Healthcare specialists in the UAE have offered crucial support to an international medical charity fighting against the deadly Ebola virus outbreak thousands of kilometres away in Africa.
Experts in the Dubai office of Doctors Without Borders (MSF) have helped to map out efforts to contain the spread of the virus. That mission is led by colleagues in the Democratic Republic of the Congo and Uganda.
The spread of the rare Bundibugyo strain of the virus was declared a public health emergency last month by the World Health Organisation, which warns that the risk remains "very high" to some communities. The WHO has recorded 91 deaths from 550 cases in DRC, with contact tracing and early testing critical. Uganda has reports at least 19 cases and two deaths.
Rami Malaeb, an epidemiologist at MSF’s Dubai office, is among a global team seeking to better understand the latest infection surge. “I'm following closely what’s happening on the ground in the DRC and Uganda, especially from an epidemiological point of view,” he said.
“But we all monitor the situation, especially in these kinds of emergencies. This is currently taking a lot of our resources. Other teams here are playing a role in mobilising resources, engaging with donors and partners in the region, supporting with communications and advocacy.”
Rapid response
Like other international healthcare organisations, MSF moved quickly after it was alerted that people were dying of a viral haemorrhagic fever – a fever characterised by bleeding – in Mongbwalu, a gold-mining town in the DRC’s Ituri province. By that time, infections had been spreading for weeks or even months.
Working with health authorities and the local community, MSF set up a 60-bed hospital for Ebola patients in Mongbwalu and is to reactivate a 32-bed treatment centre in Uganda's capital Kampala. The group's work extends beyond treatment, with minimising the spread of the Bundibugyo strain a central aim.
To control the spread Ebola, several measures have to be in place, Mr Malaeb said. Those measures include rapid detection, isolation and effective treatment, contact tracing, safe burials and community engagement. The organisation is supporting many of these functions, but conditions are far from ideal.
Healthcare challenges
“These all depend on tools and conditions that are pretty much either unavailable or severely compromised in the current outbreak in the DRC and Uganda,” he said. “We’re working in the most challenging contexts in terms of outbreak control in a place which has active armed conflict in the provinces where the outbreak is spreading.”
There is a shortage of testing capacity for the Bundibugyo virus, which has no approved treatment or vaccine, although a shot may be available for trials to begin within months.
Conflict in the country has forced large numbers of people to flee their homes, adding to the risk of the virus spreading. Ituri province has about one million displaced people, Mr Malaeb said, while another affected DRC province, South Kivu, has 1.2 million.
“You can imagine a lot of displaced population, a lot of movement happening, and this makes it very challenging to have proper surveillance, especially in very insecure areas,” Mr Malaeb said. “We don’t have access to these areas because of the insecurity and active fighting. The response is not failing, but it’s operating under extremely harsh conditions so the rapid, effective control can be difficult.”
Learning lessons
There are reasons, however, why it should be easier to limit the number of cases this time, notably because lessons have been learnt from previous outbreaks, such as those in West Africa from 2014 to 2016.
Mr Malaeb said local health authorities are now better able to react, but are hampered by a lack of resources, which increases the importance of international funding.
A lesson MSF has learnt from previous outbreaks, he said, is that the group should continue with other activities in regions affected by Ebola – projects that focus on malaria, measles, cholera, maternal health and surgical services – to ensure health services are not overwhelmed.
The number of cases remains relatively low compared with previous Ebola outbreaks. There were more than 28,000 cases and at least 11,000 deaths between 2014 and 2016, when the outbreak involved the Zaire strain of the virus and mostly affected Guinea, Liberia and Sierra Leone.
Fears of prolonged outbreak
Mr Malaeb said it is difficult to predict how long the latest outbreak would last, but if it is to be controlled within months, a “significant scale-up” in the diagnostic capacity is needed to allow cases to be detected quickly. That will allows patients to be isolated and treated, curbing the spread of infection.
More Ebola treatment centres with strengthened infection control measures are also essential, he added. “The more concerning scenario is a prolonged outbreak, which becomes more likely given the picture that we have now,” he said, referring to the conflict, displacement and the lack of testing.
It is also essential to retain the trust of local communities, Mr Malaeb said. Health centres have been attacked since the start of the outbreak, including tents used as isolation units that were sit on fire during protests in the eastern DRC. The unrest was sparked by accusations that the body of a man who had died from Ebola had not been released for burial.
Traditional burial practices, which involve washing the body, have been a factor in the spread of Ebola. But Mr Malaeb said it was possible to reduce risks while continuing to respect traditions if personal protective equipment was used.
“Community engagement and working with the community is one of the cornerstones of our response strategy approach. It’s not an obstacle,” he said. “We need to respect the traditional burial practices, but work with the community to make sure these burial practices are done in a safe manner.”
