The most recent Ebola outbreak spreading through the Democratic Republic of Congo is now the worst in the country's history, with 209 dead and 333 confirmed or probable cases, according to the DRC's health ministry.
According to The Express, efforts to contain the disease have been hampered by localized armed conflict and community resistance to health officials.
The outbreak, the second this year, began in North Kivu before spreading east to Ituri. Oly Ilunga Kalenga, the DRC’s minister of public health, said efforts to contain the deadly outbreak have been thwarted by violence against health officials and civilians as militant groups battle for control in the affected region. -Express
Two health workers were killed during the militant attack according to the minister, while 11 civilians and a soldier were killed last month in the city of Beni - the outbreak's epicenter.
And on Thursday, the United Nations announced that at least seven UN peacekeepers were killed by militants in at the epicenter of the Ebola outbreak.
"Our peacekeeping colleagues tell us that six peacekeepers from Malawi and one from Tanzania who are part of the U.N. peacekeeping operation in the DRC ... were killed yesterday, in Beni territory, in North Kivu," said UN spokesman Stephane Dujarric.
Meanwhile, a USAID worker speaking to Reuters on condition of anonymity said "We are absolutely concerned about the ongoing outbreak in the Democratic Republic of Congo. It is occurring in an area of active conflict, so physical insecurity is a persistent challenge and complication to the ongoing response efforts."
"No other epidemic in the world has been as complex as the one we are currently experiencing," said Kalenga.
As the rate of new cases has accelerated in recent weeks, neighboring Uganda began vaccinating at-risk health workers on Wednesday in case the virus crosses the border.
Now neighboring Uganda is bracing for the virus to cross the 545-mile boundary it shares with DRC. The border is porous and heavily trafficked, with large numbers of local farmers, merchants, traders, and refugees constantly moving through the area. A checkpoint in the region receives 5,000 people on an average day, with the busiest ones swelling to 20,000 twice a week on market days. -Wired
The Ugandan Health Ministry says it has 2,100 doses of vaccine available for doctors and nurses across five border districts, while four specialized Ebola treatment facilities have been constructed at hospitals near the border.
"The risk of cross-border transmission was assessed to be very high at a national level," said Jane Ruth Acent, Uganda's Health Minister at a press conference last week. "Hence the need to protect our health workers."
Meanwhile, officials in Uganda have been screening anyone crossing in from the Congo since the outbreak began.
a series of questions and no-contact infrared thermometers aimed at the side of the head that read out body temperatures like a highway patrolman’s radar gun. Fever is one of the first red flags for an Ebola infection. The process isn’t foolproof; symptoms can take up to three weeks to appear, and lots of other tropical diseases in that part of Africa can also cause soaring temperatures. -Wired
And as Wired's Megan Molteni notes, Ebola has never broken out in a war zone, while Billions of dollars in Chinese infrastructure investments have created greater connectivity throughout Africa that can encourage the rapid spread of Ebola and other diseases.
"It's a cruel irony that better roads and improved connectivity of people also make it easier for the disease to travel, particularly when the public health systems are still lagging behind," said Boston Medical Center's Nahid Bhadelia, medical director of the facility's Special Pathogens Unit. Bhadelia was on the front lines during the 2014 Sierra Leone Ebola outbreak.
Similar to the DRC, armed conflict in Uganda between rebel groups may also hobble containment efforts.
“We can’t afford for it to go deep in the red security zones where we have no access,” says Mike Ryan, Assistant Director-General of Emergency Preparedness and Response at the World Health Organization. “Ebola exploits the cracks, so the more we can keep it out in the open, the better.” -Wired
That said, the DRC outbreak appears to be turning a corner, according to Ryan, as transmission of the disease has been relegated to healthcare facilities, as opposed to out in the community.
But only in the last few weeks have health workers realized the extent to which Ebola was spreading through Beni’s network of more than 300 healthcare facilities, many of which keep poor patient records. Even as workers vaccinated victims’ close friends and family, new cases would show up seemingly out of thin air. Last week the Washington Post reported that between 60 and 80 percent of new confirmed cases had no known epidemiological link to prior cases. -Wired
"Fears of this thing becoming endemic are real, and rational, but we also need to see that as a worst-case scenario," Ryan said. "We still have plenty of opportunities to put this virus back in the box, we just need to get behind the people risking their lives on the front line and push hard for the next three to six weeks. It’s going to be a long march, but I don’t think we should be raising the white flag just yet."