Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

DRC EBOLA SITUATION REPORT 5 September 2018

5 September, 2018 SITUATION IN NUMBER 29 August, 2018 SITUATION IN NUMBER Highlights • 5 September, World Bank Chief of Health and UNICEF’s Representative 127 total reported cases conducted a high level mission to Beni and Mabalako Health Zone (MoH, 4 September 2018) • 4 September, a confirmed case has been identified in Butembo Health Zone, North Kivu province 96 confirmed cases • 3 September, schools have reopened in North Kivu and Ituri province. (MoH, 4 September 2018) During the last week, UNICEF strengthened its coverage in schools through the provision of handwashing facilities and infrared 87 deaths recorded thermometers, as well as its community engagement and Infection (MoH, 4 September 2018)

Prevention and Control mechanisms in the affected areas • 31 August, was international traditional healers day. UNICEF and WHO 2265 contacts under surveillance participated in a workshop at the Mayor complex in Beni Health Zone and (MoH, 4 September 2018)

discussed with 64 traditional healers about Ebola and its treatment. This exchange was valuable for all sides, as local traditional healers agreed to UNICEF Ebola Response take stronger protective measures and refer patients to medical experts if Appeal visited by patients with Ebola symptoms. US$ 7.624M

UNICEF’s Response

Target Result Ebola Response Funding # of at-risk people reached through community engagement Status 2018 and interpersonal communication approaches. (door-to- 3,600,000 2,731,224

door, church meetings, small-group training sessions, school Total classes, briefings with leaders and journalists, other) funding # of listed eligible people for ring vaccination informed of available* 6,393† 6,343 64% the benefits of the vaccine and convinced to receive the Funding vaccine within required protocols. Gap Ebola NK # of people with access to safe water in the affected health 681,649 563,832 36% Funding zones requirements : # of school children reached with Ebola prevention $ 7,624,546 82,500 923 information

# of families with confirmed or probable cases who received 127‡ 127 psycho-social support and/or material assistance

† The target is dynamic as listing of eligible persons is defined ‡ The target changes with changes in the epidemiology *Funds available include Reprogrammed funds from Equateur Response 1

DRC EBOLA SITUATION REPORT 5 September 2018

Epidemiological Overview Summary Table (04.09.18): Province Health Zone*1 Confirmed and Probable Cases Deaths in Confirmed and Probable Cases Suspect Cases Confirmed Probable Total Confirmed Probable Total under investigation Nord-Kivu Beni 17 4 21 12 4 16 1

Butembo 1 2 3 1 2 3 0

Oicha 2 1 3 0 1 1 0

Mabalako 66 21 87 42 21 63 3

Musienene 0 1 1 0 1 1 0 Kalunguta 1 0 1 0 0 0 0 Ituri Mandima 9 2 11 1 2 3 0 TOTAL 96 31 127 56 31 87 4 Previous Total 28 August 2018 85 30 115 47 30 77 10

Humanitarian leadership and coordination

1 With better access, the number of health zones with Ebola cases was review by the Surveillance commission and revised from 7 reported in the last update to 6 in this report. 2

DRC EBOLA SITUATION REPORT 5 September 2018 commissions on communication, WASH and psychosocial care; and active in the working groups on logistics and vaccination. A UNICEF security specialist is also deployed in the field to support security assessment and safety of the operations.

Mabalako health zone remains the most worrying area for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial are focused in Beni and Mabalako Health Zone, North Kivu province, however, UNICEF continues to implement prevention activities in other parts of North Kivu and Ituri provinces.

The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases in Makeke, Mandima Health zone and Oicha Health Zone, and the identification of probable cases in Butembo. UNICEF coordinates Makeke’s Ebola response from the coordination team based in Mangina Health Area and the coordination response for Oicha Health Zone and Butembo will be supported through Beni’s coordination team. Due to the security access in Oicha Health Zone, UNICEF works through a local partner to implement its activities.

Response Strategy The joint response plan of the government and partners has just been finalised based on the recent experience from the Equateur Ebola response. In support of the joint response plan, the UNICEF response strategy will focus on communication, WASH, and Psycho-social care, nutrition and cross-cutting education sector response.

• Risk communication, social mobilization and community engagement with the aim to (1) proactively engage with affected and at risk communities, (2) provide timely and accurate health advice to encourage positive health seeking behaviors and (3) address community concerns and rumors. The strategy is implemented through 5 pillars that include (i) community engagement; (ii) promotion of preventive behaviors; (iii) responding to resistance; (iv) advocacy and capacity building of actors and (v) communication in support of ring vaccination. • The WASH strategy, as part of the Infection Prevention and Control (IPC), aims to stop the spread of the disease through the availability of 1) WASH in health care facilities, which includes providing water and WASH kits, 2) hygiene promotion and the provision of WASH kits in schools, including handwashing station and soap/temperature check points, and 3) WASH in communities, through mass outreach on hygiene promotion to vulnerable communities and the setup of handwashing stations/temperature control in strategic transit locations, as well as the disinfection of households/neighborhoods of confirmed cases. • The child protection and psycho-social support to EVD survivors and family members of EVD cases as well as contact families seeks to (1) provide psycho-social support; (2) establish or re-establish social and community networks and support systems; (3) provide social kits to EVD affected families (4) identify and provide appropriate care to orphans and unaccompanied children due to the Ebola epidemic The key element of the strategy will include (i) psychosocial support activities for children and their families; (ii) material assistance to affected families to better support children; (iii) facilitation of professions help to children and families with more severe psychological or social problems / needs; (iv) coordinate mental health and psychosocial support (MHPSS); (vi) psycho-social assistance, appropriate care and research of long term solution to orphans and unaccompanied children. • The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases to the 6 health zones affected by Ebola or in situation of nutritional alert in North Kivu province. In addition, address young child and infant feeding practice that is impacted by the increasing number of women affected by the Ebola epidemic • The cross-cutting education sector strategy involve key EVD prevention measures on the school premises, include: (i) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas (ii) training of educational actors (students, teachers, inspectors, school administration agents, head of educational provinces) on Ebola including WASH in school, psychosocial support and against discrimination, (iii) 3

DRC EBOLA SITUATION REPORT 5 September 2018 provision of infrared thermometers and handwashing facilities, clean water, soap, and capacity reinforcement on hygiene behaviours in schools (iv) construction of isolation rooms for suspected cases at school (v) provision of specific documentation and protocol for prevention, guidance and management of suspected cases in school (vi) provide key messages on Ebola prevention to families.

Summary Analysis of Programme Response

Overview of the key elements in the response with a special emphasis on UNICEF’s response in the affected health zones Communication and social mobilization (C4D) During the reporting period, UNICEF strengthened its community engagement by developing two strong Risk Communication plan for Mangina Health Area and Ndindi district, Beni Health Zone. The objective of these plan are to engage various leaders and key actors to promote a collective commitment and daily alerts, community deaths and resistance points. Acknowledging the critical priority to address sources of reluctance, refusal, and resistance, the cross-sectoral role of communications has become a higher priority for the central coordination team. The clear role of communications is to ensure and create a workable link and a shared understanding between the rigid medical response and the sensitive cultural and sociological response, which can only be assured through integration and common planning between the communication team and the commissions of Vaccination, Surveillance, Prevention, WASH, education and Psycho-social. The integration of two international and three local sociologists/anthropologists in the response has been highly welcomed and appreciated by the other commissions, as it ensured a more culturally sensitive response to resistance as well as helped to identify mutual solutions to issues related to surveillance, treatment centers and burial practices. These interventions resulted in more systematic visits to ETUs by all families of confirmed cases and contacts. This has also been appreciated by community leaders. Additionally, C4D strengthened community engagement by reaching an additional 642 leaders through advocacy, community engagement, and interpersonal communication activities, including 350 religious leaders, 64 traditional healers, 42 magistrates and judges, 144 teachers, and various business men, transport managers, police force and members of government. Since the beginning of the response, UNICEF reached 3,202 (91% coverage) leaders out of the targeted 3,500. In addition, a total of 2,122 (68% coverage) out of the targeted 3,100 frontline workers (RECO) were trained in affected zones. Training included modules on prevention, safe burials, stigmatization of Ebola survivors, interpersonal communications, and community based approaches, of which an additional 407 were reached during the reporting period.

Since the beginning of the response, 2,731,224 (76% coverage) at-risk population were reached with Ebola prevention and control messages through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, adolescent groups, administrative employees, armed forces etc, reaching 277,000 during the reporting period. To reinforce UNICEF’s community engagement and to break down community resistance and rumours, eight Ebola survivor testimonials were recorded and each expressed a genuine call with encouragements to community members to seek early treatment, advocating for people to approach ETCs, rather than hide family members or friends with symptoms. In addition, the testimonials advocated the importance to fully accept survivors back into their communities without stigmatization, as well as promote the free of charge treatments in the ETCs. To reinforce mass communication, a meeting with nine radio stations from Butembo Health Zone was conducted to ensure commitment and engagement from all directors. New radio productions with peer-to-peer testimonials were shared and a broadcast plan activated. The creation of a new communications commission was also discussed and will be put in place this week in Butembo Health Zone.

DRC EBOLA SITUATION REPORT 5 September 2018 As of 5 September, a total of 132 (88% coverage) out of the targeted 150 households presenting resistance/hesitance to Ebola vaccination benefited from personalized house visits to address general concerns, including refusals to secure and dignified burials practices. During the reporting period, 27 cases of resistance were addressed and neutralized by prompt organization of guided tours to the ETUs for community and religious leaders, and family members of confirmed cases. As of the time of compiling this report, 6,393 (99% coverage) eligible people for the Ebola vaccination were informed about the benefits of the vaccine and were convinced to receive the vaccine within required protocols. 1, 832 people were informed on the benefits of vaccination prior to the arrival of the vaccination teams in targeted areas. Despite that the demand for vaccination remains high, no major resistance was recorded. The next Knowledge, Aptitude, and Practice survey is scheduled second week of September in order to understand how the population in affected areas receive and understand Ebola prevention messages. Key activities in the last seven days:

• This period is characterized by the intensification plan for Mangina and Mandima that includes a strong focus on community-based surveillance. Leaders from all 32 affected health areas were re-visited, and together formed a local committee to follow up on all suspected cases. Mobile phones were provided to each village chief for direct access to the hotlines as well to the dedicated communication teams who provided the support. • Following the big concern and anticipation to address the urban city of Butembo, a high-level team travelled to Butembo from Beni to participate in a large gathering of nearly 350 religious leaders called in by the Archbishop of the province. All leaders were asked to quickly pass the message and engage in community based surveillance planning. • To intensify and promote the free hot-line to report suspected cases, 200,000 reminder stickers were printed and distributed for sticking to back of cell phones and documents • The archbishop of Beni-Butembo visited an ETU centre and was vaccinated in front of public media channels to show a positive example. This was capitalized in all social mobilization and outreach activities. • An intensification plan was completed for Ngindi district in Beni, where 2 confirmed cases were recently treated. This plan includes advocacy with all leaders, creation of a community-surveillance committee, conducting rapid focus groups, and encouraging youth participation in all activities. • Radio campaigns continue to play a strong and effective role in collective behaviour change, with over 320 radio programs broadcast during this period.

Water, Hygiene and Sanitation (WASH) Since the beginning of the response, 53 of the 52 high priority health facilities in the affected health zones in North Kivu provinces benefitted from essential WASH activities; these include the provision of handwashing points, briefing of staff on hygiene promotion, and disinfection, and the installation of chlorination points, reaching six health facilities during the reporting period. Considering the dynamic of the epidemic, in total, 83 low priority health facilities should be covered to ensure full prevention and protection mechanisms in the area. As of 05 September, 344 community sites (ports, market places, local restaurants, and churches) were provided with handwashing facilities for Ebola infection control in Beni, Mandima, and Mabalako Health zones in partnership with Oxfam and Oxfam reaching 23 community sites during the reporting period. 563,832 (83% coverage) persons out of the targeted 681,649 gained access to safe water in the affected health zones, reaching 49,944 persons during the reporting period.

DRC EBOLA SITUATION REPORT 5 September 2018

Key activities in the last seven days:

• In preparation of the reopening of schools on 3 September in Ituri and North Kivu province, UNICEF up-scaled WASH activities in 250 priority schools through the collaboration with implementing partners, Oxfam, Mercy Corps, Communaute Baptiste au Centre de l’Afrique, Programme de Promotion des Soins de Santé Primaire and DRC Red Cross. As of 4 September, a total of 177 (70% coverage) out of the targeted 250 schools have been reached mainly in Beni and Mabalako Health Zones. WASH activities in schools includes rapid WASH assessment, briefing of schools teachers/Directors, and provision of WASH hygiene kits (which contains infrared thermometers, handwashing stations, and soap). These activities benefitted to an estimated 80,000 children registered in the schools covered. • Distribution of WASH kits (1 bucket, 1 20L bucket, 9 bars of 400grams of soap each, 50 Aquatab pills, 1 Ebola pamphlet) to 14 discharged patients from Ebola treatment centers in Mangina Health Area • In collaboration with UNICEF, Oxfam continues to support 45 chlorination points in five2 health areas in Mabalako Health Zone

Education 1,590 (91% coverage) teachers out of the 1,750 targeted have been briefed on Ebola prevention messages since the beginning of the response. Since the reopening of schools on the 3 September, 923 (1% coverage) students have been reached with Ebola messages.

Psychosocial and Child Protection During the reporting period, 26 families affected by Ebola Virus Disease (EVD) received psycho-social support and material assistance including food assistance in Beni, Mandima3, and Mambasa Health zones ; reaching a total of 127 (100% coverage) out of the targeted 127 families . All the discharged and cured patients receive hygiene kits from UNICEF when they leave the Ebola Treatment Center. 36 persons have been assisted since the beginning of the response. For the families who lost a family member from EVD, psycho-social agents are closely working with the Prevention Commission to provide a specific psychosocial assistance during the organization of Safe and Dignified Burials (SDB). 6 SDB, including funerals of two children, were conducted in coordination with the psychosocial commission. 30 new separated/orphan children due to the Ebola epidemic has been identified and received appropriate care; thus a total of 121 (81% coverage) out of the targeted 150 unaccompanied or orphaned children due to EBV have been reached. Specific individuals needs regarding support for schooling have also been identified. UNICEF is currently developing a specific assistance that includes the payment of tuition fees as well as the distribution of school supplies. In addition, 293 contacts families received a psycho-social support, reaching a total of 436 (48% coverage) out of the targeted 906 contact families4. A coordination meeting was organized between UNICEF, WFP and the Psychosocial Commission to harmonize the interventions. WFP will provide food assistance only to contact families. During the reporting period, 252 contact families were thus reached. UNICEF will continue the assistance to the EVD affected families through psychosocial support, material assistance (including food assistance) according to the needs identified.

2 Chlorination points health areas: Mangina, Linzo, Mangodomu, Makeke, and Bella 3 Includes Makeke Health Area 4 The target has been amended and 40% of listed contacts is the new identified target 6

DRC EBOLA SITUATION REPORT 5 September 2018

Nutrition During the reporting period, seven nutritionists received training on nutritional care from UNICEF, of which one is based in Beni Ebola Treatment Center (ETC) and another nutritionist is based in Mangina ETC. The remaining four will be deployed to Mangina over the coming days. Through UNICEF interventions, ten in-patients in Beni ETC received appropriate nutritional care. In addition, one lactating women hospitalized in Beni ETC was provided with keys messages on breastfeeding in the context of the Ebola epidemic. In terms of field coordination, UNICEF has one nutrition expert in the Beni based field coordination team. To harmonize nutrition care protocol in ETCs and in line with the guidelines of the national nutrition program, UNICEF, through its staff in the Beni-based response team, has developed a practical protocol for the nutritional management of patients with EVD. However, nutritional care activities for Severe Acute Malnutrition (SAM) cases in health centers have not yet started as UNICEF implementing partner NGO MEDAIR is in the process of organizing training session for health and nutrition workers.

Supply & Logistics Since the beginning of the response, USD $882,384 to USD $1,256,039 worth of items have been deployed for the Ebola response in Ituri and North Kivu province, composed of 3,566 buckets, 2,930kg of chlorine, 605 jerry cans of 20 liters, 648 handwashing kits, 28 motorbikes, and 199 chlorine sprayers, 2,109 boxes of soap, 14 tents, and 836 infrared thermometers. In addition, 260,000 Ebola flyers and 130,000 Ebola posters in Kiswahili, Lingala and French were procured and in the process of delivery to Beni to support community mobilization. During the last week, the Supply section was mainly focused on mobilizing and dispatching supplies for the opening of schools in 250 targeted schools and supplies to strengthen Infection Prevention and Control (IPC) in health facilities. A Logistics Specialist deployed from Supply Division arrived in Kinshasa to support the supply and logistics coordination of Ebola response.

