebola treatment tents were set ablaze with six patients inside. Medical aid group Alima and other responders worked with local health workers and community leaders to understand why people were afraid of ambulances, isolation and treatment centres.<\/p>\n
Monigi, Democratic Republic of Congo \u2013 2 June: A worker wearing protective equipment visits a patient in an isolation unit an Ebola treatment centre. Image: Daniel Buuma\/Getty Images<\/p>\n
\u201cIt required very intensive work, every day,\u201d\u00a0Carlotta Pianigiani, emergency department manager at Alima, said. Over several weeks, communities began raising alerts themselves and patients arrived for treatment earlier. By September, Rwampara was reporting only a handful of new cases a day.<\/p>\n
But experts said that they are still only fighting the fires as they emerge, and don\u2019t have enough staff or resources to get ahead of the crisis by identifying new clusters of cases and handling\u00a0them before they become new outbreaks.<\/p>\n
\u201cThere is a limit to how quickly experienced Ebola staff can be multiplied,\u201d Pianigiani said. \u201cThe epidemic can geographically expand faster than specialised response capacity can be deployed.\u201d<\/p>\n
\u00a9 2026 Bloomberg<\/p>\n
#Ebola #spreads #wildfire #health #workers #battle #exhaustion<\/p>\n","protected":false},"excerpt":{"rendered":"
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