• Gaps in Ebola response and population movement lead to the spreading of Ebola to new territories and neighbouring countries

    Latest update: 21/06/2019

    Probability

    Highly unlikely Somewhat likely Highly likely

    Impact

    Very low Moderate Major

    On 2 June 2019, the Ebola outbreak in northeast DRC surpassed 2,000 cases including nearly 1,400 deaths.? The rapid increase in case numbers since late March has been linked to widespread insecurity resulting from some 120 active armed groups in the area and violence against response workers by armed groups and villagers, that lead to temporary suspension of response activities. Community distrust due to misinformation, scepticism against the government, and a reluctance to seek treatment and adhere to preventative measures is widening gaps in Ebola treatment and tracking; it is estimated that only 75% of cases are detected.? High population mobility and frequent internal and cross-border conflict displacement aggravate the situation and increase the risk of Ebola spreading to neighbouring provinces and countries, including Rwanda, South Sudan and Tanzania. ? On 11 June, an Ebola outbreak was declared in Uganda as several people infected with the virus returned from DRC to Uganda via informal crossings to avoid health checkpoints. ? The spread to more densely populated, economic centres is particularly concerning and will make it harder to contain the outbreak. Nord Kivu’s capital Goma is a high-risk location, given its proximity to the border with Rwanda, frequent movement of goods and people, and limited preparedness. Despite response adjustments including communication campaigns that target community mistrust, an extension of the vaccination campaign, and the activation of the “Humanitarian System-wide Scale-Up” in late May, the risk of Ebola spreading remains high, with a high probability of the disease reaching Goma and then becoming even more challenging to contain. ?

    IMPACT

    This geographical spread will make it harder to gain control of the outbreak and increase the loss of human life. The case fatality rate has risen in recent months, from 61% in early January to 67% in mid-June. ? The first EVD cases in Uganda and the threat of Ebola reaching Goma near the Rwandan border mean that the declaration of a “Public Health Emergency of International Concern (PHEIC)” is likely. This would place restrictions on trade and travel.

    Trade, employment and family ties see several tens of thousands of people cross the DRC-Rwanda-Uganda borders every day. Restrictions on movement will likely impact livelihoods, food security, and nutrition. Disruptions are likely to increase reluctance towards response efforts and increase informal crossings where no screening is in place, thus further impeding humanitarian operations.? Although preparedness and response capacity was previously estimated to be good in some neighbouring countries, several factors could aggravate the situation: including other disease outbreaks that display similar symptoms such as cholera; the ongoing rainy season hindering access in Uganda and South Sudan; and the volatile security situation in South Sudan. As in the ACAPS’ Global risk analysis published in December 2018, IDP and refugee populations are anticipated to be at a higher risk due to congested displacement sites and limited access to adequate WASH facilities.

    This risk was identified in the June Quarterly Risk Report.

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