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