The Democratic Republic of Congo is undergoing its tenth epidemic of Ebola since the disease’s first appearance in the country. The epidemic, centered in the country’s province of North Kivu, likely broke out in May, though it was only officially declared in August. This latest episode of Ebola is distinguished from its many predecessors by the fact that its epicenter lies in Beni, a large and densely populated city — complicating inoculation and treatment and promoting the spread of the disease. North Kivu’s proximity to Uganda and its status as a major trade center further encourages transmission of the disease across international borders. Although a program has been successful in vaccinating around 25,000 people, more than 200 have died in the epidemic. Inoculation efforts are hampered by two major factors: instability in the region and refusal of treatment.

What is Ebola?

Ebola, a viral disease spread through direct contact with the bodily fluids of those infected (human and animal), was first discovered in 1976, in the DRC. Scientists are unsure about Ebola’s origins, but theorize that the virus is spread through bats to primates, including humans. Ebola’s early symptoms resemble those of the flu, but progress to vomiting, diarrhea, rashes, and bleeding. The average fatality rate is 50 percent. According to the Centers for Disease Control, there are no proven cures for the virus as of now, nor are there any licensed vaccines — but an experimental vaccine, called rVSV-ZEBOV, seems promising. Ebola survivors receive antibodies that protect them for a decade, but may carry the virus for months after their infection. There are several ways to prevent the spread of the Ebola virus: all of which involve limiting direct exposure to humans infected with Ebola and animals carrying the virus.

Attacks by rebel groups

Two rebel groups operate in the northern part of the DRC — the Allied Democratic Forces and the National Army for the Liberation of Uganda. The two groups are Islamist militias that operate together as the Islamic Alliance of Democratic Forces (ADF-NALU). Local sources say the alliance was behind a September attack that killed 18 people — in the face of which the World Health Organization was forced to suspend its Ebola operations for 48 hours. Although the rebel attacks themselves are not new, their newfound proximity to the infected areas of the city of Beni has major public health implications. In response to the presence of ADF-NALU, the Congolese army has launched operations against the ADF-NALU, hoping to secure the city of Beni for Ebola treatment. It is important that the Congolese army maintain control over the area in order for WHO and local public health workers to be able to stop the epidemic.

Refusal of treatment

The second issue with containing the spread of Ebola is that, while the majority of people submit for vaccinations and treatment, there is a sizable minority who believe harmful rumors about the epidemic itself. These rumors include beliefs that Ebola isn’t real, that the disease is the result of witchcraft, that the disease is a concoction of doctors and NGOs to profit, that the epidemic is engineered to delay an upcoming presidential election, and that the vaccine is intended to sterilize people. Because of the rumors, some people refuse to be traced by WHO officials and flee to “red zones” where public health workers cannot enter. Even though vaccine dodgers are a minority, even a single unvaccinated individual can prolong an existing Ebola epidemic.