Human Resources As of 5 September, 58 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri provinces.

External Communication The CO focused its external communication work on the situation of the Ebola epidemic one month after the announcement by the Government of the epidemic. In that context the CO issued a press release on UNICEF’s response and its activities run since the beginning of the epidemic, and produced a story by the Representative on UNICEF’s intranet ICON, as well as an interview with the coordinator of UNICEF’s response in the affected region. The CO facilitated during the reporting period visits of UNICEF supported programmes for the news agency AFP. Main media coverage since previous Situation Report included RFI , RFI, AP, TV5 Monde Afrique, Al Jazeera, VOA,Euronews, All Africa, DW, Quartz Africa, All Africa, Miami Herald, Europapress, CBC , Toronto Star Online, ABC News . The CO has published 16 articles on its blog since the announcement of the epidemic, as well as more than 80 tweets, 13 Facebook posts and 12 pictures on Instagram. UNICEF’s global blog Connect published a new story on UNICEF’s psychosocial work to assist children and families affected by the virus.

DRC EBOLA SITUATION REPORT 5 September 2018

Funding The Response Plan developed jointly with the Ministry of Health, United Nations Agencies and in coordination with other actors is estimated at US$ 43.837 million. Based on the joint response plan, UNICEF estimated amount required for immediate response is US$ 7.624 million. The Ebola response is in line with the 2018 DRC Humanitarian Action for Children (HAC) appeal which has a total funding requirement of USD 268 million. Funds available include funds reprogrammed from Equateur Response in consultation with World Bank (PEF), USAID, ECHO and Japan. At present, funds from Gavi (US$ 120,000), CERF (US$ 900,000), USAID (US$ 2 million), and UNICEF National Committee in Germany (US$503,147) have been allocated to support the Ebola response in North Kivu and Ituri province.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018) Funds available Funding gap Appeal Sector Requirements Funds Received Current $ % Year* WASH 2,346,521 2,297,364 49,157 2% Communication for Development 2,602,340 1,595,536 1,006,804 39% (C4D) Psychosocial Support 433,321 400,000 33,321 8% Management of Severe Acute 500,000 50,000 450,000 90% Malnutrition Operations support and 1,742,364 504,861 1,237,503 71% Coordination costs + ICT Total 7,624,546 4,847,761 2,776,785 36%

*Funds available include proposed funds to be reprogrammed from Equateur Response ** Does not include funds in the pipeline

Next Sitrep: September 11, 2018

Who to contact Gianfranco Rotigliano Tajudeen Oyewale Pierre Bry for further Representative a.i. Deputy Representative Chief Field Operations UNICEF DRC UNICEF DRC UNICEF DRC information: Tel: + (243) 996 050 399 Tel : +(243) 996 050 200 Tel: + (243) 817 045 473 E-mail: [email protected] E-mail : [email protected] E-mail: [email protected]

DRC EBOLA SITUATION REPORT 5 September 2018

Nord Kivu and Ituri Provinces, 2018 (5 September 2018)

Ebola Response Tracking Indicators Change Target Total results since last report ▲▼

RESPONSE COORDINATION

# of affected localities with functioning partner coordination mechanism 3 2 0 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, religious /traditional leaders, 3,500 3,202 642 opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on Ebola response and participatory 3,100 2,122 407 community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, adolescent 3,600,000 2,731,224 277000 groups, administrative employees, armed forces.

# of households for which personalized house visits was undertaken to address serious 150* 132 27 misperception about Ebola, refusals to secure burials or resistance to vaccination. # of listed eligible people for ring vaccination informed of the benefits of the vaccine and 6393† 6,343 1,832 convinced to receive the vaccine within required protocols. % of respondents who know at least 3 ways to prevent Ebola infection in the affected 80% 26%*** 0 communities (from Rapid KAP studies) WATER, SANITATION & HYGIENE # of health facilities in affected health zones provided with essential WASH services. 140 53 6

# of target schools in high risk areas provided with handwashing facilities 250 177 177

# of community sites (port, market places, local restaurant, churches) with hand washing 200‡‡ 344 23 facilities in the affected areas

# of people with access to safe water source in the affected areas 681,649 563,832 49,944 EDUCATION # of school children reached with Ebola prevention information 82,500 923 923

# of teachers briefed on Ebola prevention information 1,750 1,590 1,495

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of families with confirmed or probable cases who received psycho-social support and/or 127‡ 127 26 material assistance # of contact, including children, who receive psycho-social support and/or material assistance 906** 436 293 # of unaccompanied children and orphans identified who received appropriate care and 150†† 121 30 psycho-social support * The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response mature † The target is dynamic as listing of eligible persons is defined *** Baseline result of the KAP study undertaken during 6 – 8 August, 2018 (the week following declaration of the epidemic). The next KAP study is scheduled for the 8-10 September ‡ The target changes with changes in the epidemiology ** The target is dynamic and 40% of listed contacts is the identified target †† The target is an estimation and dynamic based on field experience ‡‡ The target is dynamic, based on the number of affected areas and new community sites identified for hygiene promotion

DRC EBOLA SITUATION REPORT 10 September 2018

Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

10 September, 2018 SITUATION IN NUMBER 29 August, 2018 SITUATION IN NUMBER Highlights 132 total reported cases • 5 September, a confirmed case has been identified in (MoH, 9 September 2018) Masereka Health Zone, North Kivu province 101 confirmed cases • A coordination hub has been set up in Butembo Health Zone, (MoH, 9 September 2018) with the psychosocial and communications already in place. UNICEF has deployed C4D, WASH, and psychosocial staff to 91 deaths recorded support UNICEF interventions in Butembo Health Zone and (MoH, 9 September 2018) Masereka Health Zone 1,945 contacts under surveillance (MoH, 9 September 2018) • As of 8 September, vaccinations have started in Masereka and Butembo Health Zone, in addition to previously affected health zones UNICEF Ebola Response Appeal

US$ 7.624M

UNICEF’s Response

Target Result

# of at-risk people reached through community engagement Ebola Response Funding and interpersonal communication approaches. (door-to- 3,600,000 3,368,172 Status 2018 door, church meetings, small-group training sessions, school classes, briefings with leaders and journalists, other) Total # of listed eligible people for ring vaccination informed of funding 7,537† 7,390 available* the benefits of the vaccine and convinced to receive the vaccine within required protocols. 64% Funding # of people with access to safe water in the affected health 681,649 563,842 Gap zones 36% Ebola NK Funding # of teachers briefed on Ebola prevention information 2,089‡ 2,089 requirements : # of families with confirmed or probable cases who received $ 7,624,546 131‡ 131 psycho -social support and/or material assistance † The target is dynamic as listing of eligible persons is defined ‡ The target is dynamic based on epidemiological changes

*Funds available include Reprogrammed funds from Equateur Response 1

DRC EBOLA SITUATION REPORT 10 September 2018

Epidemiological Overview Summary Table (09.09.18): Province Health Zone*1 Confirmed and Probable Cases Deaths in Confirmed and Probable Cases Suspect Cases Confirmed Probable Total Confirmed Probable Total under investigation Nord-Kivu Mabalako 66 21 87 42 21 63 4

Beni 20 4 24 15 4 19 0

Oicha 2 1 3 0 1 1 0

Butembo 2 2 4 1 2 3 16

Musienene 0 1 1 0 1 1 0 Masereka 1 0 1 0 0 0 0 Kalunguta 1 0 1 1 0 1 0 Ituri Mandima 9 2 11 1 2 3 0 TOTAL 101 31 132 60 31 91 20 Previous Total 5 September 2018 96 31 127 56 31 87 4

1 With better access, the number of health zones with Ebola cases was review by the Surveillance commission and revised from 7 reported in the last update to 6 in this report. 2

DRC EBOLA SITUATION REPORT 10 September 2018

Humanitarian leadership and coordination

Mabalako health zone remains the most worrying area for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused in Beni and Mabalako Health Zone, North Kivu province, however, UNICEF continues to implement prevention activities in other parts of North Kivu and Ituri provinces.

The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases in Makeke, Mandima Health zone, Oicha Health Zone, Butembo and Masereka Health Zone. UNICEF coordinates Makeke’s Ebola response from the coordination team based in Mangina Health Area and the coordination response for Oicha Health Zone. A new coordination hub is currently being put in place in Butembo Health Zone, which will also support the response in Masereka Health Zone. A psychosocial and communication commissions have been set up in Butembo Health Zone, composed of five clinical psychologists and communications specialists. Due to the security access in Oicha and Masereka Health Zone, UNICEF works through a local partner to implement its activities.

DRC EBOLA SITUATION REPORT 10 September 2018 • The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases to the 6 health zones affected by Ebola or in situation of nutritional alert in North Kivu province. In addition, address young child and infant feeding practice that is impacted by the increasing number of women affected by the Ebola epidemic • The cross-cutting education sector strategy involve key EVD prevention measures on the school premises, include: (i) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas (ii) training of educational actors (students, teachers, inspectors, school administration agents, head of educational provinces) on Ebola including WASH in school, psychosocial support and against discrimination, (iii) provision of infrared thermometers and handwashing facilities, clean water, soap, and capacity reinforcement on hygiene behaviours in schools (iv) construction of isolation rooms for suspected cases at school (v) provision of specific documentation and protocol for prevention, guidance and management of suspected cases in school (vi) provide key messages on Ebola prevention to families.

Summary Analysis of Programme Response

Overview of the key elements in the response with a special emphasis on UNICEF’s response in the affected health zones Communication and social mobilization (C4D) Since the beginning of the response, 5,118 (100% coverage) persons out of the targeted 5,118 members of influential leaders and groups were reached through advocacy, community engagement, and interpersonal communication activities, reaching 1,916 during the reporting period. Of those reached during the reporting period, 120 youth leaders met for a meeting organized in Mangina health area, which represent 20 youth associations from eight surrounding health areas. Common questions among leaders are questions related to the ‘source’ of Ebola: “How can a bat bring all of this? Are all bats infected? Are bats the real origin? How do animals in the forest get Ebola? How can we stop the bats?” Such questions are responded to by highlighting transmission mechanisms and prevention measures. In addition, 387 frontline workers (RECOs) in the affected zones were mobilized on Ebola response and community engagement approaches, reaching a total of 2,509 (81% coverage) out of the targeted 3,100. As of 10 September, 3,368,172 (94% coverage) at-risk population were reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, adolescent groups, administrative employees, armed forces etc, reaching 636,948 persons during the reporting period. Of those reached during the reporting period, 9,418 church goers were provided life-saving information on Ebola, of which 2,435 were members of youth groups. To reinforce mass communication, eight Ebola survivors’ testimonies have been broadcasted on 24 radio stations in Beni and Butembo Health zone and Mangina Health Area, sharing their success stories: “I am an Ebola survivor, and this testimony is real, as I have nothing to gain. If you have any symptoms of fever or vomiting, you can get checked very quickly, and then released, but if they think it may be Ebola, then staying in the treatment center is the only chance one has to survive, the sooner you get treated the better chance you have’ During the reporting period, 35 households presenting resistance/reluctance to Ebola vaccination benefited from personalized house visits to address general concerns, including refusals of secure and dignified burials practices, reaching a total of 167 (100% coverage) households since the beginning of the response. As of the time this report was compiled, 7,742 (98% coverage) eligible people for the Ebola vaccination were informed about the benefits of the vaccine and were convinced to receive the vaccine within required protocols, including 1,399 persons during the reporting period. Communication members joined the surveillance teams in a joint mission to help locate 10 contacts in Butembo’s Vutsundo neighbourhood. After responding to their concerns and questions about Ebola, all contacts were identified and families engaged to cooperate with the Ebola response.

DRC EBOLA SITUATION REPORT 10 September 2018 In order to respond to the new needs in Ndindi neighborhood of Beni, a local committee of 15 people made up of community leaders under the direction of the ward chief was set up for a multisectoral response (communication, psychosocial, SDB and epidemiological surveillance).

On the community engagement component, within the partnership with Oxfam”, to date, 77 “chefs d’avenue” (chief of street) and 30 community leaders (religious, youth leaders and women's associations) have been identified and briefed on the EVD risks, preventive measures as on community monitoring and resistance/conflict management and are already holding community dialogue sessions in the Ndindi neighborhood to strengthen the community's understanding of the risks of the disease and promote the adoption of preventive measures. For reestablishing trust towards response interventions, visits to CTEs are planned for community leaders and chiefs of wards and streets. In the same perspective, EVD survivors have been recruited for testimonials during dialogue sessions in the community. Follow-up meetings will be held weekly to assess progress and decide on possible corrective actions. In addition to what is done with Oxfam, two discussion meetings were organized with chiefs of wards and streets, and other community leaders, coordinated by the the response coordinator, and the Mayor of Beni City, who responded to all the concerns raised. This has largely contributed to reducing resistance in the community, especially with respect to vaccination against the Ebola virus.

Results for the KAP survey will be presented in the next sitrep. Key activities in the last seven days:

• Three UNICEF C4D staff and a senior anthropologist from Butembo University have been deployed to Butembo Health Zone with the objectives to define clear approaches on how to discuss and listen to local populations, while also recommending ways that all leaders cooperate with the medical protocols. • The two free existing Ebola telephone lines are used as a communication tool to provide important information about Ebola and report cases. Additional staff training and recruitment of more operators are needed. In addition, 16 large billboards were erected in Mangina health area and Beni health zone as a reminder for the general population that only through collaboration and calling the free service numbers can we beat Ebola. • Two workshops on risk communications were conducted, of which 43 journalists participated in Beni health zone and 33 journalists in Butembo Health Zone. Journalists discussed their critical roles and responsibilities in emergency situations, especially how to report and respond to negative rumors, as well as ways to amplify positive testimonies and report on Ebola activities in their neighborhoods.

Water, Hygiene and Sanitation (WASH) During the reporting period, 13 new health facilities in the affected health zones in North Kivu provinces received WASH support; these include the provision of handwashing points, briefing of staff on hygiene promotion, and disinfection, and the installation of chlorination points, reaching a total of 66 (47% coverage) out of the 140 targeted since the beginning of the response. While 66 health facilities have been fully covered so far, WASH response in additional 36 health facilities are on-going with the support of UNICEF partners. As of 7 September, 359 (100% coverage) community sites (ports, market places, local restaurants, churches) were provided with handwashing facilities for Ebola infection control in Beni, Mandima, and Mabalako Health zones, in partnership with Oxfam and Programme de Promotion des Soins de Santé Primaire. In the reporting period, UNICEF and our partners maintained the same number of water points/water supply networks to be chlorinated and monitored daily, supplying safe water to 563,832 people (83% coverage), out of the targeted 681,649.

DRC EBOLA SITUATION REPORT 10 September 2018

Key activities in the last seven days: • UNICEF WASH teams supported the joint efforts between humanitarian actors to provide basic services in Ndindi, Beni city, where community resistance has limited the Ebola Response. In close coordination with the local committee of key leaders, UNICEF provided WASH hygiene kits in all schools (23) and in 13 health facilities in Ndindi. • With new confirmed cases in Butembo, UNICEF WASH team collaborated with WHO to identify a list of priority health facilities and schools in the affected zones of the city. UNICEF and WHO will join efforts to cover at the same time WASH and IPC activities in the priority health structure identified.

Education During the reporting period, 3,480 children were reached with Ebola prevention information, reaching a total of 4,403 (5% coverage) out of the targeted 82,500. It is reported that school attendance remains low in EVD affected areas. In addition, a total of 2,089 (100% coverage) teachers were briefed on Ebola prevention messages since the beginning of the response, reaching 499 teachers during the reporting period. As schools officially opened on 3 September 2018, UNICEF continued to scale-up WASH interventions in schools, reaching a total of 255 (81% coverage) schools with WASH activities. WASH activities in schools includes rapid WASH assessment, briefing of schools teachers/Directors, and provision of WASH hygiene kits (which contains infrared thermometers, handwashing stations, and soap). These activities will reach an estimated 115,000 children registered in the schools covered. Monitoring visits have also been made in 45 schools that reached WASH support during the previous reporting period. UNICEF, in partnership with Oxfam, will also target 60 additional schools in Oicha.

