In July this year DRC Minister of Health Oly Ilunga Kalenga called an end to the ninth outbreak of the deadly Ebola virus in the river port of Mbandaka, with over a million inhabitants. He enumerated with justifiable pride the lessons learnt: The swift release of $4 million by the DRC Government, mobilization of local participation, including some 4,000 motorcycle taxi drivers to propagate vaccination and hygiene, community education to change age-old habits; swift regional and international reaction: health responders from all over Africa rushed to help, international partners stepped in with sizable donations, and the World Bank triggered its new pandemic emergency financing facility. Minister Kalenga lauded the global community’s cooperation as critical, and hoped that the lessons learnt will help prepare for outbreak ten.

The worst fears are coming true: Outbreak ten is happening. In the ungoverned, ungovernable far eastern North-Kivu province of the DRC international health providers face rebel firefights, locals react with violence against vaccination campaigns. Red Cross workers were attacked and seriously wounded on 2 October as they attempted to perform safe burials of Ebola victims critical to prevent contagion. With 130 confirmed cases and 74 deaths since the beginning of the epidemic, violence creates conditions where the epidemic can spread over the borders. Already the WHO has screened 6.5 million travellers at 53 border crossings into Sudan, Uganda, Rwanda, Tanzania and Zambia.

Several armed groups, numerous bandits, and ethnic factions are behind the violence. Near 1 million people had been displaced by violence over the past year, 235 people were killed in the Beni area alone, often by machetes. Congolese authorities have not credibly investigated the atrocities, either through inability, or, as alleged, because some military officers are involved in smuggling and other illegal activities.

A major problem is the Allied Democratic Front, a rebel movement with origins in the Ugandan civil war, with claimed support from Ghadaffi and Sudan, or from smuggling gold and drugs. Hidden in the fastnesses of the Rwenzori mountains, military operations against them were fruitless. There are other factors: ethnic conflict in the Ituri region has been dragging on for decades. Cross-border interests abound. Neighbors fomented violence when it suited them.

In west Africa Ebola claimed 11,000 lives due to lack of cooperation, slow reaction, regional disputes. In Mbandaka 33 died, despite serious challenges. Once again health professionals were on the front lines, and several died. In North-Kivu they are the angels who save lives, often at grave risk to themselves. 

When the tissue of Government is torn, the fabric of international support dissolves, Ebola and other evils can run out of control and affect millions.