The Democratic Republic of the Congo (DRC) has seen an increase in the number of reported cases of the deadly haemorrhagic virus Ebola linked to ongoing violence by armed groups targeting remote communities, the World Health Organization (WHO) said on Friday.

According to the UN agency’s latest outbreak update, 27 new cases were identified last week in the east of the country – three times the average number of infections in the past 21 days.

“The last three weeks were below 10 cases and this is only in four (DRC health) zones, and this is actually this is where we need to ensure access to finish the job,” Dr Michel Yao, Incident Manager, WHO Ebola Response in the DRC, told journalists in Geneva. “And unfortunately it is in this area where we are facing the security. This area is a mainly rural area, so for the big cities the outbreak is more or less controlled.”

Although the development is worrying, current infection rates are well down on the 120 cases a week reported during the peak of the outbreak, in late April.

In a further more promising development, WHO reported that in Beni and Mabalako Health Zones, the percentage of contacts under surveillance in the last seven days has returned to levels seen prior to “security events” that have hampered the Ebola response teams in past weeks.

A further sign of progress in the fight against the outbreak – DRC’s tenth in 40 years – is the fact that it now appears restricted to only four health zones, as opposed to the 29 originally identified in North Kivu, South Kivu and Ituri.

Nonetheless, attacks on healthworkers and Ebola clinics – including deadly violence against Ebola responders in Biakato (Ituri province) in late November - has meant that the vital work of tracing people who have come into contact with Ebola patients and vaccinating them has been severely restricted.

“In these (health) zones, there’s one (area) in particular called Lwemba that we haven’t been able to access for three weeks,” Dr Yao explained. “And when you don’t have access, you can’t vaccinate the contacts and others at risk. You can’t find confirm new cases of infection so you can’t do safe burials, you can’t get infected people out and get them medical care.”

(Dans ces zones, il y a une zone notamment appelée Lwemba ou on a eu trois semaines sans avoir accès à la zone. Et quand on n’a pas accès, on ne peut pas vacciner les contacts et les autres personnes à risque. On ne peut pas détecter de nouveaux cas, donc faire des enterrements sécurisés, on ne peut pas en fait permettre d’extraire des cas et leur permettre d’avoir accès aux soins.”)  

Most of the new cases identified in the last week were linked to one individual near Beni town who could have infected 17 people.

“The person who passed away is in a place that’s called Aloya. It’s close to Beni, but this person unfortunately died,” Dr Yao said.

According to WHO, this same person recovered from Ebola six months ago.

It is now investigating whether they were reinfected by someone else – which has never been documented - or suffered a relapse, which has happened before.

Since the outbreak began in North Kivu and Ituri last August, 2,210 people have died from the disease.

It is the second largest Ebola emergency to date, after the West Africa crisis that saw more than 28,600 cases of infection.

To ensure continued care, WHO has mounted a limited daily helicopter “air bridge” operation to the communities still at risk.

The health team on board conducted their first vaccinations on Thursday, Dr Yao said.

“The helicopter that we’re using has space for around 20 people so it means we can transport epidemiologists to do their investigations, but above all the vaccination team,” Dr Yao explained, noting that the communities had come to the Ebola responders seeking help. They “want the intervention”, he insisted, “but around we have armed groups that prevent us from reaching these communities”.

He added: “We’re mobilising communities all around to come and get vaccinated in a situation where there are (health) alerts but we can’t go to investigate because access is restricted.”

« L’hélicoptère que nous utilisons a une capacité d’une vingtaine de places et donc cela permettra de transporter des épidémiologistes pour faire des investigations mais surtout l’équipe de vaccination. Comme je l’ai dit on mobilise les communautés tout autour pour venir recevoir le vaccin dans un contexte où on a des alertes mais on n’a pas de moyens d’aller investiguer parce que l’accès reste limité. »

With up to 100 armed groups believed to operate in the vast forested region of eastern DRC bordering Uganda, Rwanda and Burundi, attacks on Ebola-hit communities have sparked a humanitarian crisis and threatened aid distribution, amid serious civil unrest.

“Since the start of this epidemic, there’s been one factor that we haven’t been able to control: the intervention context,” Dr Yao said, adding that “when these communities are attacked, there are demonstrations everywhere, which in fact stops Ebola intervention work”.

“Depuis le début de cette épidémie il y a un facteur qu’on ne maitrise pas, c’est le contexte d’intervention, notamment l’insécurité notamment des communautés qui lorsque ces communautés sont attaquées il y a des manifestations partout qui en fait arrêtent aussi les interventions d’Ebola.”

1. Wide shot: exterior, flag alley, sunny and windy conditions, Palais des Nations, United Nations Geneva.
2. Medium shot: Press room, journalists, podium speakers, sitting.
3. SOUNDBITE (EN) Dr Michel Yao, Incident Manager, WHO Ebola Response in the Democratic Republic of the Congo: “The last three weeks we were below 10 cases and this is only in four zones, and this is actually this is where we need to ensure access to finish the job. And unfortunately it is in this area where we are facing the security. This area is a mainly rural area, so for the big cities the outbreak is more or less controlled.”
4. Medium shot: podium speakers, conferring.
5. SOUNDBITE (FR) Dr Michel Yao, Incident Manager, WHO Ebola Response in the Democratic Republic of the Congo: “Dans ces zones, il y a une zone notamment appelée Lwemba (NDLR Lwemba is a health area in Mandima Health Zone) ou on a eu trois semaines sans avoir accès à la zone. Et quand on n’a pas accès, on ne peut pas vacciner les contacts et les autres personnes à risque. On ne peut pas détecter de nouveaux cas, donc faire des enterrements sécurisés, on ne peut pas en fait permettre d’extraire des cas et leur permettre d’avoir accès aux soins.”  
6. Medium shot: TV camera to left of shot, close-up, journalists seated at tables in front of laptops.
7. SOUNDBITE (EN) Dr Michel Yao, Incident Manager, WHO Ebola Response in the Democratic Republic of the Congo: “The person who passed away is in a place that’s called Aloya. It’s close to Beni, but this person unfortunately died.”
8. Wide shot: journalists typing on laptops, looking at speakers (out of shot).
9. SOUNDBITE (FR) Dr Michel Yao, Incident Manager, WHO Ebola Response in the Democratic Republic of the Congo: “L’hélicoptère que nous utilisons a une capacité d’une vingtaine de places et donc cela permettra de transporter des épidémiologistes pour faire des investigations mais surtout l’équipe de vaccination. Comme je l’ai dit on mobilise les communautés tout autour pour venir recevoir le vaccin dans un contexte où on a des alertes mais on n’a pas de moyens d’aller investiguer parce que l’accès reste limité.”
10. Close up, journalists wearing conference ear pieces, looking down at laptops (out of shot) and watching podium speakers (out of shot).
11. SOUNDBITE (FR) Dr Michel Yao, Incident Manager, WHO Ebola Response in the Democratic Republic of the Congo: “Depuis le début de cette épidémie il y a un facteur qu’on ne maitrise pas, c’est le contexte d’intervention, notamment l’insécurité notamment des communautés qui lorsque ces communautés sont attaquées il y a des manifestations partout qui en fait arrêtent aussi les interventions d’Ebola.”
12. Medium shot: photographer preparing to take photo and shooting.
13. Medium shot: journalist looking at podium (out of shot), holds pen in hand resting on cheek.
14. Close up: laptop computer with one hand hovering over mouse board.
15. Medium shot: journalist wearing mini headphones and glasses looks down at laptop (out of shot).