Table 5 Impact of conflict on Ebola outbreaks

Nakkazi 2018 [37]

DR Congo, North Kivu in DR Congo,

1 August 2018–19 August 2018

People of North Kivu in DR Congo

The conflict played a role in delaying the detection of the outbreak for 3 months

Implemented:

• The DR Congo Ministry of Health coordinated and oversaw vaccination roll­out and followed the WHO emergency use assessment and listing procedure protocol.

• All contacts and their contacts should be vaccinated

• The DR Congo needed help from partners to respond and control this outbreak

Suggested:

Not mentioned

Gostin et al., 2019 [38]

DRC,

People in DRC during armed conflict,

Between October 28 and November 26, 2018

People in DRC

• The Ebola epidemic occurred within active armed conflict and geopolitical volatility, including a million displaced persons

• Infection of healthcare workers

• Community distrust is deep after decades-long humanitarian crises, impeding information-sharing and cooperation

Implemented:

• Contact tracing

• Medical isolation

• Ring vaccination

• Investigational treatments

• Foreign health workers, nongovernmental organisations, and UN agencies had been leading an energetic international Ebola epidemic response, alongside local personnel who offered experience and linguistic and cultural awareness

• World Bank dispatched financing, while US-supported vaccines, therapies, and laboratory/epidemiology capacity- building were proved essential

Suggested:

• Responders need greater capacity in surveillance, data analysis, laboratories, and clinical response, particularly experienced personnel to work with local leaders to build community trust and communication.

• Increased security and ensuring safe humanitarian operations

• The UN Security Council should mobilize high-level political attention and resources for the Ebola response

• External partners should develop a plan to deploy public health personnel such regions

• There should be an increase in funding to enhance local response capabilities

• A transparent framework for responding to epidemics in conflict zones should be developed

• Sustainable funding for national action plans for health security and a plan to safeguard public health action in conflict zones should be created

Ilunga Kalenga et al., 2019 [39]

DRC,

28 July 2018–7 May 2019

Residents of DRC

• Organised attacks by armed groups targeting response teams and Ebola treatment centres,

• Deteriorating security

• Population’s increasing distrust of the response effort

Implemented:

• 55 million entry and exit screenings

• Real-time epidemiologic surveillance of contacts

• Provision of safe and dignified burials for most deaths

• Vaccination of high-risk people

• Medical treatment including four investigational therapies

• Rapid rollout of vaccine

• Border screening

• Rapid decontamination of facilities where cases have been identified

• Health care facilities and key sites (schools, public offices, and transit points) equipped with training, infection prevention and control equipment (including personal protective equipment), and essential consumables such as chlorine, soap, and water

Suggested:

Not mentioned

Wells et al., 2019 [40]

DRC,

SIR model for the Ebola outbreak in DRC,

30 April 2018–23 June 2019

Population of Congo

• This period of civil unrest inhibited case detection and delayed reporting of the outbreak

• Conflict events were found to reverse an otherwise declining phase of the epidemic trajectory with disruptive events found to extend the average time from symptom onset to isolation and dampen vaccine deployment and increase transmission

• Case identification and containment of Ebola was even more difficult in areas that were too dangerous for health workers to enter or work (only 20% of contacts were traced)

• Several conflict events including attacks on ETCs or healthcare workers and healthcare workers protests had direct impact on the public health response

• Mistrust of the government and the public health response among civilians compounded hostility

• Healthcare providers became the target of violence

Implemented:

Not mentioned

Suggested:

• Integrating humanitarian work in the response

• Community engagement is needed to improve trust among the residents

• Engendering trust among locals early in an outbreak through community engagement

• Fundamental to ensure that frontline workers providing treatment, conducting contact tracing, and distributing vaccines can work efficiently