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Q&A | Tackling Congo’s Ebola outbreak ‘more than a public health response’

Interview with David Gressly, the UN’s Ebola point man, on the challenges ahead

Claude Sengenya/TNH

The Ebola outbreak in northeastern Democratic Republic of Congo continues, despite a rapid and large international response and the availability – for the first time – of a highly-effective vaccine.

Appointed as UN Emergency Ebola Response Coordinator in May, David Gressly is the man responsible for getting on top of the crisis. He is advocating a structured approach to fighting the disease, in order to focus on what is “stopping the public health response from happening.”

Since Ebola was declared in August last year, 1,641 people have died in what is the world’s second-worst outbreak of the disease, in a region with an ongoing insurgent conflict.

Many of those deaths have been hidden away in private homes or in general healthcare centres. There are “significant numbers” of new confirmed cases that are unable to be traced to an existing Ebola contact, Médecins Sans Frontières warned this month.

A number of factors have made this outbreak particularly difficult to contain, triggering fears of its spread across the country’s porous borders.

There remains deep community scepticism in eastern Congo – an opposition stronghold – over the origin of the disease. Most people do not question the existence of Ebola, but ask why it continues to spread. There is also wide-ranging suspicion of the Ebola response itself, with the influx of foreign aid and health workers seen as profit-driven.

In the climate of mistrust – fueled by rumour and misinformation – there have been more than 74 attacks on Ebola clinics or health workers since January. Community alienation has been reinforced by the use of the security forces to compel people to comply with health measures.

Read more → Inside Congo’s Ebola emergency

Gressly is the point man on the international response to Ebola. Prior to his appointment, he was the deputy head of the UN peacekeeping mission in the DRC, known as MONUSCO. That security experience is proving valuable in a region where more than 100 armed groups operate, and each treatment interruption allows the virus to circulate.

In a two-part interview – via phone and email – he spoke to The New Humanitarian about the challenge of working in a region that has suffered two decades of armed conflict; where the humanitarian needs of communities extend well beyond this health crisis; and on the urgency of developing a “partner-wide” strategy to end the outbreak.

This interview has been edited and condensed for clarity.

What are the top things you’d like to change now that you’ve been on the ground for a few weeks?

Number one is to bring all of the partners in the response together so that it is more than just a public health response. There have been a number of attacks, security issues, and protests and strikes that have caused multiple interruptions to this response which, unfortunately, have allowed the virus to continue to circulate.

Secondly, there are areas where surveillance is weak, mainly because of insecurity. So sometimes the virus gets into a locality relatively undetected. Right now we are chasing the virus as it moves from place to place. What's important is to take a more structured approach that looks at the things that are stopping the public health response from happening.

So we are building in multiple layers of support to the response. We are looking at the political side in terms of engagement with the government and with armed groups, hopefully supporting any kind of dialogue between them. We’re looking at how to better secure areas without militarisation. We're very much interested in creating more of an area-wide security that benefits not just the responders, but the community at large, which can include community policing.

But most importantly is a much deeper engagement with communities, both in currently affected areas and in at-risk areas, so that we provide a broader range of support that is not just Ebola-centric. And so we can build up a level of understanding of their concerns. Hopefully, trust will come with that so that we can work more effectively on the ground.

You also have extensive experience in peacekeeping operations. What can MONUSCO do to better protect local responders on the ground?

[MONUSCO is] quite co-operative and are supporting “area security”, which normally would be a form of patrols going out, not as escorts, but in advance [of a response team] or in a general area to provide a general sense of security. They can also deploy locally to be in the area, to be available if there's an incident, to respond quickly. [The peacekeepers] can also be used as an interposition between militia forces and national forces where that may be required, where we're just trying to find a neutral space for the response to take place.

We use community policing for more urban areas as a way to provide security to the community as a whole, as opposed to just focusing on responders. But having that broader security umbrella that protects the community will protect the responders. The community policing, in this sense, would be setting up joint operations centres between the [UN] mission police and the national police, as well as quick reaction teams with joint patrols, particularly at night.

There is also a hotline for the community to call. In other areas where this has been done it has really reduced the rate of criminality significantly. And I think we'll see the same thing when we apply this in places like Butembo [an Ebola epicentre]. So it has a double impact on improving security for the population, while also serving as a deterrent that helps protect those who are providing the response.

Are you concerned over associating peacekeepers with the response?

Our primary purpose is that everyone can work in a safe operating environment. To achieve that, we are promoting an area security approach, which does not rely on always-present armed protection. Armed personnel can have a detrimental effect on responders’ work and the vast majority of the response is conducted without an armed presence.

You can have security forces operating in an area without directly escorting or directly protecting [responders], and still create a security umbrella in which they can work safely and securely.

So you can de-link the two while still providing the security required. I'm not too worried about that part. It's a question of better targeting where it needs to be done; not just in the hotspots, which has been the focus in the past.

However, as the attack on responders in Beni [in June] highlighted, the threat of physical danger to the responders exists. We use armed escorts as a last resort.

As we step up our engagement with communities, including by listening to their needs beyond Ebola and finding ways to meet them, we are seeing some of the reticence to the response ease. This will take time in some areas that have historically been distrustful of outsiders. We are making progress, but need to do more.

The virus will find a way to continue to replicate if we don't have all the holes plugged.

What can be done to try to stop the outbreak infecting so many children?

Ebola hits children in ways that are very different from adults. Children orphaned by Ebola also need sustained support. They need to be protected from stigma and discrimination. They need help reintegrating into their communities – especially at school. UNICEF, through partners in the community, has been able to provide every child known to us who has been orphaned or separated from their parents due to Ebola with psychosocial support, care and love – notably from women who are themselves Ebola survivors.

(TOP PHOTO: A health worker takes temperatures in Mangina.)

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