Why is Ebola back? The virus has killed nearly 2,000 people in the last year Why is Ebola back? The virus has killed nearly 2,000 in a year
Despite a new vaccine meant to wipe out Ebola, the deadly disease is on the rise again. Adrian Blomfield reports from the Democratic Republic of Congo, currently in the grip of the second largest outbreak on record. Pictures by Simon Townsley
This article has an estimated read time of nine minutes
Grinning broadly between dimpled cheeks, Bahati Kasereka clearly thought it was all a jolly wheeze. To his six-year-old eyes, the doctor hovering over him in a decontamination suit must have looked like an astronaut.
The isolation unit in which he had just been placed perhaps resembled one of the tents he had heard about from his soldier father. Revelling in all the attention, Bahati whispered conspiratorially to a figurine of Sheriff Woody from Toy Story on the bed beside him.
From time to time he raised his thumbs towards the strangers peering at him through the unit’s thick plastic walls, as if to say he hadn’t had this much fun for ages.
Bahati may have just days to live. A few hours earlier, he had tested positive for Ebola at a nearby clinic. Being diagnosed with the world’s most terrifying disease clearly meant little to him. Even the journey to the Ebola treatment centre (ETC) in the Congolese town of Beni, escorted by more astronaut-like figures, was just another part of the adventure.
After all, beyond running a temperature and suffering a slight cough, he did not seem particularly ill. But that’s the thing with Ebola, says Blandine Ndeturuye, a Unicef health officer at the centre. ‘Today a patient can be doing well and tomorrow they die.’
Beni’s ETC, like the others dotted across the North Kivu region of the Democratic Republic of Congo, is a miserable place, haunted by suffering and death. Beni, an attractive town of 300,000-odd people set in verdant hills to the west of the Rwenzori Mountains, has been hit hard by Ebola.
Bahati Kasereka, six, in his CUBE isoltaion unit in Beni
Nearly 350 people have died here – a fifth of all fatalities – since the disease erupted in Congo’s north-east a year ago. With no sign of the virus abating, the ETC remains almost full.
The centre, which has no permanent buildings, feels more like a Gulag than a hospital. Patients are housed in ‘Biosecure Emergency Care Units’, or CUBEs, plastic tent-like structures that seal them off from the outside world.
Orange fencing mesh divides the ETC into hazardous ‘red zones’, which only those wearing full protective equipment can enter, and safer ‘green zones’.
They may not look it, but the CUBEs are a humanitarian development: unlike in previous outbreaks, patients can now receive visitors who sit outside the structures safe in the knowledge they cannot be infected.
Even so, for those old enough to be aware of the seriousness of their condition, being placed inside one is a terrifying experience. For many, they are little more than sanitised death chambers, the plastic walls the last thing they will ever see. Since the present outbreak began, only a third of those infected with Ebola have survived.
But, as Bahati will discover in the coming weeks, there is some respite, too. For every moment patients hunch up in agony, there are brief periods of symptom-free remission.
You can see it in some of the CUBEs in Beni’s ETC.
Doctors at work inside a CUBE at the Beni treatment centre
A worker at the Butembo Ebola treatment centre
A middle-aged man weakly paces the floor. Another sits slumped in a plastic chair by his bed. But, two CUBEs down from Bahati, the other side of Ebola is all too visible as suited doctors try to restrain a woman who is screaming and writhing in pain.
An hour later the sedatives take their effect and she falls into a tormented sleep, breathing raggedly, her heaving body now clad in an adult-incontinence nappy. Next door, another man holds a crimsoned muslin cloth to his face, trying to staunch the blood seeping from his nose and mouth.
As he hovers between life and death over the coming weeks, Bahati will have to suffer through much of this. At first there will be fever, headaches and muscular pain, then vomiting and diarrhoea, and, unless he can make a recovery, quite possibly internal and external bleeding. Soon, doctors will have to insert a cannula so he can be fed and medicated by a drip.
As dehydration, which often kills Ebola victims, takes hold, finding a vein will become progressively harder. Next door to Bahati are two children farther along in their fight against the disease.
As Bahati plays, doctors desperately try to find a vein in the hand of a one-year-old boy, Felix, whose lower arm is already a blood-mangled mess from failed previous attempts. On the bed across from Felix, an eight-day-old baby girl, Felicité, lies asleep with a cannula in the side of her head.
