By Clement Bonnerot and Emma Farge
June 15 (Reuters) – One month after Ebola cases were confirmed in eastern Congo, its true scale remains unknown, with major data gaps muddying the picture and persistent, sometimes violent, community resistance hampering the response, health workers and officials say.
The three affected provinces in eastern Democratic Republic of Congo have so far recorded 782 confirmed cases and 181 deaths, meaning this is already the third deadliest Ebola outbreak on record.
The government’s figures likely understate the true toll, medical charity Medecins Sans Frontieres said in a statement, echoing a view shared by aid groups and some Congolese officials.
“No one knows the true scale or exactly where the disease is spreading in DRC,” said Kate White, emergency medical coordinator for MSF, which operates treatment centres across the Ebola-hit east.
DATA SOURCES DIFFICULT TO HARMONISE
Testing remains “one of the most significant weaknesses in the response”, the MSF statement said.
Many communities, particularly those affected by active armed conflict, still lack access to test kits, while treatment centres face significant delays receiving laboratory results, it said.
A senior Congolese public health official, speaking on condition of anonymity as he was not authorised to brief the media, told Reuters the problems run deeper than testing alone.
Data flowing from three separate sources – laboratories, hospitals and treatment centres, and epidemiological surveillance teams – is extremely difficult to harmonise, creating distortions in both directions, said the official.
Cases may be overcounted when patients cross health zones and are tested more than once. Meanwhile, people continue to die in communities without ever coming to the attention of health authorities, said the official, adding that he believed the virus began circulating in February.
The gap between official figures and the reality on the ground is visible at the local level.
Reuters reported on Friday that two people had died at a displacement camp in Ituri’s Nizi health zone on May 31 and June 1, citing a U.N. refugee agency report.
On Saturday, Nizi health zone head doctor Jean-Claude Lonzama told Reuters his zone had recorded 19 positive cases and 17 deaths since the outbreak was declared.
Yet the latest national situation report published by health authorities on Sunday logged only 11 cases and one death for the area.
Dieudonne Mwamba, director general of Congo’s National Public Health Institute, which publishes daily situation reports, told Reuters figures were regularly updated as new information came in.
BURIAL TEAMS ATTACKED, PATIENTS ABSCOND
Beyond the data, responders continue to face a wave of community resistance and violence.
On Sunday, security forces fired warning shots and tear gas at a funeral in Mongbwalu to disperse a crowd trying to seize the body of a suspected Ebola victim, according to officials and footage verified by Reuters.
The World Health Organization warned on Monday that such security incidents are a threat across the region, citing a separate attack on a burial team in South Kivu two weeks ago that forced health workers to abandon a body before completing safety protocols.
Patients are also absconding from treatment or isolation centres, it said, with at least four such incidents through the first week of June.
MSF said the problem of mistrust was widespread across Ituri.
Congo’s Mwamba told Reuters that safe burial teams would now seek to include a family member in burial preparations to build trust.
TREATMENT CENTRES STRETCHED THIN
The World Health Organization said on Monday that hospital capacity to treat and isolate Ebola patients was insufficient.
There are only 14 treatment facilities and centres in nine health zones across Ituri, North Kivu and South Kivu provinces.
But the outbreak has already reached 31 of at least 90 health zones – a defined area with a network of clinics and a referral hospital – across those provinces.
In Nizi, the absence of any treatment or isolation facility means patients return to their communities and die there, Lonzama, the head doctor, said.
MSF warned the window for containing the outbreak was narrowing. The worst outbreak was in West Africa in 2014-2016 and it killed more than 11,000 people.
“Diagnostics, surveillance, access to care, and community engagement must be urgently strengthened,” said Frederic Lai Manantsoa, MSF’s emergency coordinator in DRC.
“We urge authorities and all stakeholders to do everything possible to facilitate the movement of health workers and supplies, and enable a response that matches the scale of this crisis.”
(Reporting by Clement Bonnerot in Dakar and Emma Farge in Nairobi; Additional reporting by Benoit Nyemba and Gradel Muyisa in Bunia, Fiston Mahamba in Goma; Editing by Robbie Corey-Boulet and Alison Williams)
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