Ebola: the latest outbreak is dangerously close to out-of-control

The Ebola outbreak in the Democratic Republic of the Congo is getting worse - and health care authorities, organizations and workers are losing control.

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 ... a lawless area that is infested with rebel groups, freelance militias and armed criminal gangs.

. . .

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 ... 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.

. . .

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 ... 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.

There's more at the link.

I know that part of the world.  I've been there.  I'm here to tell you . . . this is a nightmare in the making.

The big problem in Kivu and surrounding areas is that they've been at the heart of a bloody, savage civil war and inter-tribal conflict for at least a generation.  The Kivu War began in 1994, following the Rwanda massacres, when hundreds of thousands of refugees from the latter country streamed across the border, bringing tribal tensions and conflicts with them.  It's basically continued non-stop since then, despite official claims that the region has been "pacified".  The casualty figures are unknown, because many - possibly hundreds of thousands, for all anyone knows - have died in the bush, or starved to death while making their way through the forests in search of safety.  It's entirely possible that over a million people have died in the area bounded by Kivu, Burundi, Rwanda and parts of Uganda since the conflict began.

The result is gross regional instability.  Tens of thousands of people can (and do) flee from violence whenever it erupts, surging across borders and natural obstacles to find whatever safety they can, heedless of official orders, pronouncements, laws, rules and regulations.  Officials are regarded with suspicion, because most, if not all, are out to get as rich as they can, as quickly as they can.  "Taxes" are little more than a local warlord stealing what he can before he's run off by the next warlord.  Anyone with a gun is either a bandit, or working for a group that's making out like bandits off the local populace (including the Congolese Army, which is notorious for corruption, criminality and inefficiency).  So-called "liberation movements" abound, each basically self-seeking rather than patriotic.  Anyone trying to exert any kind of authority is distrusted, feared, and shunned - to the point where many people will get up and leave rather than stay anywhere that tries to exert control over them.  Shear the sheep often enough, for long enough, and they'll flee from anyone who looks like he may have a pair of shears.

That's what makes this Ebola outbreak so deadly dangerous.  It can spread - and, by all accounts, is spreading - across a network of bush paths spreading through four nations.  (That's probably how it reached Butembo in the first place.)  The sick don't trust any authority at all in that area, so trying to tell them what to do is pointless;  they'll just suspect the person telling them of trying to control them for his or her own nefarious purposes.  Military intervention is pointless, because when the people see armed men, they flee.  It's a knee-jerk reaction, and it'll spread the disease faster than almost anything.

Tribal traditions about health, healing, and pacifying the spirits are far stronger than any understanding of or allegiance to Western medical practices (to mention just one example, the germ theory of disease is neither understood nor believed by almost all traditional healers in the area).  It's a nightmare for those attempting to contain this Ebola outbreak, because they're at risk from all the bandits and armed groups in the area, who regard them as intruders out to weaken their control over their "sheep".  Worse, the people they're trying to help regard them with not just suspicion, but active hostility, because they're trying to stop them caring for their sick and/or burying their dead in the traditional way, with lots of body contact.

Under such conditions, it's not surprising to me at all that this Ebola outbreak is spreading dangerously far and fast.  I see no way whatsoever that it can be controlled, and I think efforts to quarantine the area, to stop it spreading, are pointless.  They take no account of the reality on the ground.  There is no competent armed force that can subdue or control all the groups of bandits and terrorists in the area - the Congolese Army is just as much a gang of thugs as the latter.  Any Western armed force trying to do so will find every hand against them.  Besides, if you tell the average Western serviceman that he's going to be sent to an area where a largely fatal, highly contagious disease (for which there is no cure) is rampant, he's likely to resign or desert faster than prunes go through a duck.  I don't blame him.  In his shoes, I'd do the same thing.

If Ebola breaks free of its current geographic limitations, we're in very serious trouble indeed, as Aesop has pointed out at some length.  Keep your eye on this situation.  It may blow up into a monumental international health crisis before long.

Peter

EDITED TO ADD:  For another (equally negative) perspective on the current crisis, see here.