Bahati does not realise it yet, but he will also have to fight the disease without the comfort of loved ones. He does not know that his father died of Ebola in the same centre the week before he arrived. His mother, after dropping him off at the clinic, scarpered, perhaps fearing she too was infected. She has switched off her mobile phone and health workers have been unable to trace her.
Bahati seems oblivious to the fight he has ahead of him
An Ebola survivor cares for eight-day-old baby Felicite
Simple medical procedures become difficult with victims
Yet if fate seems to have dealt this irrepressibly cheerful little boy the cruellest of hands, there are things that could work in his favour. Young children are the most likely to die of Ebola. Just a quarter of those under five have survived the disease in the present outbreak, according to Unicef. Given that he is six, Bahati’s chances are slightly higher.
More than that, the rates of survival increase significantly for patients treated in the ETCs. Doctors are hesitant to give a figure but in recent months as many as two thirds of patients treated in Beni’s ETC have beaten off the disease. For those who remain at home undiagnosed, the mortality rate is about 90 per cent, health workers say.
There is little mystery about why this is. Patients brought into centres are given much better treatment than if they had stayed at home. Each individual symptom can be addressed, giving victims a better chance of pulling through. Experimental medicines may be saving lives.
Most importantly, the earlier the disease is caught, the higher the chances of survival are, which bodes well for Bahati. Even Felicité, whose mother died of Ebola four days after giving birth to her, has a chance. From the moment her mother was brought into the centre, Felicité was under constant monitoring in the nursery next door.
There is also potentially crucial psychological help on hand. In every CUBE, survivors of Ebola, who do not have to wear intimidating decontamination suits because they are now immune, offer a simple encouraging message: ‘I got through this and you can too.’ Such survivors, known as ‘lullaby singers’, can make the difference between life and death: without them, Unicef officials say, many victims might simply have given up.
Considering the progress being made, both in the treatment centres and in one of the most comprehensive Ebola-vaccination programmes ever mounted, the disease should be on the retreat. More than 170,000 people have received an experimental vaccine, which, although not yet commercially licensed, was first used in Congo last year. It is estimated to be 97.5 per cent effective.
Four year old Felix, whose family caught Ebola after handling the corpse of a relative
Yet the epidemic is raging as ferociously as ever. Indeed, in April, the number of new cases began to surge rather than decrease. History suggests this should not be the case. No country in the world has suffered as many outbreaks as Congo, home to the Ebola River, after which the disease is named.
Scientists debate the reason for this but it is generally agreed that Ebola is transmitted to humans by infected wild animals, particularly the fruit bat. The virus is essentially endemic in the wildlife population of eastern Congo’s vast forests, and can emerge at any time.
The previous nine outbreaks all abated within months, however. None killed more than 300 people. With approximately 1,800 deaths recorded so far, this one has claimed more than twice as many lives as the earlier nine combined. Only west Africa’s outbreak of 2014-2016, with 11,323 fatalities, has been deadlier.
There are various explanations for this. Previous outbreaks took place in sparsely inhabited and mostly stable rural areas. The present epidemic is raging in a much more densely populated region. It has mostly affected the Nande ethnic group, many of whom are traders who travel from town to town, potentially carrying Ebola with them.
The North Kivu province is also one of Congo’s most unstable. The Second Congo War, which claimed millions of lives, ended in 2003, but North Kivu has enjoyed little peace. Dozens of armed groups fighting myriad small wars, often for control of the area’s mineral resources, lurk in the region’s mountainous forests, emerging from time to time to massacre civilian populations.
Insecurity has made the medical response mounted by the international community and the Congolese government both hazardous and logistically tricky. Armed groups have attacked Ebola treatment centres. Seven workers have been killed.
Ebola survivors and their families receive assistance at the Beni treatment centre
Aristote, a health promotion officer at the Beni treatment centre
Twice, international aid agencies have had to suspend operations, hampering their ability to trace and vaccinate people who may have been in contact with victims. Each halt led to a surge in new cases. But the most significant problem is that many in the community refuse to believe Ebola is a normal disease. They suspect a conspiracy by the government and the international community to exterminate the Nande and steal their land.
That may sound counterintuitive and self-harming, but the Nande have long loathed the government in Kinshasa, blaming it for fostering insecurity in the region. Armed groups, some with links to the regime, have killed hundreds of people in Beni in recent years. When the authorities used Ebola as a pretext to prevent voting in the area in last year’s general election, suspicions crystallised into certainty.
