The public health workers behind the Ebola response in the Democratic Republic of the Congo are struggling to combat an outbreak of the deadly virus in what is effectively a war zone. Repeated rebel attacks on the city of Beni—the outbreak epicenter and the headquarters of the response operation—have given the virus an advantage over the humans trying to contain it, acknowledges Tedros Adhanom Ghebreyesus, the World Health Organization’s director-general.
The most recent attack, on Friday, targeted a military encampment close to a hotel in Beni where some Ebola responders are housed. The hotel was hit by a shell that did not detonate. In the aftermath, a decision was made the next day to evacuate 16 personnel experiencing emotional distress and to insist on heightened security from the United Nations peacekeeping force in the area, known as MONUSCO.
STAT caught up over the weekend with the WHO director-general, who traveled to Beni earlier this month. We asked Tedros, as he is known, about the WHO’s ongoing battle against Ebola in North Kivu province and whether a global health emergency should be declared.
As of Sunday, there have been 366 confirmed and probable Ebola infections reported in this outbreak; 214 of those people died.
The interview has been lightly edited for clarity and length.
Do you have a sense for whether the Ebola response team was a target of the rebels? Or is it just that they are in the line of fire, because of where they are headquartered in Beni, so close to the U.N. peacekeepers?
They were attacking the MONUSCO camp. I checked with MONUSCO Commander General Elias Martins Filho. He said the hotels where our response teams are were not attacked.
How is it for you? You said you are proud of these people, and it’s understandable why, but at some point somebody could die there. It’s a very, very dangerous situation.
Yes, it’s tough. … We have almost constant discussion with my colleagues there. And what they’re asking for now is maximum protection. And I even asked them: OK, what do you want? And they said: more boots on the ground. And more protection, so there is this deterrent effect.
So that’s exactly what they’re doing now. MONUSCO is already mobilizing. They’re increasing their troop level today.
What more could the world do to help WHO get this job done?
We’re getting the support we need, to be honest, from the international community. One is funding; it’s OK. Because the outbreak took longer than we expected, we may need more. But I’m very confident that we will get what we need.
And second is the protection. And as you know the MONUSCO troops have even sacrificed their lives. The other is, more importantly, the commitment of the government is strong, too.
But the attacks have increased since Ebola started, both in intensity and frequency. So it’s a very dangerous situation.
The insecurity is a virus. And there is another virus, Ebola. Managing two viruses at the same time is tough but at the same time, we’re having an impact.
Some people think this outbreak should be declared a PHEIC—a Public Health Emergency of International Concern. Are you thinking of reconvening the WHO’s Ebola Emergency Committee, which met in October, to advise you on whether the outbreak should be declared be a PHEIC?
That committee met recently. I think things have not really changed significantly from then. I think it’s better, based on our discussions with the [U.N. Department of Peacekeeping Operations], to see how the situation will be handled. We’re just starting. And they’re giving it their best. And if necessary, they will do even more.
If there is a change that needs another convening of the Emergency Committee, of course, I will convene. But at this point, I don’t see that it will add any value. Because even if they [propose] temporary recommendations, how different will it be from what we have now?
What would be gained from declaring a PHEIC? Is there something that you need that you can’t get because it’s not a PHEIC?
To be honest, I’m not missing anything I have asked for. That’s why the Emergency Committee also was not convinced we need to call it a PHEIC.
[International] partners, they call me. And they ask if we need anything. The U.K., the European Union, Germany—almost everybody. USAID, the same. They want to support if there is a need. The U.S. government. Wellcome Trust. They are ready.
What about in terms of personnel? The U.S. government will not allow its employees to go near the epicenter, because they say it’s too unsafe. Is that a disappointment?
They’re following their security rules. So to be honest, I cannot say anything about that, because they have to follow their rules. But they’re supporting us financially, so we can deploy people. I don’t think the personnel issue is a problem.
Of course it would be good if they could join us. But I don’t think they will be able to change the security provisions easily.
You have enough volunteers through the global health alert and response network?
We can get as many as we want. No problem in personnel.
There are supposed to be elections in DRC next month. Are you concerned that as the elections approach the violence might increase?
It’s very difficult to say. But what we’re doing is we’re working with the government to have infection prevention and control measures included in the preparation for the election, for instance in polling stations and so on.
During elections sometimes Ebola or other problems could be used politically. We’re trying to pass a message to everybody that the virus is an enemy to everybody. It’s dangerous to everybody. So no need to politicize that. We have directly and indirectly spoken to both the parties and I hope they will cooperate.
I guess what you need is for some peace and quiet, so your team can do its job. Is that it?
Exactly. That’s why I say the insecurity itself is a virus, because it’s helping the virus [Ebola] to propagate.
The two problems together really complicate the operation, because there will be inaccessible areas that we cannot reach. But not only that: When there is an attack … we may hold or stop our response for two days or so. During that time, the virus gets an advantage.