The emergencies chief for the World Health Organization says insecurity, public defiance about vaccinations and political jockeying could create a "perfect storm" leading the Democratic Republic of Congo's latest Ebola outbreak to spread.
Dr. Peter Salama says the response is at a "critical juncture" in eastern North Kivu province, where the outbreak was declared nearly two months ago. Health officials have counted 150 confirmed and probable cases, including over 100 deaths.
He told reporters Tuesday that overall trends in the Ebola response have been positive, including fewer reported cases on a weekly basis. But Salama warned that a "series of grave obstacles" such as insecurity and deadly violence caused by armed militia groups, public fears about treatment options and politicians fanning those fears ahead of elections have presented challenges.
"[These factors] may be coming together over the next weeks to months to create a potential perfect storm," Salama said.
The response is at a critical juncture and, although the weekly number of new cases has fallen from about 40 to about 10 in the past few weeks and more than 11,700 people have been vaccinated, major obstacles remain ahead, Salama said.
Attacks by armed opposition groups have increased in severity and frequency, especially those attributed to the Alliance of Democratic Forces, most dramatically an attack that killed 21 in the city of Beni, where WHO's operation is based.
The city has declared a "ville morte," a period of mourning until at least Friday, obliging WHO to suspend its operations.
Overnight on Monday, unidentified assailants entered the town of Oicha, about 20 kilometres north of Beni, burned houses, killed one man and kidnapped 14 children and one woman, according to two local officials. Oicha has two confirmed cases of the virus and one probable case.
On Monday 80 per cent of Ebola contacts — people at risk of developing the disease and so requiring monitoring — and three suspected cases in and around Beni could not be reached for disease monitoring.
'Concerning trend' in country
Pockets of "reluctance, refusal and resistance" to accept Ebola vaccination were generating many of the new cases, Salama said.
"We also see a very concerning trend. That resistance, driven by quite natural fear of this terrifying disease, is starting to be exploited by local politicians, and we're very concerned in the run up to elections, projected for December, that that exploitation... will gather momentum and make it very difficult to root out the last cases of Ebola."
Some people were fleeing into the forest to escape Ebola follow-up treatment and checks, sometimes moving hundreds of kilometres, he said.
There was one such case to the south of Beni, and another to the north, close to the riverbanks of Lake Albert. Both were inaccessible for security reasons.
Neighbouring Uganda was now facing an "imminent threat," and social media posts were conflating Ebola with criticism of the DRC government and the United Nations and "a range of conspiracy theories," which could put healthworkers at risk.
"We will not yet consider the need to evacuate but we are developing a range of contingency plans to see where our staff are best located," he said.
"If WHO and its partners had to leave North Kivu ... we would have grave concerns that this outbreak would not be able to be well controlled in the coming weeks or months."