Fighting Ebola in conflict in the DR Congo

Moran, Benedict

doi:10.1016/s0140-6736(18)32512-1

Cited by 24 publications

(22 citation statements)

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“…The one-health paradigm provides opportunities for public education and control because EVD is an animal virus that is transmitted to humans 51–53. Getting to the root of EVD control, therefore, requires continuous collective partnership and engagement of human and animal health sectors.…”

Section: Resultsmentioning

confidence: 99%

Forty-two years of responding to Ebola virus outbreaks in Sub-Saharan Africa: a review

et al. 2020

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IntroductionEbola virus disease (EVD) is one of the deadliest haemorrhagic fevers affecting humans and non-human primates. Thirty-four outbreaks have been reported in Africa since it was first recognised in 1976. This review analysed 42 years of EVD outbreaks and identified various challenges and opportunities for its control and prevention in Sub-Saharan Africa.MethodsA literature search of relevant articles on EVD was done in PubMed, Web of Science and Google Scholar electronic databases. Articles published from 1976 to 2019 were reviewed to document reports of EVD outbreaks in Sub-Saharan Africa. Data extraction focused on the year of outbreak, geographical spread, virus strain involved, number of cases and deaths, case fatality, and outbreak management. Analyses of trends in case fatality were performed by calculating ORs between times.ResultsIn the past four decades, a total of 34 EVD outbreaks affecting 34 356 cases and causing 14 823 deaths were reported in 11 countries in Sub-Saharan Africa. The overall case fatality rate (95% CI) was 66% (62 to 71) and did not change substantially over time (OR in 2019 vs 1976=1.6 (95% CI 1.5 to 1.8), p<0.001). The results of this review indicate that challenges to control EVD outbreaks are related to epidemiological, sociocultural and health system factors.ConclusionsSub-Saharan Africa continues to face considerable challenges in EVD control, whereby there are no significant changes in case fatality rates observed during the past four decades. Socioeconomic and cultural processes need to be critically considered to shape the community behaviours that lead to exposure to EVD outbreaks. Areas that need to be addressed to prevent future EVD outbreaks include a broad-based, one-health approach, effective communication, social mobilisation, and strengthening of the health systems.

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Section: Resultsmentioning

confidence: 99%

Forty-two years of responding to Ebola virus outbreaks in Sub-Saharan Africa: a review

et al. 2020

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“…During 2018, this movement disintegrated and many fighters surrendered after the victory of Félix Tshisekedi in the presidential elections. Violence continued in other parts of the country, albeit with a lower intensity, and created problems for the response to the Ebola outbreak in conflict-ridden North Kivu province in August 2018 (Moran, 2018). Figure 5 shows that the number of civilians killed in one-sided violence also dropped, reaching its lowest level since 2012.…”

Section: Non-state Conflict 1989-2018mentioning

confidence: 99%

Organized violence, 1989–2018 and peace agreements

Pettersson¹,

Högbladh²,

Öberg

2019

Journal of Peace Research

274

169

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This article reports on trends in organized violence and peace agreements collected by the Uppsala Conflict Data Program (UCDP). The number of fatalities in organized violence decreased for the fourth consecutive year, to reach the lowest level since 2012. In 2018, UCDP recorded almost 76,000 deaths: a decrease of 20% compared to 2017, and 43% compared to the latest peak in 2014. State-based armed conflict drives this downward trend in organized violence, with Syria accounting for much of the change. The number of civilians killed in one-sided violence also dropped in 2018, reaching its lowest level since 2012. In contrast, non-state conflict remained on a high level. The general decline in fatalities from organized violence does not correspond with the trend in the number of active conflicts. In fact, the world has seen a new peak in the number of conflicts after 2014, matched only by the number of conflicts in the early 1990s. In 1991, the peak in the number of armed conflicts corresponded with a similar peak in the number of signed peace agreements. This was followed by a decrease in the number of conflicts in the late 1990s and early 2000s. However, the most recent rise in armed conflicts has not been matched by a similar rise in the number of peace agreements. Two circumstances that characterize the recent rise in conflicts have also been found to make conflicts harder to solve: explicit religious claims and high levels of internationalization.

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“…The violence is centralized around politics, ethnicity, land ownership, and economics (2,3). In particular, mining regions in the provinces of North Kivu and Ituri have been destabilized by disagreements regarding entitlement, which have led to conflict from more than 70 armed groups (2)(3)(4)(5)(6). The most violent armed groups include the Ugandan Allied Democratic Forces (ADF) and the Maï-Maï Kilalo (7).…”

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confidence: 99%

“…The chronic conflict in North Kivu and Ituri has stymied surveillance, contact tracing, and vaccination (4,(9)(10)(11)(12). Case identification and containment of Ebola becomes even more difficult in areas that are too dangerous for health workers to enter or work (5,11).…”

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confidence: 99%

“…For example, violent episodes characterized by kidnappings and killings prohibited healthcare professionals from operating around the major road connecting the North Kivu and Ituri provinces (7). Moreover, health care workers and Ebola treatment centers (ETCs) were targets of attacks throughout the outbreak that have resulted in at least 10 deaths and many more gravely injured among healthcare workers thus far (4,6,9).…”

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confidence: 99%

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The exacerbation of Ebola outbreaks by conflict in the Democratic Republic of the Congo

Wells

Pandey

Ndeffo-Mbah

et al. 2019

Proc. Natl. Acad. Sci. U.S.A.

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The interplay between civil unrest and disease transmission is not well understood. Violence targeting healthcare workers and Ebola treatment centers in the Democratic Republic of the Congo (DRC) has been thwarting the case isolation, treatment, and vaccination efforts. The extent to which conflict impedes public health response and contributes to incidence has not previously been evaluated. We construct a timeline of conflict events throughout the course of the epidemic and provide an ethnographic appraisal of the local conditions that preceded and followed conflict events. Informed by temporal incidence and conflict data as well as the ethnographic evidence, we developed a model of Ebola transmission and control to assess the impact of conflict on the epidemic in the eastern DRC from April 30, 2018, to June 23, 2019. We found that both the rapidity of case isolation and the population-level effectiveness of vaccination varied notably as a result of preceding unrest and subsequent impact of conflict events. Furthermore, conflict events were found to reverse an otherwise declining phase of the epidemic trajectory. Our model framework can be extended to other infectious diseases in the same and other regions of the world experiencing conflict and violence.

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Fighting Ebola in conflict in the DR Congo

Cited by 24 publications

References 0 publications

Forty-two years of responding to Ebola virus outbreaks in Sub-Saharan Africa: a review

Forty-two years of responding to Ebola virus outbreaks in Sub-Saharan Africa: a review

Organized violence, 1989–2018 and peace agreements

The exacerbation of Ebola outbreaks by conflict in the Democratic Republic of the Congo

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