Q&A: Conflict, resistance hampering WHO’s Ebola efforts in DRC

The current Ebola outbreak in the Democratic Republic of Congo is now the second largest in history, according to the World Health Organization (WHO), with at least 426 confirmed cases in the country.

The outbreak, declared on August 1, has led to at least 198 confirmed deaths, DR Congo’s health ministry said.

It is the tenth time in DR Congo since Ebola was first detected there in 1976 and centres around the restive eastern city of Beni in North Kivu, a region which has been blighted by armed conflict, which has hampered efforts to curb the outbreak.

Al Jazeera spoke to Dr Matshidiso Moeti, Regional Director of WHO Africa, about the spread of the outbreak, lessons learned from the earlier outbreaks, and what the future holds for health issues in Africa.

Al Jazeera: DRC’s health minister called it the “worst outbreak” in the country’s history. How difficult is it for the WHO to tackle it?

Matshidiso Moeti: This is happening in a zone where there’s long-standing conflict. There is also a mistrust and the level of acceptance from the population has been a particular problem. Even as we’re there, there have been attacks on communities, kidnappings, threats to our staff and even attacks.

We’ve been keen to work at community level, with various community groups, hoping to spread the word to everyone, including the armed groups. We want to tell them that when there’s an Ebola outbreak, and the virus is circulating, we’re all at risk, including them. 

This is a combination of security issues and mistrust by the population, and even reluctance to cooperate sometimes. There are areas under the radar where the standard of infection control is very poor, they are some of the main areas where transmission is occurring and that has made the situation difficult and complicated.

This is a work in progress.

Al Jazeera: What kind of resistance did you meet from the communities?

Moeti: One of the biggest challenges has been the initial resistance from the communities. Some of them question why we’re here now. They ask where we were when they were being killed by these armed groups and how we’ve taken notice once Ebola hit them.

One thing we’re working on is safe and dignified burials. That’s one of the biggest areas of contamination and infection. In African communities, we have traditions when it comes to births, marriages and death. This is when we remember our culture and go back to practice it.

Al Jazeera: How difficult is it to let families safely part with the bodies of loved ones?

Moeti: It is difficult. People don’t find it easy to accept it. There has been resistance. But we’ve managed to do it effectively. One of the things is knowing who to work with, who has the trust of the community and a relationship with them – different leaders, religious leaders, women’s groups, etc. 

The investment in a dialogue with the community has also been important, not only for surveillance but also for building confidence in terms of persuading people to appreciate the risk and change their practices – how to deal with the loved ones who have died and essentially to hand them over for a safe burial.

Al Jazeera: How is that persuasion being done?

Moeti: For example, there is a very large number of small health clinics run by a number of health workers. This is a mix of traditional remedies and modern medicine but are not really regulated. This has been used and trusted by the population but this is where a lot of transmission has happened.

Now we’re working with them on infection prevention and control. We’re providing them with the material, knowledge and training needed so that if people visit, they understand and realise what they have to do to prevent transmission.

Al Jazeera: Malaria killed approximately 435,000 people last year, 93 percent of those in Africa. Last year, you told Al Jazeera “progress was being made but it wasn’t enough“. Why is progress still slow?

Moeti: The situation is still very similar. Twelve months is not a lot of time to turn a programme around…

Al Jazeera: … but we’re talking about more almost 400,000 deaths …

Moeti: You have to recalibrate and what additional capacity you have, address the bottlenecks you’re encountering. You see, it’s one thing to distribute bed nets but another to change what people do inside their homes – making sure they actually use it and to adopt that practice consistently.

We’ve identified 10 African countries and India as the heaviest burden countries [as part of a new initiative] and planning to improve the situation.