The WHO said the presence of armed groups and the broad spread of the disease, could make vaccination "near impossible" in North Kivu. It's the 10th outbreak in DRC since Ebola was discovered.
Image: picture-alliance/AP Photo/J. Bompengo
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The organization's emergency response chief, Peter Salama, expressed concern about the regional risks this outbreak could pose — given the pattern of its spread and its closeness to international frontiers.
"It would appear that the risk, as we can surmise for DRC, is high. For the region it's high given the proximity to borders, particularly Uganda," Salama said.
Over a dozen WHO officials have been sent to North Kivu to help contain the disease.
The Democratic Republic of Congo's health ministry said on Thursday that the Ebola variant in the most recent outbreak in North Kivu province had been identified as the Zaire strain.
The North Kivu outbreak comes just over a week after Congo had declared the end of an outbreak in the northwest of the country that began in May, and in which 33 people died. The World Health Organization (WHO) has dispelled the notion that the two outbreaks are linked.
In this week's Ebola outbreak, four cases have been registered in and around the town of Mangina, which has a population of 60,000 and is located near the border with Uganda. Two of those cases were confirmed to be health workers. An additional 20 people have died in the area since July, as a result of hemorrhagic fevers that have not been identified as Ebola.
The outbreak in northwestern Congo also belonged to the Zaire strain and an experimental vaccine from pharmaceutical company Merck was used to fight its spread.
That vaccine was given to contacts of Ebola patients and contacts of contacts, in an effort to ringfence the disease. For ring-vaccination to be effective, health workers must reach all those potentially infected with the deadly virus.
This may be difficult to do in northeastern Congo, as the WHO estimates that the outbreak could spread over tens of kilometers.
Ebola: Fight against the deadly virus
Despite the highest safety standards, people in Europe and the US have been infected with the Ebola virus. Protective suits and airports checks are being used to prevent the further spread of the disease.
Image: picture-alliance/dpa/J. Woitas
Protective clothing
Proper protective clothing for doctors and nurses is critical. All exposed skin must be covered with a material that cannot be penetrated by the virus. But the suit alone isn't enough: Proper procedure is also important.
Suiting up
Health care workers must practice correctly putting on a protective suit, as seen here at the special isolation unit in Dusseldorf. New suits are used every time, so there is no risk of infection when getting dressed. Unprotected workers are therefore able to help.
Image: picture-alliance/dpa/Federico Gambarini
Completely separate
The patient rooms in the Dusseldorf isolation unit are completely shielded from the outside world. Air is filtered, and wastewater must go through a separate treatment process. The protective suits, used at all times in the ward, are kept at positive pressure. These measures go further than is necessary: While Ebola can be transmitted by contaminated objects, the virus is not airborne.
After the patient is treated, the entire suit is sprayed from the outside with a disinfectant to kill off any potential viruses. Only after this shower can the suit be removed - cautiously.
Image: picture-alliance/dpa/Sebastian Kahnert
Outside help
When removing the protective suit, health care workers must exercise extreme caution. Using permanently installed protective gloves, outside assistance can be provided without coming into direct contact with the suit. After use, the suit is immediately disposed of and burned.
Image: picture-alliance/dpa/Federico Gambarini
Infected nurses
Despite the high safety standards, a total of three nurses in Spain and the United States have contracted the disease. The circumstances surrounding the infection have not yet been clarified. The nurses' homes (as seen here in Texas) were sealed off and disinfected after the discovery of the transmission.
Image: Reuters/City of Dallas
Protection in Africa
Doctors and nurses in West Africa have now also been outfitted with protective suits. However, these do not always meet the standards deemed necessary for effective protection. Sometimes, small areas of skin are left unprotected, or the material used in the suit is permeable. In addition, putting the suit on and removing it can be risky.
Image: picture alliance/AP Photo
Isolating the dead
Extreme caution is also necessary at the funerals of people who have died of Ebola. A West African tradition, which sees the family of the deceased wash the body has led to many new infections. For mourning friends and family, these strict isolation measures are often hard to understand.
Image: Reuters/James Giahyue
Tent as isolation units
In a region where medical care is extremely underdeveloped, such an outbreak provides a daunting challenge. Infected people, like here in Liberia, are cared for in hastily constructed tents. But even a country like Germany would probably be overwhelmed by such an epidemic. At the moment, the country only has around 50 beds set up in isolation units.
Image: Zoom Dosso/AFP/Getty Images
Incineration instead of sunlight
In some of the affected West African regions, contaminated suits are hung out in the sun in an attempt to disinfect them for further use. But it's much safer to burn the clothing immediately after use, as seen here in Guinea. However, supply shortages and the high prices of suits make such advice difficult to follow. Protective clothing can cost between €30 and €200 ($40-$250).
Image: Cellou Binania/AFP/Getty Images
Airport controls
Air travelers represent the biggest threat when it comes to transmission of the virus over long distances. For this reason, travelers' temperatures are now being monitored at some airports. However, this method does not provide absolute security: Ebola's incubation period is up to 21 days.
Image: Pius Utomi Ekpei/AFP/Getty Images
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North Kivu a conflict zone
Additionally, Salama noted that approximately 100 armed groups operate in North Kivu and this could make ring-vaccination impossible. Instead, WHO workers might consider "a more homogenous geographical strategy", he said, where security concerns are assessed on a day-to-day-basis. Staff would be based in the larger city of Goma.
Since armored personnel carriers and support from UN peacekeepers would be needed to work in North Kivu, this could make it very difficult to deploy the kind of far-reaching contact tracing required.
WHO has already dealt with an outbreak in this area, around a decade ago. "We had to negotiate with many armed factions," Salama said, in order to provide the badly needed aid.
The International Federation of Red Cross and Red Crescent Societies echoed the WHO's concerns, saying that responding to a new Ebola outbreak in North Kivu would be "highly complex," due to the security situation.
The Ebola virus is can be transported long distances by bats, who are carriers of the virues, and tend to find its way into bush meat sold at local markets.
In humans, the deadly virus spreads through contact with bodily fluids and once infected, it causes hemorrhagic fever, vomiting and diarrhea and is spread through direct contact with body fluids. Over 11,300 people died of an epidemic in West Africa from 2013 to 2016.