Psychosocial and Child Protection The Psychosocial Commission has been set up in Butembo Health Zone during the past week, which includes five clinical psychologists. 40 psychosocial agents have also been trained. During the reporting period, five affected families by Ebola Virus Disease (EVD) received psycho-social support and material assistance, including food assistance, in Beni, Mandima2 , and Mambasa Health zones; reaching a total of 132 (100% coverage) out of the targeted 132 families. It is important to note that the target of affected families also includes the assistance to suspected cases /discharged patients (who have been tested negative to EVD), the total figure can consequently be higher than the total number of EVD cases3. Since the beginning of the Ebola epidemic, 41 children (24 boys and 17 girls) have been admitted in the Ebola Treatment Center (ETC) of Mangina. Among them, nine died from EVD, one survived and 27 were discharged. Currently, there are four children in the CTE (three boys and one girl). All the children received specific psycho-social support as well as a material assistance for the one who have cured/discharged. Eight new separated/orphan children due to the Ebola epidemic has been identified and received appropriate care; a total of 129 (86% coverage) out of the targeted 150. NFI and food assistance have been distributed to the caregivers of seven separated/orphan children previously identified. Eight family members visiting their relatives received psychosocial support in the ETC of Mangina and in the transit ETC of Makeke.

2 Includes Makeke Health Area 3 Source: http://www.who.int/ebola/situation-reports/drc-2018/en/ 6

DRC EBOLA SITUATION REPORT 10 September 2018 The Psychosocial Commission identified eight households of EVD died patients, who have not been yet vaccinated. These families have been referred to the Vaccination Commission. 190 contacts families received a psycho-social support, reaching a total of 626 (80% coverage) out of the targeted 778.

Nutrition During the reporting period, one UNICEF nutritionist based in Goma was deployed to Beni Health Zone to inventorize nutrition supplies and set up a distribution system. As of 8 September, the Ebola Treatment Center (ETC) in Beni Health Zone had eight hospitalized patients and four recovering patients, of which two are lactating women. Given the risk of transmission of EVD virus to their infants, the infants were separated from their mothers and were provided with breastmilk substitutes and complementary feeding. Three women affected by Ebola were counseled on Infant and Young Child Feeding (IYCF) practices. In addition, 530 pregnant and breastfeeding women were counseled on IYCF practices at the Regional Hospital in Beni Health Zone. F75, F100 milk, and Ready to Use Therapeutic Food (RUTF) was provided to patients in ETCs through UNICEF interventions. On 10 September, an agreement between UNICEF and the national nutrition programme of the Government of DRC (PRONANUT) was signed at the Goma office to support training on Integrated Management of Acute Malnutrition (IMAM) including Severe Acute Malnutrition case management, coordination of nutrition activities in health zones affected by EVD, and quality assurance and supervision of activities.

Supply & Logistics Since the beginning of the response, USD $1,256,039 to USD$ 1,437,846 worth of items have been deployed for the Ebola response in Ituri and North Kivu province.

Human Resources As of 10 September, 54 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri provinces.

External Communication The CO focused its external communication work on the situation of the Ebola epidemic on the resuming of the school year in Ebola affected area. The CO facilitated during the reporting period visits of UNICEF supported programmes for Radio Okapi, the UN Radio in DRC. Additionally, the CO provided support to Okapi Service, an interactive programme of Radio Okapi recorded live from Beni. 200 persons attended the recorded programme which focused on preventing at risk practices and prevention measures. Main media coverage since previous Situation Report included RFI, Radio Okapi, All Africa. The CO has published 19 articles on its blog since the announcement of the epidemic, as well as more than 90 tweets, 16 Facebook posts and 13 pictures on Instagram.

DRC EBOLA SITUATION REPORT 10 September 2018

Funding The Response Plan developed jointly with the Ministry of Health, United Nations Agencies and in coordination with other actors is estimated at US$ 43.837 million. Based on the joint response plan, UNICEF estimated amount required for immediate response is US$ 7.624 million. Funds available include funds reprogrammed from Equateur Response in consultation with World Bank (PEF), USAID, ECHO and Japan. At present, funds from Gavi (US$ 120,000), CERF (US$ 900,000), USAID (US$ 2 million), and UNICEF National Committee in Germany -German Natcom (US$503,147) have been allocated to support the Ebola response in North Kivu and Ituri province. The World Bank Group through the Contingent Emergency Response Component (CERC) of its DRC Health System Project investment also approved an additional funding of US$ 3,947,688 based on the current funding gap.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018) Funds available Funding gap Appeal Sector Requirements Funds Received $ % Current Year* WASH 2,346,521 2,297,364 49,157 2% Communication for 2,602,340 1,595,536 1,006,804 39% Development (C4D) Psychosocial Support 433,321 400,000 33,321 8% Management of Severe 500,000 50,000 450,000 90% Acute Malnutrition Operations support and 1,742,364 504,861 1,237,503 71% Coordination costs + ICT Total 7,624,546 4,847,761 2,776,785 36%

*Funds available include proposed funds to be reprogrammed from Equateur Response ** Does not include funds in the pipeline

Next Sitrep: September 17, 2018

Who to contact DRC EBOLA SITUATION REPORT 10 September 2018

Nord Kivu and Ituri Provinces, 2018 (11 September 2018)

Ebola Response Tracking Indicators Change Target Total results since last report ▲▼

RESPONSE COORDINATION

# of affected localities with functioning partner coordination mechanism 3 3 1 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, religious /traditional leaders, 5,118‡ 5,118 1,916 opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on Ebola response and participatory 3,100 2,509 387 community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, adolescent 3,600,000 3,368,172 636,948 groups, administrative employees, armed forces.

# of households for which personalized house visits was undertaken to address serious 167* 167 35 misperception about Ebola, refusals to secure burials or resistance to vaccination. # of listed eligible people for ring vaccination informed of the benefits of the vaccine and 7,912† 7,742 1,399 convinced to receive the vaccine within required protocols. % of respondents who know at least 3 ways to prevent Ebola infection in the affected 80% 26% 0 communities (from Rapid KAP studies) WATER, SANITATION & HYGIENE # of health facilities in affected health zones provided with essential WASH services. 140 66 13

# of target schools in high risk areas provided with handwashing facilities 315‡ 255 78

# of community sites (port, market places, local restaurant, churches) with hand washing 359‡‡ 359 15 facilities in the affected areas

# of people with access to safe water source in the affected areas 681,649 563,832 0 EDUCATION # of school children reached with Ebola prevention information 82,500 4,403 3,480

# of teachers briefed on Ebola prevention information 2,089‡ 2,089 499

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of families with confirmed or probable cases who received psycho-social support and/or 132‡ 132 5 material assistance # of contact, including children, who receive psycho-social support and/or material assistance 778** 626 190 # of unaccompanied children and orphans identified who received appropriate care and 150†† 129 8 psycho-social support * The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response mature † The target is dynamic as listing of eligible persons is defined *** Baseline result of the KAP study undertaken during 6 – 8 August, 2018 (the week following declaration of the epidemic). The next KAP study is scheduled for the 8-10 September ‡ The target changes with changes in the epidemiology ** The target is dynamic and 40% of listed contacts is the identified target †† The target is an estimation and dynamic based on field experience ‡‡ The target is dynamic, based on the number of affected areas and new community sites identified for hygiene promotion ‡‡‡ The original target was exceeded because of an increase in the number of affected health zones, therefore, the target has been readjusted

DRC EBOLA SITUATION REPORT 17 September 2018

Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

17 September, 2018 SITUATION IN NUMBER SITUATION IN NUMBER Highlights total reported cases • As part of the nutrition response for Ebola, UNICEF provides 142 (MoH, 16 September 2018) treatment to Severe Acute Malnutrition (SAM) cases for children and adults, nutritional care of EVD patients (agreement is ongoing) and support four nutritionists in providing nutritional 111 confirmed cases care services in Ebola Treatment Centers (ETCs). (MoH, 16 September 2018)

• The second Knowledge Attitude and Practice (KAP) survey indicate 97 deaths recorded a drastic positive increase on the communities’ knowledge on (MoH, 15 September 2018) Ebola information prevention and transmission mechanisms. Results are presently being analyzed by the communication 2,173 contacts under surveillance commission and corrective actions will be taken and reported on (MoH, 16 September 2018) in next Sitrep.

UNICEF Ebola Response

UNICEF’s Response Appeal Target Result

US$ 7.624M # of at-risk people reached through community engagement

and interpersonal communication approaches. (door-to- 5,750,000‡ 3,598,172

door, church meetings, small-group training sessions, school classes, briefings with leaders and journalists, other) # of listed eligible people for ring vaccination informed of Ebola Response Funding the benefits of the vaccine and convinced to receive the 9,859† 9,656 Status 2018 vaccine within required protocols.

# of people with access to safe water in the affected health 952,946‡ 577,952 Total zones funding available* # of teachers briefed on Ebola prevention information 7,200‡ 2,230 64% Funding # of families with confirmed or probable cases who received 142‡ 142 Gap psycho -social support and/or material assistance 36% Ebola NK Funding † The target is dynamic as listing of eligible persons is defined ‡ The target was modified to accommodate an increase in affected health zones and aligned to the requirements : epidemiological trend $ 7,624,546

*Funds available include Reprogrammed funds from Equateur Response

DRC EBOLA SITUATION REPORT 17 September 2018

Epidemiological Overview Summary Table (16.09.18): Province Health Zone*1 Confirmed and Probable Cases Total Deaths Suspect Cases under Recorded investigation Confirmed Probable Total Nord-Kivu Mabalako 68 21 89 65 1

Beni 25 4 29 23 1

Oicha 2 1 3 1 0

Butembo 5 2 7 3 1

Musienene 0 1 1 1 0 Masereka 1 0 1 1 1 Kalunguta 1 0 1 0 0 Ituri Mandima 9 2 11 3 0 TOTAL 111 31 142 97 4 Previous Total 5 September 2018 101 31 132 91 20

Humanitarian leadership and coordination

1 With better access, the number of health zones with Ebola cases was review by the Surveillance commission and revised from 7 reported in the last update to 6 in this report. 2

DRC EBOLA SITUATION REPORT 17 September 2018 vaccination. A UNICEF security specialist is also deployed in the field to support security assessment and safety of the operations.

Mabalako health zone remains the most worrying area for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused in Beni and Mabalako Health Zone, North Kivu province, however, UNICEF continues to implement prevention activities in other parts of North Kivu and Ituri provinces.

An operational review of the response led by the Ministry of Health in Beni city to identify current achievements and gaps is currently underway. A meeting between partners is scheduled during the week to discuss this issue.

Response Strategy The joint response plan of the government and partners has been finalised based on the recent experience from the Equateur Ebola response. In support of the joint response plan, the UNICEF response strategy will focus on communication, WASH, and Psycho-social care, nutrition and cross-cutting education sector response.

• Risk communication, social mobilization and community engagement with the aim to (1) proactively engage with affected and at risk communities, (2) provide timely and accurate health advice to encourage positive health seeking behaviors and (3) address community concerns and rumors. The strategy is implemented through 5 pillars that include (i) community engagement; (ii) promotion of preventive behaviors; (iii) responding to resistance; (iv) advocacy and capacity building of actors and (v) communication in support of ring vaccination. • The WASH strategy, as part of the Infection Prevention and Control (IPC), aims to stop the spread of the disease through the availability of 1) WASH in health care facilities, which includes providing water and WASH kits, 2) hygiene promotion and the provision of WASH kits in schools, including handwashing station and soap/temperature check points, and 3) WASH in communities, through mass outreach on hygiene promotion to vulnerable communities and the setup of handwashing stations/temperature control in strategic transit locations, as well as the disinfection of households/neighborhoods of confirmed cases. • The child protection and psycho-social support to EVD survivors and family members of EVD cases as well as contact families seeks to (1) provide psycho-social support; (2) establish or re-establish social and community networks and support systems; (3) provide social kits to EVD affected families (4) identify and provide appropriate care to orphans and unaccompanied children due to the Ebola epidemic. The key element of the strategy will include (i) psychosocial support activities for children and their families; (ii) material assistance to affected families to better support children; (iii) facilitation of professions help to children and families with more severe psychological or social problems / needs; (iv) coordinate mental health and psychosocial support (MHPSS); (vi) psycho-social assistance, appropriate care and research of long term solution to orphans and unaccompanied children. • The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases to the 6 health zones affected by Ebola or in situation of nutritional alert in North Kivu province. In addition, address young child and infant feeding practice that is impacted by the increasing number of women affected by the Ebola epidemic

DRC EBOLA SITUATION REPORT 17 September 2018

• The cross-cutting education sector strategy involve key EVD prevention measures on the school premises, include: (i) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas (ii) training of educational actors (students, teachers, inspectors, school administration agents, head of educational provinces) on Ebola including WASH in school, psychosocial support and against discrimination, (iii) provision of infrared thermometers and handwashing facilities, clean water, soap, and capacity reinforcement on hygiene behaviours in schools (iv) construction of isolation rooms for suspected cases at school (v) provision of specific documentation and protocol for prevention, guidance and management of suspected cases in school (vi) provide key messages on Ebola prevention to families.

Summary Analysis of Programme Response

The targets for the response indicators was revised to accommodate for Masereka and Butembo Health zone with recently new confirmed cases of Ebola, in addition to Beni and Mabalako Health zone. Furthermore, the response indicators were adjusted to evolve with the epidemiological trend.

Overview of the key elements in the response with a special emphasis on UNICEF’s response in the affected health zones. Communication and social mobilization (C4D) During the reporting period, the dedicated communication teams focused on intensifying the activity in Beni and Butembo Health Zone. This includes increasing the members of the communication teams in the field and capacity reinforcement for new team members. Examples of activities to reinforce the communication team is the briefing of 950 influential members leaders and groups in order to engage them in the work with the local communities, thus reaching a total of 6,068 (85% coverage) influencers engaged since the beginning of the response. During the reporting period, in response to the emerging resistance in the Ndindi neighbourhood of Beni, a committee of 15 community leaders received training with the aim to set up a rapid multi-sectoral response including direct communications between leaders and the communication and surveillance teams. In addition, 93 “chefs d’avenue” (chiefs of street), and 56 community leaders (religious, youth leaders and women's associations) have been identified and engaged on Ebola prevention and surveillance, and agreed to advocate Ebola prevention messages and reinforce community surveillance committees. Furthermore, the local members of the communication team were briefed on Ebola Virus Disease (EVD) risks, preventive measures, community monitoring, addressing reluctance and resistance/conflict management and currently hold community dialogue sessions in the Ndindi neighbourhood to strengthen the community's understanding of the risks of the disease and promote the adoption of preventive measures. To re-establish the trust affected by the poor perceptions of treatment centers, daily visits to Ebola Treatment Centers (ETCs) were conducted for community leaders and chiefs of wards. In the same perspective, EVD survivors have been recruited to share their testimonies during community dialogue sessions. The Mayor of Beni city himself showed strong leadership and commitment by rallying all other leaders to fight against false rumors and promote correct information regarding Ebola. These actions have largely contributed to eliminating resistance in Ndindi. For reestablishing trust towards response interventions, visits to ETCs are planned for community leaders and chiefs of wards. Follow-up meetings will be held weekly to assess progress and decide on possible corrective actions. Two discussion meetings were coordinated by the response coordinator with the chiefs of wards, street chiefs, other community leaders, and the Mayor of Beni City, to discuss the concerns raised on communication and Ebola prevention. This has largely contributed to reducing resistance in the community, especially with respect to vaccination against the Ebola virus.

In addition, 246 frontline workers (RECOs) in Butembo area Beni zones were mobilized on Ebola response and community engagement approaches, reaching a total of 2,755 RECOs (59% coverage) out of the targeted 4,650. The additional frontline workers received training, with a focus on interpersonal skills on how to more effectively respond to resistance, rumours, and issues related to Ebola Treatment Units (ETUs) and Safe Dignified Burials (SDBs). As these frontline workers are active and respected members of the community, the community frontline workers received training on community surveillance and SDBs.

DRC EBOLA SITUATION REPORT 17 September 2018

Since the beginning of the response, 3,598,172 (63% coverage) at-risk population were reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, adolescent groups, administrative employees, armed forces etc, including 230,000 persons during the reporting period. Through dedicated interventions in churches, radio programing, and other public events, 178,000 people were reached in new geographical areas surrounding Butembo and Masereka.

