From Congo's Mines And Conflict Zones, Ebola Spreads In Silence

(MENAFN- Live Mint) (Bloomberg) -- At Nyankunde Hospital in the Ituri province of northeastern Democratic Republic of Congo, Dr. Charles Kashindi is on the frontline of the fight against the latest deadly outbreak of Ebola.

Erroneous testing - which targeted a different strain of the viral illness - meant his doctors initially failed to detect their first case of the rare Bundibugyo type this month, prompting what proved to be a misplaced sense of relief.

“We said, OK, glory be to God, it's not Ebola,” Kashindi said by phone. They prepared the victim's body to hand over to the family, then studied another death with similar symptoms.

Less than two weeks later, there are 25 suspected cases at Kashindi's hospital, which has no isolation rooms, little protective equipment and a rapidly dwindling supply of masks. Multiple staff members are sick, including an American surgeon who was evacuated to Germany for treatment, where he is in stable condition. Four people have died.

“It's truly a cry for help, an SOS,” said Kashindi, who's being monitored as he was in contact with infected patients.“We're really afraid of a terrible outbreak here at the hospital.”

Nyankunde Hospital, a sprawling referral center serving about 200,000 people across northeastern Congo, has long operated under the pressures of conflict. A sign at the entrance warns visitors not to attack health workers or bring guns into the facility - reminders of the insecurity that has shaped life for decades in this part of Ituri province, physician Lindsey Cooper said in a video tour posted online last May.

Congo suffered its first known Ebola outbreak half a century ago. It took nearly 20 years until the next serious one and more than a decade after that until the third.

Now, deadly flare-ups like the current one in Ituri occur much more regularly. It's the 17th outbreak recorded since the first in 1976. And they're going to keep happening, according to Jean-Jacques Muyembe, the head of Congo's National Institute of Biomedical Research and one of the world's leading experts on the disease.

Some of the uptick in cases can probably be explained by better detection methods, Muyembe told reporters Tuesday. But population growth and climate change, leading to more contact with wildlife, are the main causes of the spread of animal-born diseases like Ebola, he said.

It's a new reality that Congo - and the world - needs to come to terms with, and quickly.

The World Health Organization has declared the situation a public health emergency of international concern, its second-highest level of alarm behind a pandemic emergency. The agency said the Bundibugyo outbreak met the threshold because it has no approved vaccine or treatment and is spreading in a conflict-ravaged region with poor infrastructure and high population mobility.

By May 20, Congo had recorded 671 suspected cases and 160 suspected deaths across Ituri and North Kivu provinces, including 64 laboratory-confirmed infections. Despite an Ebola surge in the region that ended just six years ago, authorities were slow to recognize the signs this time in part because of the delay in identifying the Bundibugyo strain, according to Muyembe.

He acknowledges that the monitoring system failed, which means officials are playing catch-up to stop the spread in a population that already has doubts about trusting the government.

Efforts to deal with a viral outbreak are also complicated by the complexities of life on the ground in northeastern Congo. It's one of the world's most bio-diverse regions, a site of rich pockets of minerals, and home to multiple armed groups who've perpetrated some of the world's worst violence of the past 30 years.

Half the suspected deaths and nearly half the cases thus far have come from Mongbwalu, about 111 kilometers (69 miles) by road from Nyankunde. It's a remote area full of gold traders and miners who dig with rudimentary tools or basic machinery on permits formerly owned by AngloGold Ashanti Plc.

There are few health centers in the area, and sick miners have made the arduous journey to seek treatment at Kashindi's hospital, according to the doctor. One died two hours after arrival.

The word they've been repeating about Mongbwalu is“coffins,” Kashindi said, adding that sick diggers were saying that“people were dying, dying, dying” around the mines.

According to Muyembe, Congo's old gold mines are a particular menace because they're full of bats that can transmit Ebola to animals or humans.

“They get the virus, but they don't get sick, but they still have the virus in their blood,” he said.“And there are bats that are as big as a chicken.”

The source of the most recent outbreak hasn't yet been identified, but in previous incidences of hemorrhagic fevers like Ebola and its cousin, Marburg, meat from wild animals is a primary culprit, Muyembe said.

“Bush meat is a principal source of protein for Congolese, at least those who live in rural areas,” he added.“There's no chicken there, there's no beef, so one makes do with the fruits of hunting.”

Jennifer Hinton, a Canadian who's worked on sustainable mining projects for two decades from across Congo's border in Uganda, lived through a Marburg outbreak there. In 2009, she invested in a colonial-era gold mine after Marburg - likely from the millions of bats in the region - killed its owner.

Hinton remembers the first time she saw bats flying over Uganda's lakes.

“I was squinting and thinking, is there a storm coming?” she said.“And it's bats, fruit bats. Millions of them. It's pretty spectacular.”

Researchers estimate thousands of bats in a single colony could carry Marburg and transmit it to any person or animal that is bitten or that eats them undercooked, which posed an unexpected problem at the mining site.

“I'm just seeing 25 baboons sitting outside of a tunnel, just catching bats out of the sky like they were apples on a tree and just sitting there happily munching away,” Hinton told Bloomberg.

She said employees in Uganda knew how to protect themselves from Marburg and were all familiar with contact tracing after multiple outbreaks of hemorrhagic fevers over the years. Before she got involved, workers trapped bats in the mine to kill them, while her project scared the rest away due to increased noise, lights and activity.

The situation in the Ebola epicenter of Mongbwalu is more complicated. A large part of the population is reluctant to comply with instructions from health officials and believes Ebola is mystical.“Like a spirit of death,” according to Kashindi.

It doesn't help that authorities don't have full control of Mongbwalu, which is home to multiple armed groups linked to local ethnic communities.

In one case in 2020 and 2021, a group known as Codeco sent more than 5,000 fighters to patrol and mine in Mongbwalu, according to a United Nations report in 2021. Just last month, Codeco massacred at least 69 people from a rival ethnic community not far from mines, AFP reported, citing local security forces.

The conflict between the two communities - the Hema and Lendu - has persisted for years. When it was at its worst in 2002, Nyankunde hospital lost power from the grid. The hospital has been using generators and solar power ever since, Kashindi says.

Congolese soldiers and police can't always be trusted either. Security forces deployed at Mongbwalu“also engaged in illegal gold mining and taxation of diggers,” according to a 2022 UN report.

Congo's Minister of Health, Roger Kamba, insists his government is capable of handling the latest Ebola outbreak - after all, they've contained 16 before, and all but one without a vaccine.

“We have the expertise,” Kamba said.“Ebola is not a mystical disease.”

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--With assistance from Naomi Kresge, Jeremy Diamond, Janice Kew and Jason Gale.

(Updates to add detail on hospital in sixth paragraph; updated case numbers in 12th.)

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