The Democratic Republic of Congo will end the year carrying a load of unprecedented disease outbreaks it began with. And officials say they are resilient, even if burdened.

 

Addressing senior officials of the Congolese government on December 13, Health minister Dr Roger Kamba outlined the epidemiological situation in the country, reporting an increase in cases of Mpox, another outbreak of an unknown disease – now declared to be severe malaria -- and cholera.

Every week, this type of public health situation is presented to the Council of Ministers, something that has become a ritual in the face of successive epidemics in the DRC.

Mpox epidemicAccording to the Health minister, Mpox, which accounts for more than 90 percent of cases in the DRC, has killed 1,225 people in the country. The death toll has risen sharply compared to previous years. According to the World Health Organisation (WHO), Mpox killed 89 people worldwide in the whole of 2022.

Since the start of the epidemic, 53,860 suspected cases have been reported, of which 11,984 were confirmed, according to the Health minister.

In August, the government earmarked $10 million to step up the fight against the epidemic, particularly a new strain of the disease that has spread to several provinces.

Last month, without giving precise figures, Lucy Tamlyn, the US ambassador to the DRC, said: “Since the beginning of 2024, we have raised millions of dollars in additional health funding to strengthen laboratory resources, increase support for health workers on the ground and develop plans to get vaccines to those who need them and prevent the spread of the disease.”At present, the vaccination plan, steered by the Africa CDC, is underway. The WHO, meanwhile, declared Mpox an international public health emergency.“The Mpox epidemic is increasingly affecting people displaced by the armed conflict in North Kivu,” says medical charity Médecins Sans Frontières in a bulletin.“In the Democratic Republic of Congo, the number of cases of Mpox has been rising for more than two years.

But things have got worse in recent months, with an explosion in the number of cases, a mutation leading to human-to-human transmission of the virus, and the notification of suspected cases in certain sites for displaced persons in North Kivu.”Read: Epidemic-battered DRC declares new ‘war’ on MpoxMpox is a disease caused by the simian pox virus. It is spread by close contact between individuals or with infected animals. Mpox causes rashes, lesions and pain.

It has been endemic in Central Africa (strain I) and West Africa (strain II) since the 1970s, and has spread rapidly around the world in 2022-2023, with tens of thousands of cases linked to the West African variant reported in more than 110 countries.

This disease represents a challenge for the government, which, in addition to security, social and economic challenges, has to deal with the emergence of several other diseases in the country.

On several occasions, President Félix Tshisekedi has set up “response” or “task force” teams to deal with emergency epidemics, with the financial and logistical demands that this entails.

Mystery diseaseBut the DRC is still grappling with “an unknown disease” in its south-western region, dubbed Disease X, which has turned out to be malaria.

Its symptoms include cough, headaches, fever, aches and pains and a runny nose. It has killed 32 of those hospitalised, according to official records from the Ministry of Health. But local communities in Kwango Province, the epicentre of the disease, have put the figure as high as 150.

The Minister of Health reported that ”this week, the country recorded an increase in the number of new cases of cholera from 488 to 502, with a case fatality rate of six percent, or three deaths. The province of North Kivu accounts for 54 percent of the country’s cases this week.”In 2023, the DRC accounted for 80 percent of cholera cases in Central Africa, with 54,000 cases including 462 deaths.

Several diseases that have been eradicated or do not exist elsewhere in the world are still rampant in the DRC.

The epidemic burden also includes human African trypanosomiasis. The DRC has the most prevalence of the neglected tropical disease in the world, but it has been on the decline over the past ten years, and has not claimed any more lives, according to the national programme to combat human African trypanosomiasis.

Deadliest virusThe UN refugee agency UNHCR believes that the fact that ”the DRC and neighbouring countries are home to millions of people who have been forced to flee their homes because of conflict, natural disasters or instability” explains the rapid spread of Mpox, given that the millions of displaced people live in very cramped conditions and lack the minimum requirements for good hygiene, such as soap, drinking water and cleaner sanitary facilities.

There are seven million internally displaced people in the DRC as a result of the war.

Of all these diseases, the Ebola haemorrhagic virus is considered the most deadly.

First identified in the early 1970s, the disease has struck the Congo 15 times since its discovery. Between 2019 and 2020, the Ebola epidemic has killed more than 2,000 people.

Its average case fatality rate is around 50 percent and has varied between 25 percent and 90 percent during outbreaks of certain epidemics in the DRC, according to the WHO.

According to experts, bats, rodents and monkeys are vectors of Ebola and Mpox.“Contact between humans in rural areas and wildlife, considered to be a reservoir of Ebola, is the main reason for the persistence of this disease,” Dr Aaron Aruna, Director of epidemiological surveillance in the DRC, told local media recently.

Environmental factors can play a part in the appearance of this disease. One of these factors is the demographic pressure of humans on the environment.“A few years ago, there were protected areas, but with the exploitation of these areas, humans are now in contact with wild fauna, the main breeding ground for viruses. The interaction between man and the animal world is becoming strong,” he added.

In Congo, bushmeat is popular. Despite calls from consumer associations, monkey meat continues to be widely consumed by people who are unaware of the risks. Appeals by consumer associations to urge the Office Congolais de Contrôle, the regulatory body, to ban meat suspected of carrying the Mpox virus from the market appear to have been ignored.

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