As of 17 September, 206 (56% coverage) households presenting reluctance to Ebola vaccination, treatment or refusals of secure and dignified burials practices benefited from personalized house visits to address general concerns, reaching a total of 39 during the reporting period.

During the reporting period, 1,914 eligible people for the Ebola vaccination were informed about the benefits of the vaccine and were convinced to receive the vaccine within required protocols, reaching a total of 9,656 persons since the beginning of the response. In Butembo Health Zone, the surveillance team informed the communications members that a family of 14, all identified as contacts, collectively refused to receive the preventive Ebola vaccine. The team chosen to respond to this case included of the community chief, the district health trainer, and two commission members. The mission involved multiple visits and persisted for two days before all 14 were convinced to cooperate, and avoid the spread of negative information if the team had failed. Main concerns of the family were related to the efficacy of the vaccine, fear of going to the ETC and dying there, and other unknowns about this disease.

A second Knowledge, Attitude, and Practice (KAP) survey was conducted one month since the beginning of the outbreak with the aim to evaluate and assess the impact of the communication interventions, as well as bring forward recommendations for adjusting the communication strategies and approaches. It will measure progress against the first KAP conducted between August 7-9, 5 days following the official outbreak declaration. The second survey included 480 respondents from Beni Urban Health Zone Mabalako Health Zone, which includes the Rural Epicenter of Mangina Health Area. The results of this midline survey indicate that basic knowledge of Ebola (Signs, ways of transmission, ways of prevention) has increased from 20% to 94%.

Among the main results of the KAP are the following:

- Over 90% of respondents know to not touch an infected or dead person, whereas over 80% of participants identified handwashing with soap or ashes as a prevention method; - 94% of respondents are aware that direct members of family are at most risk of Ebola transmission, in comparison only 26% during the first KAP survey; - 78% of respondents know to immediately inform health authorities when Ebola symptoms appear, in comparison to 12% for the first KAP survey; - Knowledge on identification of key Ebola symptoms increased by almost four-fold, from 20% to 86% in Mabalako Health Zone; - Attitudes concerning Safe and Dignified Burials and knowledge on community deaths (to not touch or wash the body of a deceased person) increased from 17% to 86% in the community in rural Mangina health area. However, in the urban Beni Health zone, only 49% of respondents possessed such knowledge; - Over 80% of respondents obtained key source of information on Ebola from local radio whereas over 50% from local churches.

DRC EBOLA SITUATION REPORT 17 September 2018

Overall, awareness and attitudes among youth were generally 10% lower than adults, and therefore more emphasis will be placed on youth engagement activities. Results are presently being analyzed by the commission and corrective actions and additional analysis will be taken and reported on in next sitrep.

Key activities in the last seven days:

• As the free Ebola hotline provides general information about Ebola, it is reported that calls have increased by 70% and reaching 170 calls per day. A request for additional trained operators paid by UNICEF has been approved. 27 out of 30 community leaders who have received cell phones and phone credit from UNICEF, have used them to report community cases to the communications and surveillance teams. All 27 reported cases were confirmed negative. • A dialogue with 32 traditional healers was conducted in Butembo Health Zone on the understanding of the national strategy and commitment to immediately refer symptomatic patients to specialized ETUs. A collective understanding and action was also taken to improve IPC (Infection and Prevention Control) measures among traditional healers and their patients. • In the Butembo neighborhood of Kyaghala, a group of angry mothers returned to school and removed their children while informing other parents that the school intended to vaccinate all children with the EVD vaccine without their permission. In response, the director called for the communications commission to intervene. The same afternoon, the commission facilitated a meeting with 52 teachers and parents to inform them about the facts of Ebola as well as respond to all parent and teacher concerns. Other community meetings were conducted the same evening and as a result, all children returned to school the next morning. To date, directors and teachers from 76 schools have been briefed and engaged to fight Ebola in Butembo.

Water, Hygiene and Sanitation (WASH) During the reporting period, 18 new health facilities in the affected health zones in North Kivu provinces benefitted from essential WASH activities; these include the provision of handwashing points, briefing of staff on hygiene promotion, and disinfection, and the installation of chlorination points, reaching a total of 88 (28% coverage) out of the 320 targeted since the beginning of the response. UNICEF’s partner Centre de Promotion Socio-Sanitaire (CEPROSSAN) completed WASH package in five health structures in Butembo city, which recently notified confirmed cases. While 88 health facilities have been fully covered so far, WASH response is on-going in additional 42 health facilities with the support of UNICEF partners. As of 17 September, 430 (47% coverage) community sites (ports, market places, local restaurants, churches) were provided with handwashing facilities for Ebola infection control in Beni, Mandima, and Mabalako Health zones in partnership with Oxfam and Programme de Promotion des Soins de Santé Primaire (PPSSP). Since the beginning of the response, 294 (49% coverage) schools in high risk were provided with handwashing facilities, reaching 39 during the reporting period. 14,120 persons gained access to safe water in the affected health zones during the reporting period, reaching a total of 577,952 (61% coverage) out of the targeted 952,946 since the beginning of the response.

Key activities in the last seven days:

• A full WASH package has been implemented in Ndindi, a neighborhood in Beni where the Ebola Response faced a lot of community resistance. In close collaboration with the local committee, UNICEF completed WASH activities in all schools (29), in all main health facilities (13) and in 27 key public places chosen by the local committee. • With new confirmed cases in Butembo Health Zone, UNICEF WASH team deployed to Butembo and worked with the local authorities and partners to plan a WASH intervention. An initial plan targeting 46 priority schools in affected neighborhoods and 50 health structures is being prepared.

DRC EBOLA SITUATION REPORT 17 September 2018

• WASH and C4D teams in Butembo Health Zone started to work together to have an integrated communication (C4D) approach under community WASH activities. This means that WASH partners who implement Community WASH activities will be in line with the communication commission strategy and use the same methodologies of community engagement. UNICEF will work with partners to ensure that the health promotion activities are done using two-way dialogue and community engagement.

Education Since the beginning of the response, 33,825 (11% coverage) school children were reached with Ebola prevention messages, of which 29,422 were reached during the reporting period. An additional 141 teachers were briefed on Ebola prevention information, reaching a total of 2,230 (31% coverage) since the beginning of the response. In 20 monitored schools in Beni Health zone and Mangina Health area, the number of children attending schools augmented from 41%2, in comparison to only 11% when schools reopened on the 3rd of September. However in the rural areas, it is important to note that the numbers remain relatively low with just 20% of students currently attending schools, in comparison to 3% in early September.

Psychosocial and Child Protection During the reporting period, 10 affected families by Ebola Virus Disease (EVD) received psycho-social support and material assistance including food assistance in Beni, Mandima3, and Mambasa Health zones; reaching a total of 142 (100% coverage) out of the targeted 142 families. Among them, 22 families received a food assistance4, which included a specific psychosocial support for 19 families who lost one member from EVD. The material assistance is adapted according to the needs of women and girls, by including for example specific hygiene kits. Three individual recreational materials were distributed to children in the Ebola Treatment Centers located in Beni, Mangina, and Butembo Health Zone. In Butembo Health Zone, four suspected cases and one confirmed case received a psychosocial support, as well as 24 contacts families. The psychosocial agents are starting the evaluation of the needs for the affected families and the material assistance will start this week. Six new separated/orphan children due to the Ebola epidemic has been identified and received appropriate care; a total of 135 (45% coverage) out of the targeted 300. 20 orphan children, previously identified, received support to go back to school that includes the payment of tuition fees as well as the distribution of school supplies. 375 contacts families received a psycho-social support, reaching a total of 1,001 (66% coverage) out of the targeted 1,521 contacts.

Nutrition UNICEF is providing technical and financial support to the national nutrition programme of the Government of DRC (PRONANUT) to complement UNICEF’s implementing partner NGO MEDAIR’s interventions in nutrition for the Ebola response. This support aims to reinforcing nutrition capacities in providing (i) treatment to Severe Acute Malnutrition (SAM) cases for children and adults, (ii) nutritional care of EVD patients (agreement is ongoing) and (iii) funds for four nutritionists

2 Data source: UNICEF and Ministry of Primary, Secondary, and Professional Education 3 Includes Makeke Health Area 4 Food assistance is provided by UNICEF through implementing partner Danish Refugees Council 7

DRC EBOLA SITUATION REPORT 17 September 2018 in providing nutritional care services in Ebola Treatment Centers (ETCs). During the reporting period, the nutritionists received training on bio-security in nutritional care. During the reporting period, 15 pregnant women and 2 lactating women were sensitized and received support on the infant and young children feeding practices (IYCF) in Ebola context related. Specific interpersonal communication, sensitization and support was ensured for the caregiver in charge of the under 6- month infant admitted in the Mangina Ebola treatment Center (ETC) whom was separated from her mother (EVD positive).

Supply & Logistics Since the beginning of the response, USD $ 1,464,995.78 worth of items composed of WASH, C4D, Child Protection supplies have been procured for the Ebola response in Ituri and North Kivu province. During the reporting period 100 Personal Protective Equipment (PPE) were handed over to UNICEF local transporter for air delivery from Kinshasa to Beni (via Goma).

Human Resources As of 17 September, 56 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri provinces.

External Communication UNICEF covered the Ebola response with additional video and photo material from the affected areas, which is shared on We Share. Following the announcement of new Ebola cases in the commercial city of Butembo, the CO issued a new press release stressing the importance of a prompt response to this new development in the epidemic. During the reporting period media coverage of UNICEF’s response to the Ebola outbreak included VOA, NOS, CVM TV - Jamaica; All Africa; All Africa; Slate Afrique; El Pais; Mail & Guardian; Radio Okapi. The CO has published 20 articles on its blog since the announcement of the epidemic, as well as more than 90 tweets, 16 Facebook posts and 13 pictures on Instagram.

Funding The Response Plan developed jointly with the Ministry of Health, United Nations Agencies and in coordination with other actors is estimated at US$ 43.837 million. Based on the joint response plan, UNICEF estimated amount required for immediate response is US$ 7.624 million. Funds available include funds reprogrammed from Equateur Response in consultation with World Bank (PEF), USAID, ECHO and Japan. At present, funds from Gavi (US$ 120,000), CERF (US$ 900,000), USAID (US$ 2 million), and UNICEF National Committee in Germany -German Natcom (US$503,147) have been allocated to support the Ebola response in North Kivu and Ituri province.

DRC EBOLA SITUATION REPORT 17 September 2018

The World Bank Group through the Contingent Emergency Response Component (CERC) of its DRC Health System Project investment also approved an additional funding of US$ 3,947,688 based on the current funding gap.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018) Funds available Funding gap Appeal Sector Requirements Funds Received $ % Current Year* WASH 2,346,521 2,297,364 49,157 2% Communication for 2,602,340 1,595,536 1,006,804 39% Development (C4D) Psychosocial Support 433,321 400,000 33,321 8% Management of Severe 500,000 50,000 450,000 90% Acute Malnutrition Operations support and 1,742,364 504,861 1,237,503 71% Coordination costs + ICT Total 7,624,546 4,847,761 2,776,785 36%

*Funds available include proposed funds to be reprogrammed from Equateur Response ** Does not include funds in the pipeline

Next Sitrep: September 24, 2018

DRC EBOLA SITUATION REPORT 17 September 2018

Nord Kivu Province 2018

Ebola Response Tracking Indicators (29 Aug 2018) Change since Old Target New Target % increase Total results last report ▲▼

RESPONSE COORDINATION # of affected localities with functioning partner coordination 3 3 0% 3 1 mechanism COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, religious /traditional leaders, 5118 7,100‡ 39% 6,068 950 opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on ebola 3100 4,650‡ 50% 2,755 246 response and participatory community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, 3,600,000 5,750,000‡ 60% 3,598,172 230,000 door-to-door, church meetings, schools, adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious misperception about Ebola, refusals 206 368* 79% 206 39 to secure burials or resistance to vaccination. # of listed eligible people for ring vaccination informed of the benefits of the vaccine and convinced to receive the vaccine within 7912 9,859† 25% 9,656 1,914 required protocols. % of respondents who know at least 3 ways to prevent Ebola 80% 80% 0% 74% 48% infection in the affected communities (from Rapid KAP studies)** WATER, SANITATION & HYGIENE # of health facilities in affected health zones provided with essential 140 320‡ 129% 88 22 WASH services. # of target schools in high risk areas provided with handwashing 315 600‡ 90% 294 39 facilities # of community sites (port, market places, local restaurant, 359 900‡ 151% 430 71 churches) with hand washing facilities in the affected areas # of people with access to safe water source in the affected areas 681649 952,946‡ 40% 577,952 14120 EDUCATION # of school children reached with Ebola prevention information 82500 297,000‡ 260% 33,825 29422 # of teachers briefed on Ebola prevention information 2089 7,200‡ 245% 2,230 141 CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of families with confirmed or probable cases who received 132 142*** 8% 142 10 psycho-social support and/or material assistance # of contact family members, including children, who receive 778 1842** 137% 1001 375 psycho-social support and/or material assistance # of unaccompanied children and orphans* identified who received 150 300†† 100% 135 6 appropriate care and psycho-social support

* The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response mature † The target is dynamic as listing of eligible persons is defined *** Baseline result of the KAP study undertaken during 6 – 8 August, 2018 (the week following declaration of the epidemic). The next KAP study is scheduled for the 8-10 September ‡ The target changes with changes in the epidemiology ** The target is dynamic and 40% of listed contacts is the identified target †† The target is an estimation and dynamic based on field experience ‡‡ The target is dynamic, based on the number of affected areas and new community sites identified for hygiene promotion ‡‡‡ The original target was exceeded because of an increase in the number of affected health zones, therefore, the target has been readjusted

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018

Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

Photo Credit: Thomas Nybo

24 September, 2018 SITUATION IN NUMBER 29 August, 2018 SITUATION IN NUMBER Highlights 150 total reported cases - 21 September, a confirmed case has been identified in Tchomia (MoH, 23 September 2018) Health Zone, Ituri province. UNICEF has deployed a mixed team composed of WASH, C4D, and psychosocial to Tchomia to implement 118 confirmed cases the response. (MoH, 23 September 2018)

- 21 September, a meeting was held with the Secretary General of 100 deaths recorded Ministry of health, UNICEF, WHO, and other partners to discuss (MoH, 23 September 2018) capacity building in fifteen priority provinces as part of the Ebola emergency preparedness plan, which aims to control Ebola 1,836 contacts under surveillance outbreaks within the country. (MoH, 23 September 2018)

- 22 September, increasing security incidents in Beni, Butembo, and UNICEF Ebola Response Tchomia Health Zone is hindering UNICEF’s operations in the Appeal affected areas. US$ 7.624M

UNICEF’s Response

Target Result Ebola Response Funding

# of at-risk people reached through community engagement Status 2018 and interpersonal communication approaches. (door-to- 5,750,000 3,899,172 door, church meetings, small-group training sessions, school Total classes, briefings with leaders and journalists, other) funding # of listed eligible people for ring vaccination informed of available* the benefits of the vaccine and convinced to receive the 11,904† 11,498 64% Funding vaccine within required protocols. Gap Ebola NK # of people with access to safe water in the affected health 952,946 639,134 36% zones Funding requirements : # of teachers briefed on Ebola prevention information 7,200 3,163 $ 7,624,546 # of families with confirmed or probable cases who received 150* 150 psycho -social support and/or material assistance † The target is dynamic as listing of eligible persons is defined * The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response mature *Funds available include Reprogrammed funds from Equateur Response

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018

Epidemiological Overview Summary Table (23.09.18): Province Health Zone*1 Confirmed and Probable Cases Total Deaths Suspect Cases under Recorded investigation Confirmed Probable Total Nord-Kivu Mabalako 69 21 90 65 4

Beni 29 4 33 24 4

Oicha 2 1 3 1 1

Butembo 6 2 8 4 2

Musienene 0 1 1 1 0 Masereka 1 0 1 1 0 Kalunguta 1 0 1 0 0 Ituri Mandima 9 2 11 3 0 Tchomia 2 0 1 1 0

TOTAL 119 31 150 100 11 Previous Total 17 September 2018 111 31 142 97 4

Humanitarian leadership and coordination

1 With better access, the number of health zones with Ebola cases was review by the Surveillance commission and revised from 7 reported in the last update to 6 in this report. 2

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018 actively in the coordination meetings at the national level and in Beni (operational headquarters) and co-leads the commissions on communication, WASH and psychosocial care; and active in the working groups on logistics and vaccination. A UNICEF security specialist is also deployed in the field to support security assessment and safety of the operations.

