Wednesday, June 12, 2019

Stopping the Epidemic

"The new protocol is that we just abandon the body."
"They will learn their lesson when they get sick."
Philemon Kalondero, 39, Ebola response team

"Can we stop the epidemic? Certainly we can."
"[But to succeed, a political solution is first required to reduce the violence]."
Mike Ryan, World Health Organization emergencies program
Health workers carry a coffin containing a victim of Ebola virus on May 16, 2019, in Butembo, DRC, a city at the epicenter of the Ebola crisis.
Health workers carry a coffin containing a victim of Ebola virus on May 16, 2019, in Butembo, DRC, a city at the epicenter of the Ebola crisis.

In Democratic Republic of Congo, in rural Beni, subsistence farmer Janvier Muhindo Mandefu set aside his farming occupation to work instead buying the bodies of Ebola victims, aware of the highly contagious state of the decomposing bodies. He is aware of the possibility of contagion, handling these bodies, but he perseveres. The bodies' threat to his own state of health is one thing, the threat he is equally aware of that he and his burial team could be attacked by relatives of the dead, is more worrying. He has already experienced one such attack.

Mourners accuse burial team members of stealing organs from the corpses, threatening to throw the team members into the open graves. Mr. Muhindo has been attacked by a swinging hoe. On another occasion a mourner had a hand grenade. On that occasion the entire team scattered and failed to return. The three-year-old Ebola victim remained unburied. "Someone like me can be buried alive", Mr. Muhindo said, watching his team hose down the trucks following another day of burials.

It was thought that the Ebola outbreak in eastern Congo was under control. Now, however, it has roared back, and is spiraling out of control mostly because combat efforts have been interfered with by attacks on treatment centers and health workers, making this outbreak the second-largest ever recorded. Growing mistrust of government managing the efforts at eradication, and mistrust of international medical experts struggling to steer patients into treatment centers, have taken their toll.
Insecurity has significantly complicated efforts to contain the DRC's ongoing Ebola outbreak [File: Al-Hadji Kudra Maliro/AP]
Insecurity has significantly complicated efforts to contain the DRC's ongoing Ebola outbreak [File: Al-Hadji Kudra Maliro/AP]

Treatment centers were attacked by gunmen, others set on fire, health workers suspended their work when a doctor was killed. Some international groups have seen fit, given the dangers involved, to pulling some of their personnel out of the situation. Mid-May saw almost 1,150 deaths from Ebola. When the outbreak first occurred, police would remove bodies from homes sometimes at gunpoint. Now, the bodies are left as a result of the violence from relatives of the dead.

The outbreak has occurred in the part of eastern Congo afflicted by armed groups, conflicts over land possession, natural resources, ethnicity and religion motivating them. One of the groups is tied to the Islamic State. When the latest wave of health experts and humanitarian workers arrived they had their previous experience treating Ebola. They had lessons learned from the outbreak across West Africa in 2013 that killed over 11,000 people. And they had recently contained an outbreak in western Congo.

They brought with them medical advances, an effective vaccine, experimental treatments and a transparent enclosure called the "cube", where patients would be placed within, reducing the risk of transmission. Because the outbreak was in a vulnerable region close to the borders of Rwanda, Uganda and South Sudan it was imperative to bring it under control to halt its spread.

The region had been exempt from the presence of Ebola until last year when it manifested in a town called Mangina and by late summer it had shown up in Beni, a city of about 350,000.

In Beni massacres by machete killed an estimated 800 people in recent  years. Local politicians speculated the government had imported the disease in a region where an estimated two percent of those surveyed felt mistrust for the national government. "Scientifically, I don't believe that it's possible to first have the killings of people in Beni, and now this disease without them being related", sagely said Crispin Mbindule Mitondo, a national assembly member, his remarks broadcast on local radio.

A tight national election was occurring along with the first transfer of power by ballot in Congo since 1960's independence. But when Ebola arrived Kinshasa suspended voting in Ebola-effected areas claiming that polling places might spread the disease in an area that was an opposition stronghold. A coincidence that persuaded locals that Ebola was part of a government plot to deny them the vote. And a day later an Ebola triage center in Beni was set on fire by protesters.

"When they cancelled the elections, it was a disaster for us", Emmanuel Massari of Doctors Without Borders remarked. Vaccination teams traveled under armed police or military escort, adding to the locals' suspicion, which made it appear as though the Ebola response was in reality an extension of an unpopular national government. Where, during confrontations with grieving family members, police officers and soldiers accompanying medical teams have opened fire.

The city of Butembo, with its million residents is now another disease locale where patients who had Ebola refused to go to treatment centers, viewing them as a place where they would not be cured, but die from the infection. In Katwa, an outlying area of Butembo, operated by Doctors Without Borders the Ebola treatment center was set on fire, the patients fleeing into the night.

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Tuesday, March 17, 2015

Savagery Unabated in Democratic Republic of Congo

When the savage slaughter in Rwanda was over in 1994 and the Tutsis who had been targeted by the ruling Hutus, managed to take control of the country and rout the murderous Hutu leaders engaged in ethnic cleansing, the Hutus made themselves scarce in Rwanda, crossing the border to invade neighbouring countries. In particular the "genocidaires" marched to Democratic Republic of Congo and renamed themselves the Democratic Forces for the Liberation of Rwanda.

And then ran amok in the DRC. The forests of North and South Kivu provinces in eastern DRC provides perfect haven for the Hutus in company with other rebel groups. Attempts have been made to disarm the Hutus. A United Nations-led initiative to persuade them to surrender their arms for amnesty went ignored with a relative handful of ill and elderly rebels surrendering, and left behind was an estimated 1,500 combatants dedicated to murder and mayhem.

Congolese national police officers in front of the 83 Democratic Forces for the Liberation of Rwanda guerrillas who surrendered in Kigogo.  Sarah Fluck - The New York Times
And rape, mass rape, a special weapon of their special ethnic-cleansing war. A military formation of South African, Tanzanian and Malawian troops under UN control had a mandate to attack the rebel groups in the eastern DRC, to avoid anything approximating the disaster of the UN forces in Rwanda using force only in self-defence, while slaughter went on around them and they were helpless to stop the mass murders by ethnic Hutu militias.

Partial success was realized in routing the Rwandan rebels from North Kivu in 2013. And then DRC President Joseph Kabila appointed two generals who appeared on a United Nations "red list" for suspected human rights violations to lead the joint African operation against the Hutus.  President Kabila refused to replace the generals leading the UN to suspend its support. The African Union has been ignored in its calls on President Kabila to accept UN support.

The Congolese army is poorly paid, infused with low morale, suffers from poor discipline and a telling lack of special forces training to enable them to combat guerrilla fighters like the Hutu in the rugged landscape that they have existed in for 20 years. And while the Hutu guerrillas have been accused of mass rape, so too have the Congolese army.

Over a million civilians in the Kivus were displaced in 2009 by Congolese and Rwandan troops with retreating Hutu fighters taking to massacring villagers and destroying their villages to send a message to the international community. Without the UN engaged in humanitarian work in light of such huge displacements and to oversee the Congolese troops so their history of human rights abuses do not once again run amok, civilians become the victims of the fighting.

The UN withdrew its support for the offensive after a dispute over the campaign's leadership [AFP]

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