The witch is performing evil rituals again, facing our way. As the Ebola hemorrhagic fever (EHF) dances menacingly at our western gate, Rwandans can only drop to their knees, desperately calling on the Almighty to keep the deadly scourge at bay for the 10th time. The Government of Rwanda through the Ministry of Health has in the past been able to keep the country safe from incursions by the Ebola virus, by exercising due diligence in employing mechanisms like screening and high alert to respond at targeted entry points. So far, as the neighbouring Democratic of Congo declares its 10th outbreak in 40 years, which has been termed the second deadliest ever, Rwanda has succeeded through a combination of vigilance and sheer luck, to keep its citizens safe.
However, as the current outbreak continues to defiantly spread like a raging fire outbreak in a savannah grassland, Rwanda might need more than vigilance and sheer luck to contain the deadly virus. This is due to the fact that previous outbreaks were never reported to have spread as close as Goma, the Congolese town that is only a stone throw away from our own Rubavu, where thousands of human traffic and goods are exchanged on a daily basis. This is inarguably the busiest entry point and this lays a humongous burden on the health ministry and stakeholders in the field of public health.
Close borders?
Members of the International Health Regulations Emergency Committee assessing the outbreak, at the UN in Geneva advised against closing of borders with DR Congo as a possible control measure, citing the need to protect livelihoods of the people most affected by the outbreak by keeping transport routes and borders open. The experts said it was “essential to avoid the punitive economic consequences of travel and trade restrictions, on affected communities.”
“It is important that the world follows these recommendations. It is also crucial that states do not use (the declaration) as an excuse to impose trade or travel restrictions, which would have a negative impact on the response and on the lives and livelihoods of people in the region,” said Professor Robert Steffen, chair of the Committee.
Rwanda received its first scare on 11 June 2019, when Uganda announced that three people had been positively diagnosed with Ebola, the first cross-border cases since the outbreak began. The Ministry of health announced intensification and the highest class alert. To the their credit and considering the magnitude of pressure at the formal and informal entry points between Rwanda and the Democratic Republic of Congo, no case has been reported on Rwandan soil this far.
However, the deadly virus has continued to rage on relentlessly, centered in the northeast of the DRC, keeping the Rwandan ministry’s heart rate beyond normal with anxiety. Without helping on the rising apprehension, the World Health Organisation (WHO) has officially declared the current Ebola outbreak a Public Health Emergency of International Concern. Apart from the panic that would come with such a declaration that finds an already tense situation, there is also relief in the fact that this means that the world has been called on to intervene in the situation and Rwanda’s efforts might receive supplementary support. Although Rwanda has never fallen short, this intervention would be a welcome development, considering the direction the current outbreak is taking.
As the first anniversary of the complex outbreak in the volatile eastern part of the country approaches, the WHO Director General Tedros Adhanom Ghebreyesus observed that it was time to “work together in solidarity with the DRC to end this outbreak and build a better health system.
According to WHO’s International Health Regulations, which constitute a binding legal agreement involving 196 countries across the globe, a Public Health Emergency of International Concern (PHEIC) is defined as, “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”.
This definition implies a situation that is: Serious, sudden, unusual or unexpected and also carries implications for public health beyond the affected State’s national border and may require immediate international action.
According to a WHO statement, the Committee “cited recent developments in the outbreak in making its recommendation, including the first confirmed case in Goma, a city of almost two million people on the border with Rwanda, and the gateway to the rest of DRC and the world.”
“Extraordinary work has been done for almost a year under the most difficult circumstances”, said Mr. Tedros, following the fourth meeting of the International Health Regulations Emergency Committee assessing the outbreak, at the UN in Geneva. “We all owe it to these responders – coming from not just WHO but also Government, partners and communities – to shoulder more of the burden”, he added.
The Committee, according the UN website, also issued specific conclusions and advice to affected countries, their neighbours, and for all States, in terms of how the outbreak needs to be dealt with moving forward.
According to Medicins Sans Frontiere (MSF) which has been active in Congo DR for decades, so far, there have been more than 2,500 cases of infection, and nearly 1,670 have died in the provinces of Ituri and North Kivu, where multiple armed groups and lack of local trust have hampered efforts to get the outbreak under control.
Democratic Republic of Congo (DRC) declared their tenth outbreak of Ebola in 40 years on 1 August 2018. The outbreak is centred in the northeast of the country. With the number of cases passing 1,000, it is now by far the country’s largest-ever Ebola outbreak. It is also the second-biggest Ebola epidemic ever recorded, behind the West Africa outbreak of 2014-2016.
According to MSF, overall, the geographic spread of the epidemic appears to be unpredictable, with scattered small clusters potentially occurring anywhere in the region. This pattern makes ending the outbreak even more challenging. Given the appearance of new confirmed cases ever further to the south, the risk of the epidemic reaching Goma, the capital of the province and hub of business between Rwanda and DR Congo, is another cause for concern.
Hassan The Hussler 