Beni health zone is the most worrying area for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused around three coordination hubs based in Beni, Butembo, and Mabalako Health Zone.

The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases in Makeke, Mandima Health zone, Oicha Health Zone, Butembo, Masereka, and Tchomia Health Zone. UNICEF coordinates Makeke’s Ebola response from the coordination team based in Mangina Health Area and the coordination response for Oicha Health Zone. A coordination hub is put in place in Butembo Health Zone, which will also support the response in Masereka Health Zone. A psychosocial and communication commissions have been set up in Butembo Health Zone, composed of five clinical psychologists and communications specialists. Due to the security access in Oicha and Masereka Health Zone, UNICEF works through local partners to implement its activities.

The identification of a confirmed case in Tchomia Health Zone, Ituri, is important in the evolution of the Ebola epidemic as the confirmed Ebola case is located near Lake Albert, which is in close proximity to Uganda. This increases the risk of disease spill over to Uganda due to high movements of population across the lake and in the vicinity. Furthermore, the identification of a new case near Lake Albert places Bunia city at risk, which is located about 30km from Tchomia Health Zone. Due to security reasons, UNICEF’s response will be coordinated from Bunia. A mixed team composed of WASH, C4D, and psychosocial are currently underway to implement the response.

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018 social problems / needs; (iv) coordinate mental health and psychosocial support (MHPSS); (vi) psycho-social assistance, appropriate care and research of long-term solution to orphans and unaccompanied children. • The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases to the 6 health zones affected by Ebola or in situation of nutritional alert in North Kivu province. In addition, address young child and infant feeding practice that is impacted by the increasing number of women affected by the Ebola epidemic • The cross-cutting education sector strategy involve key EVD prevention measures on the school premises, include: (i) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas (ii) training of educational actors (students, teachers, inspectors, school administration agents, head of educational provinces) on Ebola including WASH in school, psychosocial support and against discrimination, (iii) provision of infrared thermometers and handwashing facilities, clean water, soap, and capacity reinforcement on hygiene behaviours in schools (iv) construction of isolation rooms for suspected cases at school (v) provision of specific documentation and protocol for prevention, guidance and management of suspected cases in school (vi) provide key messages on Ebola prevention to families.

Summary Analysis of Programme Response

The targets for the response indicators was revised to accommodate for Masereka and Butembo Health zone with new confirmed cases of Ebola, in addition to Beni and Mabalako Health zone. UNICEF staff and implementing partners are currently operational in Beni, Mandima, Mabalako, Musienene, Butembo, Tchomia, Oicha, and Masereka to support WASH, C4D, and psychosocial activities. Furthermore, the response indicators were adjusted to evolve with the epidemiological trend. Overview of the key elements in the response with a special emphasis on UNICEF’s response in the affected health zones.

Communication and social mobilization (C4D)

The communication team focused on strengthening coordination between the three communications commissions (in Butembo, Beni and Mangina), in order to learn from each other’s lessons learned and experiences and better coordinate the actions for increased efficiency. An additional effort was made to better position communication in each of the surveillance, Dignified and Safe Burials (SBD) and vaccination commissions, so that to ameliorate and adjust the communication on technical aspects of the response. The analysis of rumors, resistance and refusals was deepened and the insights serve to design appropriate communication responses to each situation, including by strengthening radio programs to be more reactive to present changes and needs. An investigation team was sent to Tchomia Health Zone, 20km from Bunia City to investigate the identification of a new confirmed Ebola case. This week’s situation report is dedicated to sharing few best-practices.

Organizing a public welcome in their communities for survivors has become common practice for RCCE teams, thus creating opportunities for community dialogue on the efficiency of the treatment and reducing the reluctance. On Sept 20, a hero’s welcome in her community was organized for Ebola survivor Madsika Janine (30), released from the ETU. The members of the by the communications and Psycho-Social teams accompanied her to her home in Beni, where over 200 people were waiting to welcome her back. Clearly touched by the event, she took time to thank everyone and publicly acknowledged the professional care and treatment she received in the ETU and pleaded with everyone present to cooperate with the response teams and not be affected by false rumors. She credited her survival to an early detection and treatment in the Ebola Treatment Units (ETUs). This important event sent a critical message to the surrounding communities that Ebola survivors should not be stigmatized, Ebola is fully treatable if diagnosed early, and that Ebola Treatment Centers (ETCs) are both safe and can save lives. During the reporting period, 378 influential leaders, like Janine, were reached through

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018 advocacy, community engagement and interpersonal communication activities to highlight the importance of treatment and reducing reluctance, reaching a total of 6,446 (91% coverage) since the beginning of the response. The week was marked by an important reduction in the tension created by youth groups in Butembo. Previously, detecting an increase in young people’s resistance in Butembo, the Communications Commission identified four youth groups to collaborate with. The communication team met with its leaders of Vernda Muchanga, the largest of these four groups, including over 2,000 members, to listen to their concerns, share with them the facts about Ebola, and discuss the roles and responsibilities of young people and how this can influence the evolution of epidemic in their communities. Following these open discussions, the group leaders accepted the need to collaborate for the benefit of their communities and engaged to identify 10 youth trainers and facilitate a large Ebola workshop for 700 youth, which was organized on September 19. The leaders of other three groups have been contacted in the same manner to assure their positive engagement and support to surveillance teams. The team believes that these interventions were instrumental in reducing the resistance and tensions from youth groups. Mass communication, such as the approach implemented in Butembo, reached 301,000 at-risk population during the reporting period through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, adolescent groups, administrative employees, armed forces. Since the beginning of the response, the communication team has reached a total of 3,899,172 (68% coverage) persons. The coordination of activities in the urban district of Ndindi (Beni), where growing resistance was reported previously, had visibly improved. The chiefs of all its three districts (along with the sub-chiefs of all 107 avenues), were visited in person and briefed on Ebola prevention, surveillance, and community engagement. From these encounters, a central Ndindi committee was established and that united all three districts, and which also included representation from all the Chiefs of Avenues. Other sub-committees were created to address specific audiences such as young people, authorities, teachers, and special groups. This central committee is now responsible for coordinating and facilitating all Ndindi activities, including surveillance, SDB and prevention of resistance. The creation of this structure has already shown a positive impact in the coordination of community interventions. The mobilization of 347 frontline workers (RECOs) enabled to break down reluctance and collaborate with the community in the affected areas. Overall, 3,102 (67% coverage) RECOs have been working since the beginning of the response.

In Ndindi, a total of 124 mobile telephones (with credit) were distributed to all the Chiefs of Avenues and a calling protocol was put in place for chiefs to dial to report suspected cases and for other communication needs. In the last three days, six serious cases were reported by seven Chiefs of Avenues. In partnership with Oxfam’s community teams, a reporting system is being put in place to record and analyze all suspected cases, deaths, and resistance cases.

The temporary crisis in the education sector in Oicha health zone, north of Beni, provoked by a rumor, was successfully solved. It started with and rumor launched by a program visitor on a local radio station, claiming that the Ebola vaccine is now available for children in schools. Despite the political agenda of the messenger, the consequences were immediately observed in communities. The following day, 20% of the schools had to shut down due to parents fearing their children will be vaccinated without their permission. In response, the RCCE commission quickly recorded radio messages from both the national Ebola coordinator and the director of education, focusing on the eligibility for Ebola vaccine. The messages were immediately broadcast on all 16 neighboring radio stations, including the one in Oicha Health Zone. In parallel, and with help from local leaders, the RCCE commission and education team also sponsored community sessions with parent associations to address their concerns. One week after the incident, it is reported that 100% of schools are open and that all students are back in their normal routine, however the issue remains sensitive.

In Mangina Health Area, the impact of the different commissions working together was apparent in the village of Kiavisimi. A couple confirmed with Ebola escaped from Beni to come and hide here due to fear of ETUs. Aware of this, the surveillance teams tried to intervene, but they were threatened and not allowed to made contact with the couple. The Mangina coordination team quickly sent a mixed team that included members of surveillance, RCCE, PS, a local survivor and a leader from the neighboring community of Kanzaba. Upon arrival, they were finally able to have a truthful dialogue with the village chief, as well as with other leaders and close family members. The team remained in the community and continued the 5

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018 dialogue until everyone understood the consequences if they did not cooperate. With additional help of the catholic nuns from the local convent, they were finally able to convince the community to allow the couple to be treated in the ETU. With 204 people now identified as contacts, the team also convinced them to receive the vaccine. Of the couple, the wife passed away while the husband has shown improvement in his condition. A few days later, the community leader excused himself for the behavior of the community, and acknowledged that if they acted sooner, they may have saved the life of their sister.

A total of 41 households were reached with communication to break down reluctance to Ebola vaccination, treatment or refusals of secure and dignified burials practices benefited from personalized house visits to address general concerns, reaching a total of 247 (67% coverage) households since the beginning of the response. Water, Hygiene and Sanitation (WASH) During the reporting period, 28 new health facilities in the affected health zones in North Kivu provinces benefitted from essential WASH activities; these include the provision of handwashing points, briefing of staff on hygiene promotion, and disinfection, and the installation of chlorination points, reaching a total of 116 (36% coverage) out of the 320 targeted since the beginning of the response. UNICEF with the support of its partners OXFAM, CEPROSSAN and Mercy Corps completed the installation of a WASH package in 10 health structures in Butembo Health Zone. While 126 health facilities have been fully covered so far, WASH response in additional 16 health facilities is on-going. As of 21 September, 438 (49% coverage) community sites (ports, market places, local restaurants, churches) out of the targeted 900 were provided with handwashing facilities for Ebola infection control in Beni, Mandima, Mabalako and Butembu Health zones in partnership with Oxfam and PPSSP and CEPROSSAN. 61,182 persons gained access to safe water in the affected health zones, reaching a total of 639,134 (67% coverage) out of the targeted 952,946 since the beginning of the response.

Key activities in the last seven days:

• Distribution of family hygiene kits to 100 households in the village of Kiavisimi in the health zone of Mabalako after a suspected case was identified. The village showed maximum community commitment to the response against Ebola after some resistance showed previously. • After a confirmed case in Bunia, a member of WASH team joined the Rapid Response team deployed to support the Bunia office. More WASH staff from Kinshasa office will join soon for additional support. • WASH and C4D teams continued their ongoing community WASH activities to identify capacity building needs for partner staff in Community Engagement. A workshop is scheduled to take place on 24 September 2018 in Butembo. A mapping of regular community feedback and rumours is ongoing on use and perceptions of WASH services, more specifically the use of chlorinated water.

Education As 24 September, 48,125 (16% coverage) school children were reached with Ebola prevention messages, of which 14,300 were reached during the reporting period. In addition, 933 teachers were briefed on Ebola prevention, reaching a total of 3,163 (44% coverage) teachers since the beginning of the response. Since the beginning of the response, 309 (52% coverage) schools in high risk were provided with handwashing facilities, reaching 15 during the reporting period.

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018 Psychosocial and Child Protection During the reporting period, nine affected families by EVD received psycho-social support and material assistance including food assistance in eight health zones, reaching a total of 150 (100% coverage) out of the targeted 150 families. 12 families of discharged patients previously identified received a material assistance during the reporting period. In Mangina Health Area and since the beginning of the response, 126 discharged patients - among which 36 cured persons and 90 non-case patients, received a psychosocial support and material assistance. In addition, a total of 58 families who lost one member from EVD received a specific assistance. 19 new separated/orphan children due to the Ebola epidemic has been identified, of which 11 from the Butembo health zones, reaching a total of 154 (57% coverage) out of the targeted 300. All of them received appropriate care and support. 27 separated/orphan children - previously identified - received NFI kits, which also support their extended families and/or caregivers. A total of 112 of school age children who became orphans due to the Ebola virus received UNICEF assistance to return to school. 350 contacts families received a psycho-social support, reaching a total of 1,351 (74% coverage) out of the targeted 1,836. In Beni Health Zone, some psychosocial agents were jointly deployed with World Food Programme (WFP) to provide psychosocial support to 41 contacts persons who also received food assistance. A new training for psychosocial assistants was organized for the Butembo Health Zone for 35 people. 15 new agents are now acting in the field.

Nutrition During the reporting period, 21 Ebola patients, of which two lactating women and one child (three months), have benefited from specific nutrition treatment and counseling in Beni and Mangina Ebola Treatment center (CTE). In collaboration with UNICEF, this treatment is ensured by four governmental nutritionists trained on Ebola patient care and biosecurity. Nutrition care consists of providing support through the four phases: intensive, maintenance, transition and stimulation phases. A package of nutrition supplies including therapeutic milk, anthropometric equipment (electronic scales, MUAC) have been donated to Butembo Health Zone to facilitate the therapeutic treatment in Butembo ETC. UNICEF Nutrition team and governmental representative has drafted a reporting template to be validated and codified to facilitate the rapid SMS reporting of nutrition interventions.

Supply & Logistics Since the beginning of the 10th Ebola Emergency Response, the total value of supplies procured is US$1.5 million.

Human Resources As of 24 September, 60 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri provinces.

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018 External Communication The CO ended a content gathering mission in the affected region leading to new videos and photos on WeShare. A new press release focused on children that have become orphan or are unaccompanied following Ebola was issued during the reporting period. UNICEF highlighted the issue during the press briefing at the Palais des nations in Geneva. During the reporting period media coverage of UNICEF’s response to the Ebola outbreak included Radio Okapi, Radio Okapi Magazine des Nations Unies, XinhuaNews Agency, All Africa, Actualites.cd, Reliefweb, Les depeches de Brazzaville . New digital publications on the Ebola epidemic and UNICEF’s response include a photo essay and human interest stories. The CO has published 25 articles on its blog since the announcement of the epidemic, as well as more than 130 tweets, 20 Facebook posts and 14 pictures on Instagram.

Funding The Response Plan developed jointly with the Ministry of Health, United Nations Agencies and in coordination with other actors is estimated at US$ 43.837 million. Based on the joint response plan, UNICEF estimated amount required for immediate response is US$ 7.624 million. Funds available include funds reprogrammed from Equateur Response in consultation with World Bank (PEF), USAID, ECHO and Japan. At present, funds from Gavi (US$ 120,000), CERF (US$ 900,000), USAID (US$ 2 million), and UNICEF National Committee in Germany -German Natcom (US$503,147) have been allocated to support the Ebola response in North Kivu and Ituri province. Agreement was approved and signed with the DRC Government through the World Bank‘s funded project “DRC Health System Project” for a total amount of US$ 3,947,688

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018) Funds available Funding gap Appeal Sector Requirements Funds Received $ % Current Year* WASH 2,346,521 2,297,364 49,157 2% Communication for 2,602,340 1,595,536 1,006,804 39% Development (C4D) Psychosocial Support 433,321 400,000 33,321 8% Management of Severe 500,000 50,000 450,000 90% Acute Malnutrition Operations support and 1,742,364 504,861 1,237,503 71% Coordination costs + ICT Total 7,624,546 4,847,761 2,776,785** 36%

*Funds available include proposed funds to be reprogrammed from Equateur Response ** Does not include funds in the pipeline

Next Sitrep: October 1, 2018

Who to contact Gianfranco Rotigliano Tajudeen Oyewale Pierre Bry for further Representative a.i. Deputy Representative Chief Field Operations UNICEF DRC UNICEF DRC UNICEF DRC 8 Tel: + (243) 996 050 399 Tel: + (243) 817 045 473 information: Tel : +(243) 996 050 200 E-mail: [email protected] E-mail : [email protected] E-mail: [email protected]

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018

Ebola Response Tracking Indicators (24 September 2018) Change since last Target Total results report ▲▼

RESPONSE COORDINATION # of affected localities with functioning partner coordination mechanism 4 4 1 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, 7,100 6,446 378 religious /traditional leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on Ebola response and 4,650 3,102 347 participatory community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church 5,750,000 3,899,172 301,000 meetings, schools, adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious misperception about Ebola, refusals to secure burials or resistance to 368 247 41 vaccination. # of listed eligible people for ring vaccination informed of the benefits of the 11,904† 11,498 1,842 vaccine and convinced to receive the vaccine within required protocols.

