Three volunteers with the International Federation of Red Cross and Red Crescent Societies died in the Democratic Republic of Congo after becoming infected with Ebola while managing bodies in Ituri province, the organisation announced on Saturday, May 23. The workers, identified as Alikana Udumusi Augustin, Sezabo Katanabo, and Ajiko Chandiru Viviane, are believed to have contracted the virus while carrying out dead body management activities on March 27 as part of a humanitarian mission unrelated to Ebola. The deaths come as the outbreak in northeastern Congo escalates, with treatment centres being set ablaze and patients fleeing into surrounding communities.
The IFRC said the three volunteers were from the DR Congo Red Cross in Ituri, the northeastern province which is the outbreak’s epicentre, and worked for the Mongbwalu branch of the organisation in Djugu territory. One died on May 5; the other two died on May 15 and 16. All three fell ill weeks before authorities formally identified the outbreak and put containment measures in place.
“At the time of the intervention, the community was not aware of the Ebola virus disease outbreak, and the outbreak had not yet been identified. They are among the first known victims of the outbreak,” the IFRC said in a statement.
The confirmation of their deaths places the outbreak’s likely origin significantly earlier than previously understood. According to the Associated Press, the three volunteers’ exposure on March 27 pushes back the timeline of the outbreak from what had been the previously known first confirmed death in late April in Bunia, the capital of Ituri province.
“These volunteers lost their lives while serving their communities with courage and humanity,” the Geneva-based IFRC said. “Their commitment reflects the extraordinary dedication shown every day by Red Cross volunteers working in complex and high-risk environments to support vulnerable people.”
The deaths are not the only crisis confronting responders on the ground. A tent used for treatment of the Ebola outbreak in eastern Congo was set on fire for the second time this week, and 18 people suspected of infection escaped, a local hospital director said Saturday. Dr. Richard Lokudi, director of the Mongbwalu General Reference Hospital, told the Associated Press that unidentified people arrived at the clinic in Mongbwalu on Friday night and set fire to a tent set up by Doctors Without Borders for suspected and confirmed Ebola cases.
“We strongly condemn this act, as it caused panic among the staff of the Mongbwalu Referral Hospital and also resulted in the escape of 18 suspected cases into the community,” Lokudi said.
On Thursday, another treatment centre in the town of Rwampara was set ablaze after family members were prevented from collecting the body of a local man. Authorities have barred families from handling the remains of those who died of Ebola because the bodies remain highly contagious and have driven further spread through traditional burial practices and funeral gatherings.
Tensions between health workers and local communities have complicated containment at every stage of the response. David Basima, a team leader with the Red Cross overseeing burials, said a burial in Rwampara on Saturday had to take place under tight security. “Arriving at the (healthcare) structure, we experienced a lot of difficulties, including resistance from young people and the community. So we were forced to alert the authorities so that they could come to our aid, just for safety,” he said.
Dr. Craig Spencer, an emergency room physician and public health professor at Brown University who survived Ebola after contracting it while working with Doctors Without Borders in Guinea in 2014, told CBS News he was particularly worried about healthcare workers responding to the outbreak. “Healthcare workers are the group that I’m really concerned about because they had very close contact with people when they’re most contagious, particularly around the time of folks’ death,” Spencer said.
Regional and Global Impact
The World Health Organization said the outbreak now poses a “very high” risk for Congo — upgraded from a previous categorisation of “high” — while keeping the regional risk level at high and the global risk level at low. WHO Director-General Tedros Adhanom Ghebreyesus said on Friday that 82 cases and seven deaths have been confirmed in Congo, but that the outbreak is believed to be “much larger.” There are now 750 suspected cases and 177 suspected deaths, with more expected as surveillance expands.
Authorities in northeastern Congo on Friday banned funeral wakes and gatherings of more than 50 people in an effort to curb the spread of the virus. Dr. Jean Kaseya, director-general of the Africa Centers for Disease Control and Prevention, said a response to the outbreak must include building trust with communities.
The IFRC said it remained committed to supporting affected communities and is sending volunteers door-to-door to counter misinformation about Ebola circulating in the outbreak zone, according to Reuters.
Background
The Bundibugyo strain of Ebola, for which there is no approved vaccine or treatment, was declared an emergency of international concern by the World Health Organization on Sunday. The virus spread undetected for weeks in Congo’s Ituri province following the first known death, while authorities tested for another, more common, Ebola virus strain and came up negative. Ebola spreads through direct contact with the bodily fluids of infected individuals, including the dead. The Bundibugyo strain is rarer than the more widely known Zaire strain and has historically had a lower case fatality rate, but the absence of any licensed vaccine or treatment leaves health workers with no pharmacological tools to protect themselves or their patients. The IFRC operates in more than 191 countries and has more than 17 million volunteers worldwide, according to the organisation.
What Happens Next
The WHO’s elevation of the risk level for Congo to “very high” will prompt intensified global resource mobilisation and technical assistance to the DRC government, according to the organisation’s standard protocols. The IFRC confirmed it is expanding door-to-door outreach in Ituri province to address community distrust that has fuelled the attacks on treatment centres. Authorities in Ituri are enforcing the ban on large gatherings and are working with security forces to protect burial teams operating in areas where resistance has been strongest. The WHO has said it will continue to monitor the risk of regional spread, which it currently assesses as high, and is coordinating with neighbouring Uganda and other bordering countries on preparedness measures.
