It is worrying that one year into the Ebola outbreak in the Democratic Republic of Congo (DRC), there is still no end in sight. With over 2,400 cases, more than 1,700 deaths, and a declaration by the World Health Organization (WHO) that this is a public health emergency of international concern-it is time to ask a few hard questions. What has not worked so far and what would it take to end the second largest Ebola outbreak in history?
Two main factors - insecurity and community resistance-have set back the response. The Ebola outbreak is unfolding in a region affected by two decades of conflict that has claimed countless lives and deprived millions of their most basic needs. Attacks against health facilities and health workers have been a constant and tragic feature of this Ebola response. In April, violence reached its peak in Katwa and Butembo, blocking response activities and igniting a massive spike in cases. Despite this, the number of Ebola cases in Katwa and Butembo are finally coming down. This signals that even in the most insecure places, the response can be successful, if the tools to end the Ebola epidemic exist-and are primarily in the hands of the community.
Yet this still remains our biggest challenge. A biomedical response, primarily driven by international experts was not accompanied by equal efforts in terms of engaging communities, thus creating resistance and alienating parts of the population. As a result, we lost critical access to vulnerable populations who needed help most.
If we aim to end this outbreak within the next twelve months, we need three strategic shifts.
First, we need to move beyond an exclusively Ebola-focused response. The humanitarian needs in North Kivu and Ituri are enormous. Ongoing measles and cholera outbreak in DRC, including in Ebola-affected areas, have killed more people than Ebola. Malaria is endemic and access to safe water is severely limited. Hundreds of thousands have been displaced by conflicts and more people have died from violence than from Ebola. These are priorities for the affected communities and must be priorities for the responders. It is time for a comprehensive approach that addresses the Ebola outbreak, but also tackles broader health and humanitarian needs.
Second, we need to use this response as an opportunity to strengthen the fragile health system in Eastern Congo. It is disheartening to see that the current epicentre of the outbreak is Beni, a district that had previously succeeded in reducing the spread of the virus and had several weeks without cases. The gains made were just as rapidly lost, and the response now must be boosted again. Without investments in preparedness and rapid response against infectious diseases, Ebola will continue to spread, and communities will remain vulnerable to the next outbreak.
Third and most importantly, we need to put communities at the centre of this response and strengthen their own resilience. Listening to communities is not enough. Acting on what they tell us must be the standard to which we hold ourselves accountable. This is not a one-off process. This is hard work that shifts the ownership of the response to affected families and communities. This means having responders, like Red Cross volunteers, selected from within the communities. It means involving the almost 1,000 survivors of this epidemic as a force for change in every village and town. It requires all international responders to take a step back and local Congolese to take a step forward.
These changes require sustained financial investments to tackle this Ebola outbreak and to address the other humanitarian needs in the region. This includes continuous technical support to local authorities and deep, sincere community engagement at all levels. There is no shortcut. It's a long journey, but one which needs to start now, as we enter the second year of this deadly outbreak.
Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Emanuele Capobianco is IFRC's global director of health and care.