% of respondents who know at least 3 ways to prevent Ebola infection in the 80% 74% 0 affected communities (from Rapid KAP studies) WATER, SANITATION & HYGIENE # of health facilities in affected health zones provided with essential WASH services. 320 116 28

# of target schools in high risk areas provided with handwashing facilities 600 309 15 # of community sites (port, market places, local restaurant, churches) with hand 900 438 8 washing facilities in the affected areas # of people with access to safe water source in the affected areas 952,946 639,134 61,182 EDUCATION # of school children reached with Ebola prevention information 297,000 48,125 14,300

# of teachers briefed on Ebola prevention information 7,200 3,163 933

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of families with confirmed or probable cases who received psycho-social support 150* 150 8 and/or material assistance # of contact family members, including children, who receive psycho-social support 1,836** 1351 350 and/or material assistance # of unaccompanied children and orphans* identified who received appropriate 300†† 170 35 care and psycho-social support NUTRITION # of < 23 months children caregivers who received appropriate counseling on IYCF 9,756 571 21 in emergency * The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response mature † The target is dynamic as listing of eligible persons is defined ** The target is dynamic and 100% of listed contacts is the identified target †† The target is an estimation and dynamic based on field experience

DRC EBOLA SITUATION REPORT 1 October 2018

Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

Photo Credit: Mark Naftalin

1 October, 2018 SITUATION IN NUMBER 29 August, 2018 SITUATION IN NUMBER Highlight 160 total reported cases - An Ebola Treatment Center has been established in Tchomia Health (MoH, 30 September 2018) Zone, Ituri Province to provide treatment to the confirmed cases in the surrounding affected areas. A coordination hub for the response 128 confirmed cases is being put in place in Tchomia, with a strategic coordination hub in (MoH, 30 September 2018) Bunia, the capital of Ituri province. WASH items have been deployed to Tchomia as a first response to contain the spread of the virus. 105 deaths recorded - 26 September, UNICEF’s Representative conducted a high level (MoH, 30 September 2018)

mission to Bunia Health Zone to conduct a situation analysis of the Ebola response. 1,463 contacts under surveillance (MoH, 30 September 2018) - The social unrest in Beni city which affected implementation is now easing and response activities are now being resumed. - A review of the Ebola response to respond to the current situation is UNICEF Ebola Response

currently underway, under the leadership of the Ministry of Health Appeal to include the newly affected health zones. US$ 7.624M

UNICEF’s Response

Target Result Ebola Response Funding

Status 2018 # of at-risk people reached through community engagement

and interpersonal communication approaches. (door-to- 5,750,000 4,182,552 Total door, church meetings, small-group training sessions, school funding classes, briefings with leaders and journalists, other) available*

# of listed eligible people for ring vaccination informed of 64% 13,295† 12,875 Funding the benefits of the vaccine and convinced to receive the Gap vaccine within required protocols. 36% Ebola NK Funding # of people with access to safe water in the affected health 952,946 639,134 requirements : zones $ 7,624,546 # of teachers briefed on Ebola prevention information 7,200 3,566 # of families with confirmed, suspects, or probable cases who received psycho-social support and/or material 160* 160 assistance † The target is dynamic as listing of eligible persons is defined *Funds available include Reprogrammed funds from *The target is estimated based on both the number of confirmed, probable and suspect case, and would be Equateur Response adjustment as the response matures 1

DRC EBOLA SITUATION REPORT 1 October 2018

Epidemiological Overview Summary Table (30.09.18): Province Health Zone Confirmed and Probable Cases Total Deaths Suspect Cases under Recorded investigation Confirmed Probable Total Mabalako Nord-Kivu 69 21 90 65 2

Beni 37 5 42 29 4

Oicha 2 1 3 1 0

Butembo 7 2 9 4 2

Musienene 0 1 1 1 0 Masereka 1 0 1 1 0 Kalunguta 1 0 1 0 0 Ituri Mandima 9 2 11 3 0 Tchomia 2 0 2 1 1

TOTAL 128 32 160 105 9 Previous Total 24 September 2018 119 31 150 100 11

Humanitarian leadership and coordination

DRC EBOLA SITUATION REPORT 1 October 2018 commissions on communication, WASH and psychosocial care; and active in the working groups on logistics and vaccination. A UNICEF security specialist is also deployed in the field to support security assessment and safety of the operations.

Beni health zone is the most worrying area for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused around four coordination hubs based in Beni, Butembo, Bunia, and Mabalako Health Zone.

The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases in Makeke, Mandima Health zone, Oicha Health Zone, Butembo, Masereka, and Tchomia Health Zone. UNICEF coordinates Makeke’s Ebola response from the coordination team based in Mangina Health Area and the coordination response for Oicha Health Zone. A coordination hub is put in place in Butembo Health Zone, which will also support the response in Masereka Health Zone. Due to the security access in Oicha and Masereka Health Zone, UNICEF works through local partners to implement its activities.

The identification of a confirmed case in Tchomia Health Zone, Ituri, is important in the evolution of the Ebola epidemic as the confirmed Ebola case is located near Lake Albert, which is in close proximity to Uganda. This increases the risk of disease spill over to Uganda due to high movements of population across the lake and in the vicinity. Furthermore, the identification of a new case near Lake Albert places Bunia city at risk, which is located about 30km from Tchomia Health Zone. Due to security reasons, UNICEF’s response will be coordinated from Bunia, of which a coordination hub is currently being established.

Response Strategy The joint response plan of the government and partners is currently under review, to identify key progress, challenges and modifications to upscale the response and respond to the current epidemiology. In addition, the MoH out in pace a team that include MoH WHO, UNICEF and World Bank to review the joint response plan based on the field level review. In support of the joint response plan, the UNICEF response strategy will focus on communication, WASH, and Psycho-social care, nutrition and cross-cutting education sector response.

DRC EBOLA SITUATION REPORT 1 October 2018 • The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases to the six health zones affected by Ebola or in situation of nutritional alert in North Kivu province. In addition, address young child and infant feeding practice that is impacted by the increasing number of women affected by the Ebola epidemic • The cross-cutting education sector strategy involve key EVD prevention measures on the school premises, include: (i) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas (ii) training of educational actors (students, teachers, inspectors, school administration agents, head of educational provinces) on Ebola including WASH in school, psychosocial support and against discrimination, (iii) provision of infrared thermometers and handwashing facilities, clean water, soap, and capacity reinforcement on hygiene behaviours in schools (iv) construction of isolation rooms for suspected cases at school (v) provision of specific documentation and protocol for prevention, guidance and management of suspected cases in school (vi) provide key messages on Ebola prevention to families.

Summary Analysis of Programme Response

The targets for the response indicators were revised to take into account Tchomia, Masereka and Butembo Health zones with new confirmed cases of Ebola, in addition to Beni and Mabalako Health zones. UNICEF staff and implementing partners are currently operational in Beni, Mandima, Mabalako, Musienene, Butembo, Tchomia, Bunia, Oicha, and Masereka to support WASH, C4D, and psychosocial activities. Furthermore, the response indicators were adjusted to evolve with the epidemiological trend. Overview of the key elements in the response, with a special emphasis on UNICEF’s response in the affected health zones, is detailed below. Communication and social mobilization (C4D) The reporting period was largely characterized by Beni’s five-day civil lockdown and the activation of Tchomia’s Communications commission. Due to high security risks, the social mobilization teams were not allowed to move and dialogue with affected communities in Beni City. The situation has now improved and activities related to the Ebola response have resumed. The new confirmed case in Tchomia, Ituri Province, required an early deployment of C4D, WASH, and psychosocial team to the affected area. The zone is characterized by insecurity, cross-border commerce with Uganda, heavy traffic of fisherman throughout Lake Albert ports, and some groups of resistant young people. Upon arrival of C4D team in the area, the communications commission was activated and teams were formed to visit the two most influential Chiefs in the area, the Sectorial Chief (Political/administrative), and the high Traditional Chief (religious/traditional). Following many questions concerning the disease and its dangers, both leaders ensured full engagement and representation in the Communications response. Soon after, the commission sponsored a successful meeting organized by two religious networks, reaching a total of 233 religious leaders from 141 churches in Tchomia Health Zone. The aim was to inform, discuss the role and responsibilities of the church and its leaders toward Ebola disease. They also met with youth leaders, engaged moto-taxi associations and organized a caravan of 300 motorcycles, implemented awareness raising activities in 11 fishing ports, engaged with two radio stations and provided materials to broadcast in local languages. In addition, the Butembo team succeeded in engaging 14 influential personalities to join the Ebola communications commission. These influential leaders included the president of the moto-taxi associations, three youth leaders, a popular comedian, two well-respected journalists and two religious leaders. The two leaders were able to identify an additional 31 leaders, with the aim to reach out to all 224 churches and mosques in the area. During the reporting period, a significant meeting organized by the two mayors in the city of Butembo reached 204 political actors. Following a presentation and Q&A, they were all engaged and acknowledged the importance of their support for the response. During the reporting

DRC EBOLA SITUATION REPORT 1 October 2018 period, 710 influential leaders and groups were reached on Ebola prevention messages during the reporting period, reaching a total of 7,156 (100% coverage) leaders since the beginning of the response. In support of the interventions with influential leaders, 913 frontline workers (RECOs) were mobilized in the affected health zones on Ebola response and participatory community engagement approaches, reaching a total of 4,015 (86% coverage) out of the targeted 4,650 workers.

Since the beginning of the response, 4,182,552 (73% coverage) at risk population were reached through community engagement, church meetings, radio, adolescent groups, reaching 283,380 persons during the reporting period. As part of those reached during the reporting period, the communications and WASH teams helped unite 700 young people in Butembo to address their concerns on Ebola Treatment Units (ETU). Prior to the meeting, the young people requested to visit the ETU with real Ebola patients inside. With innovative help from the WASH team and Médecins Sans Frontières’ (MSF) collaboration, the team was allowed to enter, film the inside of the center and interview a well-known health worker survivor. In addition, the team also interviewed a suspected Ebola person. The video was projected in front of the 700 young people, and upon seeing the health worker’s testimony, they were positively astonished and amazed to see her again and talking. It was reported by the team that this initiative stimulated an immediate trust and change in behavior towards ETUs. Two nurses in Butembo Health Zone have heroically fought and survived Ebola under the care and encouragements of the medical teams. On September 27, the coordinator of the commission himself came to present them with their certificate of good health, fully healed from Ebola. There was a very big celebration in the ETU, as a large team gathered to congratulate them, and gift them with new clothes, shoes, make-up and other gifts. “It was a moment of immense joy to see the two nurses smiling again,” said the coordinator. They both thanked the entire team, acknowledged how well they were treated, and one of them said, “at the beginning I was very scared, then seeing the help I was getting, I started to gain courage little by little, today I am 100% healed, and I want to now call my family I am coming home.” At the end of the ceremony, the psychosocial and Communications teams escorted the two nurses back to their homes. Both psychosocial and communication teams continue to work on their re-integration and assure that communities do not stigmatize Ebola survivors. The community-based alert system in the hotspots of Ndindi neighborhood, Beni Health Zone, has shown positive outcomes in terms of community ownership and actions, with 13 alerts reported to the surveillance and communication teams. With temporary suspension of field activities in Beni city, the continuous feedback by the telephone system has been crucial to ensure that communities were informed on Ebola and maintained trust in the communications’ system. 126 of the 158 engaged local leaders have made calls and reported on suspected resistance cases. Due to this positive and enabling environment, the teams have experienced closer collaboration between community focal points and the local health authorities, and have also reported self-referral cases of people who were in contact with positive Ebola patients, of which three suspected cases have been identified this far. The team will continue this week to address negative perceptions of Dignified and Safe Burials (SDB), trust in ETUs, acceleration of referrals, and improved trust in vaccination teams. In the Butembo suburbs, the Communication commission revisited Muslim leaders who have expressed concern over the religious and cultural aspect of SDBs, namely not washing and purifying the body of a deceased family member. Immediate action was taken to train three Imams on SDB protocols and procedures by Red Cross. Upon completion of this training and to relieve the tension in communities, a public declaration was made to Muslims, validating the Ebola protocols until the epidemic is over. A telephone system was proposed for citizens to call if they had concerns or needed to report a suspected case, a qualified Muslim leader would be available to respond. In all, Muslim leaders and followers were engaged and committed to fight against Ebola. UNICEF facilitated a two-day workshop with North Kivu Risk Communication and Community Engagement Commission to update and finalize the Beni Health Zone communication intensification strategy. Identified strategic elements was an update of the situation analysis (KAP1/KAP2), participant analysis, influencers, media analysis, and taking into account lessons learned from the response so far, especially in Mangina Health Area. In addition, a theory of change for the Beni 5

DRC EBOLA SITUATION REPORT 1 October 2018 RCCE Response was developed, and the vice president of the commission has a good command of it and can easily explain it to partners. The strategy will be presented to partners next week as well as the overall coordination meeting. In an effort to break down reluctance on Ebola vaccination, treatment in ETCs, or refusal of secure and dignified burials, 55 households were reached through the communications team during the reporting period, reaching a total of 302 (82% coverage) out of the targeted 368 since the beginning of the response. Furthermore, 1,377 (97% coverage) listed eligible people were informed of the benefits of the vaccine and convinced to receive the vaccine within required protocols.

Water, Hygiene and Sanitation (WASH) During the reporting period, one new health facility in the affected health zones in North Kivu provinces benefitted from essential WASH activities; these include the provision of handwashing points, briefing of staff on hygiene promotion, and disinfection, and the installation of chlorination points, reaching a total of 117 (37% coverage) out of the 320 targeted since review of UNICEF targets. In Tchomia Health Zone, UNICEF carried out interventions in 11 schools, six health centers and 12 community sites. The activities included distribution of WASH kits in schools, essential WASH activities in health centers and installation of handwashing facilities in community sites. In coordination with the C4D team, WASH partners received training in Butembo Health Zone on how to ensure community dialogue while implementing WASH activities. The training includes understanding on how to respond to sensitive questions and address rumours through participative discussion. As of 28 September, 449 (50% coverage) community sites (ports, market places, local restaurants, churches) out of the targeted 900 were provided with handwashing facilities for Ebola infection control in Beni, Mandima, Mabalako and Butembo Health zones in partnership with Oxfam, Programme de Promotion des Soins de Sante Primaire (PPSSP) and Centre de Promotion Socio-Sanitaire (CEPROSSAN). Since the beginning of the response, a total of 639,134 (61% coverage) persons have gained access to safe water in the affected health zones, out of the targeted 952,946.

Key activities in the last seven days:

• In the General Hospital of Tchomia, UNICEF completed the disinfection of a 20m2 water tank, construction of a protection structure and installation of six handwashing facilities.

• 28 September, two trucks with WASH materials were sent from Beni to Bunia and Tchomia Health Zones as a first response to contain the spread of the virus. Materials deployed included five tents of 72m2, 100 Plastic Tarpaulin rolls (4X50m) and 100 Sprayer knapsacks (20l).

• WASH partners in Butembo Health Zone received training on communication and ensuring dialogue with community during the implementation of WASH activities. These teams will be providing trainings in health centres, teachers and community leaders, in addition to provision of water and handwashing stations. The same training is ongoing for UNICEF WASH partners in Bunia and Tchomia Health Zones.

Education As of 1 October, 60,785 (20% coverage) school children were reached with Ebola prevention messages, of which 12,660 were reached during the reporting period. In addition, 403 teachers were briefed on Ebola prevention, reaching a total of 3,566 (50% coverage) teachers since the beginning of the response. Of those teachers reached during the reporting period, 355 were from Tchomia and Kasenyi Health Zones. During a workshop organized by UNICEF, 48 schools out of the targeted 6

DRC EBOLA SITUATION REPORT 1 October 2018 65 were present for the workshop. The low number of schools represented can be explained by the high population movement to Uganda due to the repetitive insecurity incidents in the affected area. In addition, UNICEF briefed 30 authority members from EPSP Ituri on Ebola prevention messages, provision of psychosocial support in schools, and the importance of handwashing as a prevention mechanism. The role of authority members, media, and the provision of free treatment for suspect cases in school settings was highlighted.

