Violence against health workers in the Democratic Republic of Congo is complicating the response to a massive measles outbreak and accelerating the spread of the disease, which has claimed twice as many lives than an ongoing Ebola epidemic.
More than 5,000 people have died from measles since the start of the year, with over 90 per cent of them being children under the age of five, according to statistics released by the United Nation Children's Fund's (UNICEF) on Nov. 27. More than 140,000 people died from the easily preventable disease worldwide in 2018.
Meanwhile, an Ebola outbreak, which the World Health Organization (WHO) declared an international emergency in July, has killed more than 2,000 people in the country since August last year, UNICEF Congo representative Edouard Beigbeder said.
Violence and insecurity, medical kit shortages and a lack of access to health care and vaccines are some of the main factors hindering efforts to stop measles from spreading, Beigbeder said.
Attacks on health workers, treatment centres and communities have been frequent occurrences during this latest Ebola outbreak, which is the second largest on record, the UN said in a statement. WHO has documented over 300 attacks on health-care workers and patients since the start of the year.
On Nov. 28, two attacks targeting Ebola responders killed four and injured five at a camp in Biakato Mines, about 3,000 kilometres east of the capital Kinshasa, and a co-ordination office in the small town of Mangina.
The insecurity is being attributed to an estimated 100 armed groups operating in eastern Congo. WHO said this has "significantly complicated" the work of the authorities attempting to eradicate the diseases.
Health workers associated with disease
Bonnie Henry, provincial health officer for British Columbia's Ministry of Health, said this unrest, insecurity and violence has disrupted routine immunization programs, leading to the high number of measles infections.
Henry, who worked with UNICEF to control an Ebola outbreak in Uganda, said very high immunization rates are needed to protect the whole population.
Congo was no stranger to having violent outbreaks and the lack of a stable government contributed significantly to this outbreak, she told CBC News.
Congo has been caught in a bloody cycle of violence, with the central African country being hit by waves of rebellions, protests and political turmoil since the end of the 1997-2003 civil war that killed an estimated five million people.
"Communities distrust the government and the ability of their leaders to protect them. So when an international aid organization comes in they are immediately suspicious of their presence," she said.
Grant Leaity, co-ordinator of UNICEF's Ebola response, told CBC Radio that people living in isolated rural communities see aid workers appear in their towns without warning dressed in "space suits," which is then perceived as a threat.
"There is a feeling that by these health workers coming in, they will actually spread the contamination."
Complicating the situation further, Leaity said, was that this was the first time an epidemic response was being co-ordinated in an "active war zone."
"We have not done this before anywhere."
Conflict was also igniting north of Beni between government forces and the Allied Democratic Forces (ADF) rebel group, making access to locations "very tricky," he said.
Outbreak "enormous" by global standards
Gwen Eamer, a senior officer for public health emergencies at the International Red Cross, said the measles outbreak is "enormous" by both Congolese and global standards.
"Measles is one of the most infectious diseases that exists. If you have an un-immunized population and just one case of measles, they can spread it to around 18 other people. While with Ebola, they can only spread it to around two."
The Congo is particularly at risk because of its weakened health system, difficultly accessing communities and lack of education around immunization, Eamer said.
"When you get these big outbreaks it tends to be an indicator of underlying issues. Either the communities are hesitant or afraid of vaccines, or there are access problems and they want vaccines but can't get them."
Issues that have made it tough to fight Ebola — such as the multiple generations of conflict — will also make it tough to fight measles. However, there hasn't been direct overlap yet.
"It will be complex in the same regards as the Ebola campaign is complex," Eamer said.