‘The problem is people here have very little trust in authority,’ says Aristote, a community outreach volunteer at Beni’s ETC. ‘They have lived through tragedy, much of it inflicted by the government. Some think Ebola is just a new strategy to kill people: “They used to kill us with weapons, now they kill us with illness.”’
Aristote’s job is to convince people that Ebola is not an invented disease. Sitting among visitors waiting outside the centre, he quietly tries to persuade them that the doctors are not planning to kill their relatives in order to sell their body parts to devil worshippers.
Accompanied by survivors, he also evangelises in villages. Aristote was a mobile-phone salesman until the outbreak began; he gave up his lucrative position to work as a volunteer.
Like other officials at the centre, from the doctors treating the sick to the nurses and orderlies disposing of hazardous waste, his is a job fraught with danger. Some 132 health workers have been infected by the virus; 41 have died. There are other perils, too. An angry mob killed two community outreach officers to the south of Beni last month.
Ebola nurse Martine Gavor, 24, with one-year-old Joel Josue at the UNICEF creche in Butembo
The daily tragedies make Aristote’s work all the more difficult. At the entrance of the centre, a woman in a blue dress falls to her knees in grief. Her third child has just died, and she blames the doctors. ‘The people here are killing my children,’ she sobs, as the relatives of other patients look on in horror. Aristote’s work has just become harder still.
There are other deaths too. Outside the centre’s mortuary, a gaggle of mourners wait for the body of Elodie Kitsama, a 19-year-old student, who fell sick in her village a fortnight earlier. ‘She felt cold, she was vomiting,’ says her eldest brother, Alexis, wearing a photograph of his sister around his neck. ‘It didn’t cross our mind it could be Ebola, so we just treated her for malaria.’
As is not uncommon, Elodie lived in a commune with 50 members of her extended family. Although they have now been vaccinated, and Elodie’s bed and clothes burnt, they are all at risk.
Aristote’s work has had an impact, however. The family understand the need for a safe burial. In groups of four, they view Elodie’s body through a glass partition, before standing back as men in suits place her sealed coffin on the back of a lorry. The mourners will have to keep a safe distance even when her body is lowered into the ground at a cemetery patrolled by policemen.
It is all a far cry from a traditional Congolese funeral, where mourners weep over and caress the deceased. This is one of the most common causes behind the rapid spread of the disease.
Ebola tore through Neema Pilipili’s family after they handled the body of her nephew, who – unbeknown to his relatives – had died of the disease. Within a fortnight, nine members would be dead, including her father, mother and sister. When Ebola wipes out most of a family in such a short time, it is not hard to see why conspiracy theories take hold.
The dead are handled and buried only by trained health workers in protective clothing
Health workers carry the body of Elodie Kitsama, 19, who died after four days at the centre
Until March, Sylvain, Ishara and Kathia Vitswa, aged 17, 15 and 11 respectively, were members of a raucous family of 10. Within a week, their number was reduced by six: three brothers died, then their mother Laurentine and her baby daughter, infected by her breast milk, and finally another sister.
Their father, overcome with grief, refuses to live with his surviving sons and still does not believe that it was Ebola that devastated his life. ‘He thinks white people are poisoning the Nande in order to steal their land,’ says Sylvain, who, along with Ishara, is now training to be a mechanic to support his family.
Unless his mother returns, or another relative steps forward, Bahati too may be left to fend for himself. First he will have to survive, of course.
There is one happy corner in Beni’s ETC. Clapping along to rumba music, a gaggle of patients exchange banter on the recovery ward. After a month in the CUBEs, they are now able to enjoy the fresh air and feed themselves.
Fazeela Mayamoto dandles her seven-month-old son on her knee while scolding his four-year-old brother, who has been blowing raspberries at an older male patient. All three are certain to recover, although they have to remain in the red zone until they are no longer contagious.
While she is still coming to terms with the death of her eldest son, Mayamoto can scarcely believe that so many of her family, including her husband, who has already been discharged, have survived. Within a week, she and her younger children will be home, cured and immune. ‘We are living a miracle. God has given us a second chance.’
What are the chances that, after a month, Bahati too could end up in this happy place? Exhausted, his doctor, Kasereka Nzala, refuses to be drawn. He might pull through, he might not. It all depends on his viral load. Becoming emotional about one case, he sighs, is no way to get through the job. He has seen far too much death to be sentimental. ‘Ebola is a cruel disease,’ he says, and leaves it at that.
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