Psychosocial and Child Protection In Tchomia and Bunia (Ituri province), the Psychosocial Commissions are currently being established. In Tchomia Health Zone, four psychosocial assistants (APS) have been deployed to rapidly respond to the first needs of children and families affected by Ebola Virus Disease (EVD). 50 psychosocial assistants have been identified in Tchomia Health Zone and will receive training in psychosocial support. During the reporting period, 10 affected families by EVD received psychosocial support and material assistance in 9 health zones1; reaching a total of 160 (100% coverage) out of the targeted 160 affected families. In Mangina Health Area, 22 former cured patients continued to be followed by psychologists. 11 newly separated/orphaned children due to the Ebola epidemic were identified and received appropriate care, reaching a total of 181 (60% coverage) out of the targeted 300 children since the beginning of the response. Among them, 5 orphans have been identified from one woman who died from EVD in the Tchomia Health Zone. All 5 children received temporary assistance and are currently placed with their extended family in Beni Health Zone. In addition, 15 previously identified separated/orphan children received Non Food Items (NFIs) and school kits. Also during the reporting period, 355 contact families received psychosocial support, reaching a total of 1,706 families (90% coverage) out of the targeted 1,983 since the beginning of the response.

Nutrition Four nutritionists provided nutrition care to all in patients in Ebola Treatment Centers (ETCs) and providing counseling on Infant and Young Child Feeding (IYCF) to pregnant and lactating women, reaching 69 (7% coverage) women during the reporting period in Mangina and Beni ETC. On 28 September, two nutritionists received training on bio-security and started providing nutrition care to in-patients in Butembo ETC. The nutritional team from UNICEF, World Food Programme (WFP), and National Nutrition Program, based in Beni Health Zone has developed a nutritional care protocol for Ebola in-patients, including children under 6 months, from 6 to 59 months, older children and adults. The nutritional care protocol and monitoring indicators was approved by the director of the national nutrition program. UNICEF held a workshop with the psychosocial care committee in Beni Health Zone to identify the list of orphans and separated children by affected health zones, which will enable UNICEF to provide adequate nutritional care and food assistance to the orphaned and separated children. As part of this intervention, a three-month old orphan whose mother has died from Ebola, was identified and put under breastmilk substitute in Beni Health Zone under the supervision of the community psychosocial support staff and nutrition supervisor. An agreement (fiche technique) is currently under development between the national nutrition programme of the Government of the DRC (PRONANUT) Ituri and UNICEF to provide nutritional care in Tchomia ETC.

1 Beni, Butembo, Kalunguta, Mabalako, Masereka, Musienene, Oicha, Mandima, Tchomia Health Zones. 7

DRC EBOLA SITUATION REPORT 1 October 2018

Supply & Logistics 25 September, 9.5 metric tons of WASH items composed of buckets, infrared thermometers, gloves, boots, chlorine High Test Hypochlorite (HTH), apron, soap, and chlorine pool tester has been deployed from Kinshasa and was delivered by air to Bunia via Goma. Since the beginning of the response, USD $ 1,672,602 worth of items composed of WASH, C4D, Child Protection, Health and Education supplies have been procured for the Ebola response in Ituri and North Kivu province.

Human Resources As of 24 September, 60 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri provinces.

External Communication The CO issued a press release focused on the involvement of Ebola-survivors in the community communication activities that UNICEF is running with its partners to help avoiding the further spread of the disease. New video material and photo material on UNICEF’s response to the epidemic was posted on WeShare. During the reporting period media coverage of UNICEF’s response to the Ebola outbreak included CNN, VOA, ABC.es, De Volkskrant, Xinhua News Agency, Radio Okapi, All Africa, UN News, Reliefweb. Since the beginning of the outbreak, CO published in total 27 articles on humanitarian related issues on its blog www.ponabana.com during the reporting report, as well as 22 Facebook posts, 15 Instagram posts and more than 150 tweets.

Funding The Response Plan developed jointly with the Ministry of Health, United Nations Agencies and in coordination with other actors is estimated at US$ 43.837 million. Based on the joint response plan, UNICEF estimated amount required for immediate response is US$ 7.624 million. A revision of the plan is current on-going under the leadership of MoH. Funds available include funds reprogrammed from Equateur Response in consultation with World Bank (PEF), USAID, ECHO and Japan. At present, funds from Gavi (US$ 120,000), CERF (US$ 900,000), USAID (US$ 2 million), and UNICEF National Committee in Germany -German Natcom (US$503,147) have been allocated to support the Ebola response in North Kivu and Ituri province. Agreement was approved and signed with the DRC Government through the World Bank‘s funded project “DRC Health System Project” for a total amount of US$ 3,947,688.

DRC EBOLA SITUATION REPORT 1 October 2018 Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018) Funds available Funding gap Appeal Sector Requirements Funds Received $ % Current Year2 WASH 2,346,521 2,297,364 49,157 2% Communication for 2,602,340 1,595,536 1,006,804 39% Development (C4D) Psychosocial Support 433,321 400,000 33,321 8% Management of Severe 500,000 50,000 450,000 90% Acute Malnutrition Operations support and 1,742,364 504,861 1,237,503 71% Coordination costs + ICT Total 7,624,546 4,847,761 2,776,785* 36%

* Does not include funds in the pipeline

Next Sitrep: October 8, 2018

2 The World Bank fund is yet to be disbursed to UNICEF 9

DRC EBOLA SITUATION REPORT 1 October 2018

Ebola Response Tracking Indicators (1 October 2018) Change since last Target Total results report ▲▼

RESPONSE COORDINATION # of affected localities with functioning partner coordination mechanism 4 4 1 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, 7,156 7,156 710 religious /traditional leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on Ebola response and 4,650 4,015 913 participatory community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church 5,750,000 4,182,552 283,380 meetings, schools, adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious misperception about Ebola, refusals to secure burials or resistance to 368 302 55 vaccination. # of listed eligible people for ring vaccination informed of the benefits of the 11,904† 12,875 1,377 vaccine and convinced to receive the vaccine within required protocols.

# of target schools in high risk areas provided with handwashing facilities 600 345 36 # of community sites (port, market places, local restaurant, churches) with hand 900 449 11 washing facilities in the affected areas # of people with access to safe water source in the affected areas 952,946 639,134 0 EDUCATION # of school children reached with Ebola prevention information 297,000 60,785 12,660

# of teachers briefed on Ebola prevention information 7,200 3,566 403

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of families with confirmed, suspects, probable cases who received psycho-social 160* 160 10 support and/or material assistance # of contact family members, including children, who receive psycho-social support 1,463** 1,706 355 and/or material assistance # of unaccompanied children and orphans* identified who received appropriate 300†† 181 11 care and psycho-social support NUTRITION # of < 23 months children caregivers who received appropriate counseling on IYCF 9,756 571 21 in emergency † The target is dynamic as listing of eligible persons is defined *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures ** The target is dynamic and 100% of listed contacts is the identified target †† The target is an estimation and dynamic based on field experience ††† Result is cumulative since initiation of the activity. Note number of contact is on the decline as the response proceeds

UNICEF DRC EBOLA SITUATION REPORT 8 October 2018

Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

Photo Credit: Mark Naftalin

8 October, 2018 SITUATION IN NUMBER SITUATION IN NUMBER Highlights • On 8 October, two confirmed case of Ebola has been identified in 181 total reported cases Komanda Health Zone, Ituri. (MoH, 7 October 2018) • Insecurity in Beni city remains challenging, however, UNICEF operations in the affected areas have resumed. 146 confirmed cases • The Joint Response plan is still under reviewed by a team comprised of (MoH, 7 October 2018) representative from the Ministry of Health, WHO, UNICEF and World Bank. deaths recorded • A new communication strategy has been validated in Beni Health Zone, 115 (MoH, 7 October 2018) which seeks to shift focus towards reinforcing the ownership of community leaders and frontline workers to the response by encouraging them to report and conduct surveillance tasks at the 2,215 contacts under surveillance community level. (MoH, 7 October 2018)

• The nutrition care and treatment algorithm for Ebola cases in the Ebola Treatment Centers developed with UNICEF’s technical support was UNICEF Ebola Response validated at national level. • The U.S. Agency for International Development (USAID) has deployed a Appeal Disaster Assistance Response Team (DART) to the Democratic Republic of the Congo (DRC) to boost current efforts by the United States and the US$ 7.624M Government of the DRC to contain the outbreak of Ebola in Eastern DRC.

UNICEF’s Response Target Result

# of at-risk people reached through community engagement and interpersonal communication approaches. (door-to-door, church 5,750,000 4,448,552 meetings, small-group training sessions, school classes, briefings

with leaders and journalists, other) # of listed eligible people for ring vaccination informed of the benefits of the vaccine and convinced to receive the vaccine 15,514† 15,114

within required protocols.

952,946 644,083 # of people with access to safe water in the affected health zones # of teachers briefed on Ebola prevention information 7,200 3,566

# of families with confirmed, suspects, or probable cases who 181* 181 received psycho-social support and/or material assistance † The target is dynamic as listing of eligible persons is defined *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures

UNICEF DRC EBOLA SITUATION REPORT 8 October 2018

Epidemiological Overview Summary Table (07.10.18): Province Health Zone Confirmed and Probable Cases Total Deaths Suspect Cases under Recorded investigation Confirmed Probable Total Mabalako Nord-Kivu 70 21 91 65 2

Beni 49 8 57 35 6

Oicha 2 1 3 1 0

Butembo 11 2 13 7 1

Musienene 0 1 1 1 0 Masereka 1 0 1 1 2 Kalunguta 1 0 1 0 0 Ituri Mandima 9 2 11 3 0 Komanda 1 0 1 0 0 Tchomia 2 0 2 2 0

TOTAL 146 35 181 115 11 Previous Total 1 October 2018 128 32 160 105 9

UNICEF DRC EBOLA SITUATION REPORT 8 October 2018 Humanitarian leadership and coordination

Beni health zone is the most worrying area for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused around five coordination hubs based in Beni, Butembo, Tchomia, and Mabalako Health Zone. And one sub-coordination hub is operational in Bunia city.

The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases in Makeke, Mandima Health zone, Oicha Health Zone, Butembo, Masereka, and Tchomia Health Zone. UNICEF coordinates Makeke’s Ebola response from the coordination team based in Mangina Health Area and the coordination response for Oicha Health Zone. A coordination hub is put in place in Butembo Health Zone, which will also support the response in Masereka Health Zone. Due to the security access in Oicha and Masereka Health Zone, UNICEF works through local partners to implement its activities.

The identification of a confirmed case in Tchomia Health Zone, Ituri, is important in the evolution of the Ebola epidemic as the confirmed Ebola case is located near Lake Albert, which is in close proximity to Uganda. This increases the risk of disease spill over to Uganda due to high movements of population across the lake and in the vicinity. Furthermore, the identification of a new case near Lake Albert places Bunia city at risk, which is located about 30km from Tchomia Health Zone. Due to security reasons, UNICEF’s response will be coordinated from Bunia, of which a coordination hub is currently being established.

Furthermore, two new confirmed Ebola cases has been identified in Komanda Health Zone, Ituri province. UNICEF has scaled up its reponse by deploying C4D, WASH, and psychosocial teams to the newly affected areas. Response Strategy The joint response plan of the government and partners is currently under review, to identify key progress, challenges and modifications to upscale the response and respond to the current epidemiology. In addition, the MoH out in pace a team that include MoH WHO, UNICEF and World Bank to review the joint response plan based on the field level review. In support of the joint response plan, the UNICEF response strategy will focus on communication, WASH, and Psycho-social care, nutrition and cross-cutting education sector response.

UNICEF DRC EBOLA SITUATION REPORT 8 October 2018 • The child protection and psycho-social support to EVD survivors and family members of EVD cases as well as contact families seeks to (1) provide psycho-social support; (2) establish or re-establish social and community networks and support systems; (3) provide social kits to EVD affected families (4) identify and provide appropriate care to orphans and unaccompanied children due to the Ebola epidemic. The key element of the strategy includes (i) psychosocial support activities for children and their families; (ii) material assistance to affected families to better support children; (iii) facilitation of professions help to children and families with more severe psychological or social problems / needs; (iv) coordinate mental health and psychosocial support (MHPSS); (vi) psycho-social assistance, appropriate care and research of long-term solution to orphans and unaccompanied children. • The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases to the six health zones affected by Ebola or in situation of nutritional alert in North Kivu province. In addition, address young child and infant feeding practice that is impacted by the increasing number of women affected by the Ebola epidemic • The cross-cutting education sector strategy involve key EVD prevention measures on the school premises, include: (i) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas (ii) training of educational actors (students, teachers, inspectors, school administration agents, head of educational provinces) on Ebola including WASH in school, psychosocial support and against discrimination, (iii) provision of infrared thermometers and handwashing facilities, clean water, soap, and capacity reinforcement on hygiene behaviours in schools (iv) construction of isolation rooms for suspected cases at school (v) provision of specific documentation and protocol for prevention, guidance and management of suspected cases in school (vi) provide key messages on Ebola prevention to families.

Summary Analysis of Programme Response

The targets for the response indicators were revised to take into account Komanda, Vuhovi, Tchomia, Masereka and Butembo Health zones with new confirmed cases of Ebola, in addition to Beni and Mabalako Health zones. UNICEF staff and implementing partners are currently operational in Beni, Mandima, Mabalako, Musienene, Butembo, Tchomia, Bunia, Oicha, and Masereka to support WASH, C4D, and psychosocial activities. Furthermore, the response indicators were adjusted to evolve with the epidemiological trend. Overview of the key elements in the response, with a special emphasis on UNICEF’s response in the affected health zones, is detailed below. Communication and social mobilization (C4D) The Risk Communication and Community Engagement (RCCE) teams adjusted to the multiple security threats faced in the affected areas, evaluated the reasons for poor surveillance, and identified ways to promote community monitoring related to movements of people considered suspects or contacts. A person considered a contact in Beni Health Zone, fled to Mangina Health Area this week, thus interrupting the 10-day period without a confirmed case. In Mangina Health Area, new instructions has been given to all community leaders and frontline workers (RECOs) immediately report all new arrivals within their community. During the reporting period, 411 RECOs were mobilized in the affected health zones on Ebola response and participatory community engagement approaches, reaching a total of 4,426 (95% coverage) out of the targeted 4,650 workers. In Beni Health Zone, community leaders, and members of the local committees met to discuss how the previous week of partial suspension has impacted the perception of Ebola, its services, and to discuss other local solutions to quickly control the spread of Ebola. During the reporting period, 239 community leaders and influential groups were reached with Ebola prevention messages, reaching a total of 7,395 (100% coverage) leaders since the beginning of the response. Mass media and interpersonal communication activities have reached 4,448,552 (77% coverage) at risks persons with Ebola prevention messages since the beginning of the response, reaching 266,000 persons during the reporting period. However, the community based alert network warns of specific population groups who are not fully trusting the vaccination, surveillance 4

UNICEF DRC EBOLA SITUATION REPORT 8 October 2018 and Safe and Dignified Burials, and suggested personalized visits to each of these groups, and which are presently being conducted. To mitigate this obstacle, 68 households presenting reluctance on Ebola vaccination, treatment in ETCs, or refusal of secure and dignified burials were reached during the reporting period, reaching a total of 370 (100% coverage) households since the beginning of the response. In addition, 14,869 (97% coverage) people were informed of the benefits of the vaccine and convinced to receive the vaccine within required protocols. The attacks on the SDB burial teams in Butembo Health Zone was an example of the specific challenges faced by the Ebola response teams, and not only that of RCCE. However, due to the early efforts of the RCCE teams in Butembo Health Zone, community leaders and youth associations were already approached by the Ebola response team and explained about the importance of SDB, as a result, no negative consequences on the public was recorded. In addition, 27 additional religious networks in Butembo signed an ‘Ebola commitment and pledge’ to ensure that all followers will respect Ebola protocols and to actively contribute to case-surveillance in their communities. The Beni communication strategy and its operational plan was put into action this week after validation by the national commission. The new strategy seeks to shift focus towards reinforcing the ownership of community leaders and frontline workers to the response by encouraging them to report and conduct surveillance tasks at the community level. A focus on Beni was necessary in view of the increasing number of new confirmed cases in the health zone in the last week. In the Beni hot zones of Kanzuli, Butsili and Kasangatua, 452 telephone calls were made by 162 leaders participating in the community alert system, representing 82% of active reporting recorded in the last week. Over the course of the week, five alerts were reported from these calls, Kanzuli (4) and Kasangatua (1) and were being assessed by the surveillance team. A focus group in Mangina Health Area showed that people were still apprehensive about the usage and role of ambulances. As a response, a communications team quickly met with the leaders from Timbo and Katango villages in the Mangina Health Area, and gave them a chance to share their concerns, and also for the team to provide convincing answers concerning the importance of using ambulances to transport probable cases to Ebola Treatment Units (ETUs), and deceased family members to burial locations. 23 alerts from Mangina Health Area were successfully facilitated in these two communities during this week. In similar light, church leaders from Makeke, Mundubiena, Mangina and Mangodomu, have expressed some concerns over the efficacy and characteristics of the mortuary bag in which their loved ones may be contained. To address this, members of the communication and SDB commissions visited these churches and performed live demonstrations of the bag and allowed people to move up close and express further concerns they may have. This demystification of the bag has been openly appreciated, and perhaps addressing one of the most misunderstood protocols in the response. In Mangina Health Area, parents still did not fully understanding the reasons of using a thermo flash on their children in schools, therefore, the communications commission was alerted and asked to help address a sudden drop in school attendance. In collaboration with the Education and WASH teams, the commission was quickly able to organize meetings with 14 school directors, 34 teachers and student-parent associations of 11 communities to discuss the usage of thermos- flash in schools, and possibly isolation protocols, if need be. Following these participatory activities, the attendance rose back to 80%, yet further efforts on school attendance remains critical if we are to avoid such sudden reactions on other issues. Water, Hygiene and Sanitation (WASH) During the reporting period, there have been five new confirmed cases in Beni Health zone, therefore, the Coordination team requested all partners to scale up activities and concentrate their efforts in the zones with confirmed cases. UNICEF is coordinating the WASH response with partners working in the area and is exploring ways to scale up the interventions. As of 05 October, nine new health facilities in the affected health zones in Ituri Kivu provinces benefitted from essential WASH activities; these include the provision of handwashing points, briefing of staff on hygiene promotion, and disinfection, and the installation of chlorination points, reaching a total of 136 (43% coverage) out of the 320 targeted since the beginning of the response.

