DRC:Responding to the new Ebola outbreak in Équateur province

On 1 June 2020, a new Ebola virus disease outbreak was declared in Équateur province, western Democratic Republic of the Congo (DRC), the country’s eleventh recorded epidemic. Declared while DRC was still grappling with the tenth Ebola epidemic in the country’s northeast, and amidst the COVID-19 pandemic, this new Ebola outbreak has already spread to 11 health zones in the province, in a very hard-to-reach region where some villages are only accessible by river. As of 1 September, 2020, MSF teams are supporting nine treatment and isolation centres in five health zones to provide care as close as possible to the active hotspots of the disease, supporting community surveillance and providing rapid treatment to patients. 
As the epidemic is moving with people by land and river, to remote areas where only accessible by river using canoes or after hours of difficult transport by rough roads through the forest.©Franck Ngonga
Équateur province is 37 times the size of Hong Kong, among the 11 health zones affected by Ebola,  some health zones are only accessible by river using canoes or after hours of difficult transport by rough roads through the forest. Only one helicopter is available to humanitarian organisations to move around the region. In order to curb the spread of the disease, MSF is setting up a decentralised response and deploys our teams in the most remote, affected health areas in Bolomba, Bikoro, Monieka, Ingende and Lotombe, with small structures easily accessible to the communities. 
“To respond to emergency medical interventions, MSF's Emergency team permanently has a pre-positioned stock with vehicles, motorcycles or outboard motors to be installed on boats or canoes,” says Mathias Dembo, logistics coordinator with Médecins Sans Frontières (MSF). “We deploy these stocks according to the difficulties of the areas. And in Equateur province, challenges are massive! To reach the health zone of Bolomba for example, we had to go up the Likelemba river with all the equipment and our team on canoes.”
To reach the most remote health areas in Bolomba, MSF teams use motorcycles in the middle of the equatorial forest.©Franck Ngonga
In Bolomba health zone, in addition to the support provided to the Ebola treatment centre at the general hospital, we set up two small treatment and isolation centres in the remote health areas of Boso Mondomba and Yuli. The same decentralised approach has been adopted in the health zones of Monieka and Bikoro, where MSF is supporting four small care and isolation structures in difficult-to-access health areas. In order to guarantee the continuity of primary health services there, and allow early detection of suspected cases, MSF is also supporting health centres in the hotspots by donating drugs, training local medical personnel on Ebola or strengthening infection prevention and control measures.
Little information is circulating on Ebola in the province, that’s why MSF health promotion teams are supporting those of the Ministry of Health to strengthen awareness and community-based surveillance. We recruit Ebola survivors to join MSF outreach team and share their stories with the community as well as explain what the symptoms of the disease are. This community-based approach allows communities to detect suspected cases and quickly escalate alerts and leads to an ownership of the response to the epidemic by the communities themselves. 
Blaise, MSF health promoter, talks to community members of Ikoko health area about the Ebola epidemic. Health promotion teams have a community-based approach: Blaise and his team go from house to house to explain the disease and how to recognize symptoms and inform the surveillance system in case of alert. This approach allows communities to detect suspected cases themselves and quickly escalate alerts. It leads to an ownership of the response to the epidemic by the communities themselves.©Franck Ngonga
As of September 2, a total of 110 Ebola virus disease cases had been recorded in Equateur province – 104 confirmed, 6 probable – with 47 deaths. Équateur province experienced its last Ebola epidemic two years ago, between May and July 2018, with 54 cases and 33 deaths.
The tenth Ebola outbreak declared over in northeast DRC on 25 June 2020. This is by far the country's largest-ever Ebola outbreak, with 3,470 cases recorded and 2,287 deaths. MSF has been active since the declaration of the epidemic, intervening in various areas of the region and on several fronts: patient care, management of suspect cases, infection prevention and control, alert investigation and health promotion. Following the attacks on the Katwa and Butembo Ebola treatment centres, our teams have focused on support to the local healthcare facilities, to help provision of access to care and to facilitate early detection and diagnosis of Ebola cases. Our teams also supported the local healthcare infrastructure in North Kivu and Ituri through activities like primary healthcare, triage, isolation, infection prevention and control, water and sanitation, referrals and health promotion. We also support a 34-bed treatment centre in Bunia and a small ETC in Goma, while finalising the construction of a larger, 72-bed ETC in the city.
Medical staff providing treatment inside the MSF-supported Bolomba Ebola treatment center.©Franck Ngonga