MSF suspends work at Katwa Ebola center as WHO seeks more support - CIDRAP

Doctors Without Borders (MSF) said today that it has suspended all activities at the Ebola treatment center in Katwa, following a violent attack over the weekend, severely limiting access to care in the Democratic Republic of Congo's (DRC's) main hot spot.

And in other key developments, the DRC's health ministry reported three more cases, and World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, said $148 million is urgently needed to support the Ebola response in the DRC. He also warned that without help from the global community, the country is at risk of backsliding in its efforts to contain the disease.

Work needed to build community trust

In a statement, MSF said the attack began at 10 pm on Feb 24 when unidentified assailants began throwing rocks at the 70-bed MSF-managed treatment center, which has admitted 602 patients, including 49 confirmed cases, since December. Then the group set parts of the structure on fire, which destroyed medical wards and equipment. The brother of a patient died while trying to escape, though the exact circumstances of his death are still unclear, the group said.

Six patients with suspected Ebola and four with confirmed infections were transferred to other facilities, and all treatment center staff were evacuated.

Emmanuel Massart, MSF's emergency coordinator in Katwa, said in the statement, "This attack was traumatic for patients, their relatives, and staff present inside the center at the time. This attack has crippled our ability to respond to what is now the epicenter of the outbreak."

MSF said earlier Ebola outbreaks showed the importance of gaining community acceptance, and without the peoples' trust, the sick and dead remain hidden and health workers risk threats and attacks.

Meinie Nicolai, MSF's general director in the DRC's North Kivu province, said, "Although the reasons behind the attack are unclear and such violence is unacceptable, what we know is that the actors of the Ebola response—MSF included—have failed to gain the trust of a significant part of the population."

"All those involved in this response must change their approach and truly engage with the grievances and fears of the communities," she said.

Three new cases lift total to 875

Meanwhile, the DRC's health ministry today reported three new cases, one each from Mandima in Ituri province and from Vuhovi and Butembo in North Kivu province, raising the overall outbreak total to 875 cases, 810 of them confirmed and 65 listed as probable. Outbreak responders are still investigating 196 suspected cases.

Three more deaths were reported from Ebola, all from the same locations as the new cases and all of them people who died in community settings, a factor known to dramatically increase the risk of transmission.

The health ministry said work continues to refine patient databases, which has resulted in reclassifying some cases based on where symptoms began, which it said isn't always easy to ascertain. For example, a patient from Katwa who fled to Bunia with her family and died in Komanda was reclassified as a Katwa case.

And in a related development, Lubero health officials today reported the detection of that area's first case, a woman from Katwa who was a contact of a known case and fled to Lubero after refusing treatment at the Ebola treatment center when she became ill. The woman died at Lubero General Regional Hospital. The ministry said her illness is classified as Katwa health zone, where her symptoms first appeared.

In a weekly update today, the WHO's African regional office said ongoing active local transmission continues, and over the past 21 days, 55% of new cases have been from Katwa and 25% from Butembo.

One new infection in a healthcare worker was reported last week, raising the total to 69, including 21 deaths.

Contact tracing is still under way in 15 health zones, where insecurity and pockets of community resistance are still a problem. The WHO said efforts are ongoing to beef up contact follow-up in Vuhovi, where violence recently disrupted response activities.

Funds needed for unprecedented challenges

In making a plea for more funds from international donors for the Ebola response today, Tedros said so far, only $10 million has been pledged. According to the WHO statement, he will travel to the DRC next week to meet the country's president in Kinshasa before visiting the two current epicenters, Butembo and Katwa.

"The situation is unprecedented: there has never been an Ebola outbreak in these conditions, with such a highly mobile population and with many gaps in the health system," he said.

Security is another major concern, Tedros said, adding that he is deeply saddened by the attack on the MSF facility in Katwa. Despite the tough challenges, he said the DRC and its partners have made major gains and averted hundreds or maybe even thousands of deaths, with more than 80,000 people vaccinated and more than 400 Ebola patients treated.

However, he warned that Ebola could spread from Butembo and Katwa to even more volatile areas that almost no partners could reach. Tedros praised generous technical and financial support that's already come from donors.

"We now need them to join us in the final push. No country or partner can face this deadly virus alone. The impact on public health and the economic ramifications can expand far beyond one country or continent."

See also:

Feb 26 DRC statement

Feb 26 MSF statement

Feb 26 WHO statement

Feb 26 WHO African regional office weekly report

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