Ebola, conflict and disease surveillance

Ebola has struck again, claiming lives in remote areas of the Democratic Republic of the Congo (DRC). Given the proximity of the epicentre to Uganda and the wider Great Lakes region, the outbreak has raised serious concern about regional spread. That is why the World Health Organisation (WHO) moved quickly to issue an international alert.

According to WHO, there are six known species within the ebolavirus group. The virus takes its name from the Ebola River, near the site of one of the first recorded outbreaks in what is now the DRC, in 1976. Four of these six species are known to cause disease in humans and the major African outbreaks have been linked mainly to Zaire, Sudan and Bundibugyo ebolaviruses. Such outbreaks become especially dangerous when the index case is missed or when diagnosis is delayed.

The current outbreak has been identified as Bundibugyo ebolavirus. Unlike Zaire ebolavirus, for which approved vaccines exist, Bundibugyo still has no licensed vaccine or specific approved treatment. Reports also suggest that early field tests did not immediately identify the strain, contributing to delays in confirmation.

The evidence is clear: disease spreads more easily in conditions of conflict and insecurity. Amid violence, surveillance systems weaken, health workers operate in fear, access to communities becomes harder and dangerous gaps open up in the chain of protection needed to contain an outbreak.

The outbreak emerged in Ituri Province, in northeastern DRC — a region that is no ordinary setting. It has been the theatre of protracted conflict for many years. In many areas, state authority is weak and communities endure repeated cycles of violence, including attacks attributed to the Allied Democratic Forces (ADF), an armed group linked by several observers to the Islamic State’s Central Africa network.

Eastern DRC is also afflicted by multiple armed groups, among the best known of them being M23. The role of neighbouring states has been repeatedly debated and documented in UN reporting, giving the conflict not only a local dimension but a regional one as well.

The result is a lethal combination of violence, insecurity and weak public health coverage that allows Ebola to emerge, spread and kill, while placing the wider region — and indeed the world — on alert.

The cycles of violence in the DRC have killed far more people than Ebola. Broadly cited estimates suggest that conflict and its indirect consequences caused roughly 5.4 million deaths between 1998 and 2007 alone. The true toll today is almost certainly higher. It is therefore understandable that many people are more preoccupied with dodging bullets or machetes than with taking precautions against Ebola or participating fully in the flow of information on which disease surveillance depends.

It follows, then, that better Ebola surveillance also depends on progress in addressing conflict, insecurity and the armed encirclement imposed by rebel groups. Epidemiological surveillance cannot be fully separated from efforts to resolve the violence that has devastated these populations for decades.

Meeting this challenge will require a collaborative strategy from all the countries in the region. It will require them to move beyond selective support for different armed groups and to act together against a menace that ultimately threatens them all. We speak about Ebola because it is transmissible and because it lays bare our shared vulnerability. Death from a bullet, by contrast, often remains invisible to those far away; it is borne disproportionately by poor and isolated communities in eastern Congo. Yet it is precisely that violence and the institutional breakdown it produces, that makes Ebola more dangerous. If the region acts in concert to pacify these areas, it will not only save those communities from war but also reduce the wider risk of recurrent outbreaks.

If we are serious about strengthening disease surveillance, we must be equally serious about confronting rebel violence as a public health threat in its own right — one that has already claimed far more lives than Ebola. Containing epidemics in eastern Congo cannot be separated from containing the violence that devastates communities, weakens institutions and obstructs health responses. Only by tackling both threats together can we hope to prevent future Ebola outbreaks and reduce the danger of transmission beyond the epicentre.

Anthony Ohemeng-Boamah is an expert in African development and socioeconomic transformation.