How conflict has complicated Congo’s battle against the Ebola outbreak

But there’s another key factor. Health officials are battling the outbreak in one of the world’s most conflict-ridden regions, where years of conflicts between armed groups have weakened healthcare systems and thus hampered response efforts.

Here’s a short history of the roots of the conflict in the region and how it has exacerbated the challenges posed by the lack of resources, proper healthcare systems and trained personnel.

Repeated Ebola outbreaks in African countries

Central and Western African nations have seen repeated outbreaks of Ebola, which spreads through infected bodily fluids, since it was first identified in 1976. The largest ever outbreak of the disease was in 2014-16, when 28,600 people in West Africa were infected, and over 11,000 were killed.

The current outbreak has sparked serious concerns. “Never before has an Ebola outbreak recorded so many cases so soon after its declaration,” said Médecins Sans Frontières deputy director Dr Alan Gonzales according to a BBC report.

Health experts also say international aid cuts last year by the US and other rich nations were devastating for eastern Congo. Health and aid workers are also facing anger from local communities owing to scepticism as well as the strict protocols around the burial of suspected victims.

Congo’s history of armed violence

The DRC outbreak is unfolding in the provinces of Ituri and North Kivu, regions long scarred by armed violence and humanitarian crises. Over a hundred armed groups operate across these eastern provinces.

“Across both provinces, around four million people need urgent humanitarian assistance, two million are displaced and ten million face acute hunger,” WHO chief Tedros Ghebreyesus has said.

This has raised concerns that the disease might spread to the large displacement camps near the city of Bunia, where the first cases were reported.

So who are these militant groups in the DRC? To understand this, one must go back to a tragedy that took place in DRC’s eastern neighbour: Rwanda.

The Rwandan Genocide of 1994 saw ethnic Hutu extremists killing an estimated one million minority ethnic Tutsis and moderate Hutus.

Following the Tutsi takeover, two million Hutu refugees crossed the border into DRC, mostly settling in camps in the North Kivu and South Kivu provinces.

According to the US-based think tank Council on Foreign Relations, some of these Rwandans who entered DRC were Hutu extremists who formed militias and started targeting Tutsi locals in the country. Tutsi militias, too, organised against the Hutu groups.

Today, the Hutu armed group FDLR and Tutsi-led groups like the M23 are still fighting with each other, aside from several other militant groups and the army.

These armed groups have been able to sustain themselves by taking control of the mineral-rich land of eastern Congo where cobalt, coltan and copper, all used in electronic devices, can be found.

While the Congolese government still largely controls the northeastern Ituri province, that control is tenuous, the Associated Press reported. The Allied Democratic Forces, a Ugandan Islamist group linked to IS, is also one of the dominant rebel groups there and responsible for violent attacks against civilian targets.

Ghebreyesus has called for a ceasefire, stating: “No cause, no conflict, no grievance is worth condemning innocent people to death from a preventable disease.”

The damage to healthcare facilities

Since 2019, the UN has reported around 300 attacks on healthcare personnel, resulting in six deaths and 70 injuries among workers and patients. In 2023 alone, 115 cases of obstruction or violence against healthcare facilities were reported in the DRC, with 41 doctors being kidnapped and health supplies being looted at least 34 times. In other attacks, vital medicines, equipment and solar panels were looted from health centres and pharmacies.

Before the outbreak, Doctors Without Borders said that the insecurity in Ituri had worsened recently, causing doctors and nurses to flee and leaving overwhelmed health facilities and, in some parts, “catastrophic conditions”.

Treatment facilities are operating at low capacities with reports of shortages of PPE and basic sanitation supplies.

Conflicts in the DRC have also weakened surveillance and detection systems. According to the International Health Regulations, disease surveillance relies on effective communication lines and the rapid identification and reporting of outbreaks.

In the case of the current outbreak, a critical gap passed between the presumed first case, with symptoms developing on April 25, and laboratory confirmation on May 14.

This was caused in part because the nearest functional laboratory was located outside the conflict-affected zone, requiring samples to be transported across insecure roads. With damaged medical infrastructure, this crucial step towards recognising a biological threat was delayed.

How does the government react?

The outbreak in Congo is being managed by the government and in part by rebel authorities, with an array of aid agencies also helping, AP reported.

The government has initiated a set of responses which range from healthcare services in collaboration with international health agencies to trying to establish military control over the armed groups to contain their violence.

According to a Council on Foreign Relations report, Central Africa has extensive experience dealing with Ebola. Both Uganda and the DRC have faced multiple localised outbreaks in the past decade and have successfully contained and ended them.

However, the report said, people’s confidence in the DRC government is low, large swathes of eastern territory remain under the control of the M23, “and murky security-for-minerals deals fuel uncertainty and suspicion”.

This raises the question of whether the DRC needs political stability first in order to expedite treatment facilities for the Ebola outbreak. With cases rising, the DRC may not have the time to keep waiting for an answer.

The author is an intern with The Indian Express