UNICEF DRC EBOLA SITUATION REPORT 8 October 2018 In Tchomia Health Zone, UNICEF continued interventions in schools, health centers and community sites, which includes the distribution of WASH kits in schools, essential WASH activities in health centers and installation of handwashing facilities in community sites. Following reports from WASH partners on gaps in integrated and coordinated response to WASH related community feedback, a pilot accountability monitoring system across the commissions was launched this week. The system allows WASH partners and other sectors to raise feedback from communities and link with other commissions to help respond to community feedback. As of 05 October, 477 (53% coverage) community sites (ports, market places, local restaurants, churches) out of the targeted 900 were provided with handwashing facilities for Ebola infection control in Beni, Mandima, Mabalako, Butembo and Tchomia Health zones in partnership with Oxfam, Programme de Promotion des Soins de Sante Primaire (PPSSP) and Centre de Promotion Socio-Sanitaire (CEPROSSAN). Since the beginning of the response, a total of 644,083 (68% coverage) persons have gained access to safe water in the affected health zones, out of the targeted 952,946. Key activities in the last seven days:

• In Tchomia Health Zone, UNICEF continued distribution of WASH package in 9 health centers and WASH kits in 20 schools. Also, 28 handwashing stations were installed in public areas bringing the total number to 36 since the beginning of activities. • Meeting of UNICEF WASH partners to discuss the scale up activities in Beni area, three partners have confirmed the availability and are conducting evaluations in health centers and schools in the affected areas. • In the General Hospital in Tchomia Health Zone, UNICEF finished the installation of a 10,000L bladder and cleaning of the hospital compound. • Training for UNICEF WASH partners Action Contre la Faim (ACF) and MUSACA in Tchomia Health Zone was conducted last week. A total of 30 staff was trained on Ebola response and how to engage communities throughout our WASH programmes. Education A total of 1,623 schools have been identified in the affected health zones, amongst which 304 schools have been classified as red, i.e. located in the communities with confirmed cases. These schools have been prioritized for the UNICEF Ebola response in the education sector. Additional 697 schools have been categorized as orange i.e schools in locations with contacts. About half of the orange schools have been included as targets in the UNICEF response plan. As of 8 October, 69,338 (23% coverage) school children were reached with Ebola prevention messages, of which 8,553 were reached during the reporting period. In addition, 3,566 (50% coverage) teachers were briefed on Ebola prevention. During the reporting period, 20 schools in high risk areas were provided with handwashing facilities, reaching a total of 365 (61% coverage) schools since the beginning of the response.

Psychosocial and Child Protection During the reporting period, 21 affected families by Ebola Virus Disease (EVD) received psycho-social support and material assistance in nine health zones1, reaching a total of 181 (100% coverage) families. All the patients in the Ebola Treatment Centers (ETCs) are supported by psychologists deployed in the treatment centers. In addition, 75 affected families have received psychosocial support and food assistance in collaboration with the World Food Programme (WFP).

1 Beni, Butembo, Kalunguta, Mabalako, Masereka, Musienene, Oicha, Mandima, Tchomia Health Zones. 6

UNICEF DRC EBOLA SITUATION REPORT 8 October 2018 8 new separated/orphan children due to the Ebola epidemic were identified and received appropriate care, reaching a total of 255 (98% coverage) out of the targeted 300. 43 separated/orphan received material assistance which includes: 6 NFI kits, 32 school kits, and 5 newborn kits. In Mangina Health Area, 11 schools were visited by psycho-social agents to follow 79 orphans who have been reinserted. The children are feeling well and are not stigmatized by the community. In Mangina Health Area and Makeke Health Zone, two houses have been rehabilitated, where two orphan’s newborns (3 months and 4 months) were placed with their extended families. One of the child has a physical disability and has been referred to a center for appropriate care. The two children are followed by psycho-social agents. A total of 255 contacts families; 96 in Beni, 19 in Tchomia, 29 in Mangina, and 111 in Butembo, received a psycho-social support, reaching a total of 1961 (89% coverage) out of the targeted 2,215. 50 psychosocial assistants (APS) have been trained in the Tchomia Health Zone and deployed to the affected areas. Nutrition During the reporting period, 80 pregnant and lactating women were sensitized on Infant and Young Children Feeding in emergency (IYCF-E) by nutritionists in three Ebola Treatment Centers, Mangina, Beni, Butembo Health Zone, reaching a total of 720 (7% coverage) persons since the beginning of the response. In collaboration with the psychosocial commission, 14 orphans or children separated from their mothers (4 under 6 months and 8 aged from 6 to 11 months), were put under the Breastmilk Substitute (BMS). In Beni Health Zone, the medical care committee organized a meeting chaired by the national coordinator to formalize the validation of the protocol for nutritional care for patients in ETCs. Furthermore, UNICEF team and the national coordinator of care led a mission to the Butembo ETC and provided training to two nutritionists on the protocols of nutritional care on Friday, 5th of October 2018. Finally, with the support of UNICEF this week, the National Nutrition Focal Point for the response to the Ebola outbreak has arrived in Beni area to support the team in coordinating interventions. Supply & Logistics Since the beginning of the response, USD $ 1,986,931 worth of items composed of WASH, C4D, Child Protection, Health and Education supplies have been procured for the Ebola response in Ituri and North Kivu province. 2 metric tons of office and C4D supplies was delivered by Air from Goma to Beni with the following breakdown:

• Operations supplies were composed of 12 office chairs, 04 desk tables , 02 filing cabinets , 02 warehouse handling equipment • C4D supplies were composed of 03 Generators (5 KVA) and 50 bicycles. • 20 MT truck payload dispatched WASH supplies by road from Beni to Tchomia during the reporting period. WASH Supplies were composed of :

• 500 Family Hygiene & Dignity kits , 1 electronic submersible pumps , 20 Plastic Tarpaulin (4x50 m) • 5,500 soaps , 100 buckets (20 L) , 100 sprayers (20 L) Offshore procurement represents a total value of $ 791,383 $ (40 %) and Local procurement represents a total value of $ 1,195,549 (60 %). Human Resources As of 8 October, 60 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri provinces. In addition, UNICEF is reviewing the HR strategy for a sustained response to the epidemic.

UNICEF DRC EBOLA SITUATION REPORT 8 October 2018 External Communication The CO issued four press releases in September highlighting the community communication work, the expansion of the epidemic, the assistance provided by UNICEF on Ebola-orphans and unaccompanied children, the involvement of Ebola- survivors in sensitization on Ebola. Last week media coverage included All Africa, ABC.es, Agencia EFE, Prensa Latina, Infobae, All Africa, EuropaPress, UNTV ebola briefing, UN News, India Blooms, Panapress, Globalsecurity, M2presswire, Financialwire, South South news, and Radio Okapi. New video material and photo material on UNICEF’s response to the epidemic is posted on WeShare. Since the beginning of the outbreak, CO published in total 31 articles on humanitarian related issues on its blog www.ponabana.com, as well as 27 Facebook posts, 20 Instagram posts and more than 170 tweets. Funding The Response Plan developed jointly with the Ministry of Health, United Nations Agencies and in coordination with other actors, has an estimated need of US$ 43.837 million. Based on the joint response plan, UNICEF estimated amount required for immediate response is US$ 7.624 million. A revision of the plan is currently on-going under the leadership of MoH. Funds available include funds reprogrammed from Equateur Response in consultation with World Bank (PEF), USAID, ECHO and Japan. At present, funds from Gavi (US$ 120,000), CERF (US$ 900,000), USAID (US$ 2 million), and UNICEF National Committee in Germany -German Natcom (US$503,147), World Bank (US$ 3,947,688) have been allocated to support the Ebola response in North Kivu and Ituri province. Funding for education ensures UNICEF’s visibility for safe running of schools during the Ebola epidemic, reaching Ebola affected out of school children, and highlighting the important role of education to fight Ebola.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018)

Reprogrammed Funds Received for Requirements Funds available Appeal Sector funds from Equateur North Kivu $ $ Response $ $

WASH 2,346,521 723,295 2,238,874 2,962,169 Communication for 2,602,340 371,558 2,961,857 3,333,415 Development (C4D) Psychosocial Support 433,321 100,000 548,800 648,800 Management of Severe 500,000 0 549,800 549,800 Acute Malnutrition Operations support and 1,742,364 132,761 1,171,414 1,304,175 Coordination costs + ICT Total 7,624,546 1,327,614 7,470,745 8,798,359

Next Sitrep: October 15, 2018

UNICEF DRC EBOLA SITUATION REPORT 8 October 2018

Ebola Response Tracking Indicators (8 October 2018) Change since last Target Total results report ▲▼

RESPONSE COORDINATION # of affected localities with functioning partner coordination mechanism 5 5 1 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, 7,395 7,395 239 religious /traditional leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on Ebola response and 4,650 4,426 411 participatory community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church 5,750,000 4,448,552 266,000 meetings, schools, adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious misperception about Ebola, refusals to secure burials or resistance to 370 370 68 vaccination. # of listed eligible people for ring vaccination informed of the benefits of the 15,514† 15,114 1,971 vaccine and convinced to receive the vaccine within required protocols.

# of target schools in high risk areas provided with handwashing facilities 600 365 20 # of community sites (port, market places, local restaurant, churches) with hand 900 477 28 washing facilities in the affected areas # of people with access to safe water source in the affected areas 952,946 644,083 4,949 EDUCATION # of students reached with Ebola prevention information in schools 297,000 69,338 8,553

# of teachers briefed on Ebola prevention information in schools 7,200 3,566 0

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of families with confirmed, suspects, probable cases who received psycho-social 181* 181 21 support and/or material assistance # of contact family members, including children, who receive psycho-social support 2,215** 1,961 255 and/or material assistance # of unaccompanied children and orphans* identified who received appropriate 300†† 189 8 care and psycho-social support NUTRITION # of < 23 months children caregivers who received appropriate counseling on IYCF 9,756 720 149 in emergency † The target is dynamic as listing of eligible persons is defined *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures ** The target is dynamic and 100% of listed contacts is the identified target †† The target is an estimation and dynamic based on field experience ††† Result is cumulative since initiation of the activity. Note number of contact is on the decline as the response proceeds

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

Photo Credit: Mark Naftalin

15 October, 2018 SITUATION IN NUMBER SITUATION IN NUMBER Highlights 214 total reported cases • Insecurity in Beni city remains challenging, however, UNICEF operations (MoH, 14 October 2018) in the affected areas have resumed. UNICEF continues to break down reluctance on Ebola vaccination, treatment in Ebola Treatment Centers, confirmed cases or refusal of secure and dignified burials through scaled up community 179 (MoH, 14 October 2018) engagement approaches • The Joint Response plan is currently being reviewed by a team comprised of representative from the Ministry of Health, WHO, UNICEF and World 139 deaths recorded Bank to encompass newly affected health zones. (MoH, 12 October 2018)

• Since the last reporting period, 30 new Ebola cases have been identified, particularly in the epicentre of the epidemic, Beni Health Zone. Of the 4,195 contacts under surveillance new cases identified, there has been an increase in the number of deaths (MoH, 14 October 2018) and confirmed cases of children

• Community resistance and insecurity has increased in Butembo Health UNICEF Ebola Response Zone, leading to ville morte over a couple of days • Tchomia Health Zone has stabilized as no new cases have been identified Appeal during the reporting period US$ 7.624M

UNICEF’s Response Target Result

# of at-risk people reached through community engagement and interpersonal communication approaches. (door-to-door, church 5,750,000 4,634,907 meetings, small-group training sessions, school classes, briefings with leaders and journalists, other) # of listed eligible people for ring vaccination informed of the benefits of the vaccine and convinced to receive the vaccine 17,405† 16,973 within required protocols. 952,946 740,991 # of people with access to safe water in the affected health zones

# of teachers briefed on Ebola prevention information 7,200 3,629 # of affected families with confirmed, suspects, probable cases who received one or several kits of assistance to support their 214* 214 children † The target is dynamic as listing of eligible persons is defined *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

Epidemiological Overview Summary Table (14.10.18): Province Health Zone Confirmed and Probable Cases Total Deaths Suspect Cases under Recorded investigation Confirmed Probable Total Mabalako Nord-Kivu 71 21 92 67 0

Beni 76 8 84 55 19

Oicha 2 1 3 1 0

Butembo 12 2 14 8 3

Musienene 0 1 1 1 0 Masereka 4 0 4 1 1 Kalunguta 2 0 2 1 1 Ituri Mandima 9 2 11 3 1 Komanda 1 0 1 0 0 Tchomia 2 0 2 2 0

TOTAL 179 35 214 139 25 Previous Total 8 October 2018 146 35 181 115 9

During the reporting period, a UN staff was confirmed with Ebola in Beni Health Zone.

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018 Humanitarian leadership and coordination

Beni health zone is the most worrying area for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused around five coordination hubs based in Beni, Butembo, Tchomia, and Mabalako Health Zone. And one sub-coordination hub is operational in Bunia city.

The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases in Makeke, Mandima Health zone, Oicha Health Zone, Butembo, Masereka, and Tchomia Health Zone. UNICEF coordinates Makeke’s Ebola response from the coordination team based in Mangina Health Area and the coordination response for Oicha Health Zone. A coordination hub is put in place in Butembo Health Zone, which will also support the response in Masereka Health Zone. Due to the security access in Oicha and Masereka Health Zone, UNICEF works through local partners to implement its activities.

The stabilisation of the epidemiological situation in Tchomia Health Zone, Ituri, has been important in the evolution of the Ebola epidemic as the previously confirmed Ebola case was located near Lake Albert, which is in close proximity to Uganda. This increases the risk of disease spill over to Uganda due to high movements of population across the lake and in the vicinity. Due to security reasons, UNICEF’s response will be coordinated from Bunia, of which a coordination hub is currently being established.

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

and unaccompanied children due to the Ebola epidemic. The key element of the strategy includes (i) psychosocial support activities for children and their families; (ii) material assistance to affected families to better support children; (iii) facilitation of professions help to children and families with more severe psychological or social problems / needs; (iv) coordinate mental health and psychosocial support (MHPSS); (vi) psycho-social assistance, appropriate care and research of long-term solution to orphans and unaccompanied children. • The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases to the six health zones affected by Ebola or in situation of nutritional alert in North Kivu province. In addition, address young child and infant feeding practice that is impacted by the increasing number of women affected by the Ebola epidemic • The cross-cutting education sector strategy involve key EVD prevention measures on the school premises, include: (i) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas (ii) training of educational actors (students, teachers, inspectors, school administration agents, head of educational provinces) on Ebola including WASH in school, psychosocial support and against discrimination, (iii) provision of infrared thermometers and handwashing facilities, clean water, soap, and capacity reinforcement on hygiene behaviours in schools (iv) construction of isolation rooms for suspected cases at school (v) provision of specific documentation and protocol for prevention, guidance and management of suspected cases in school (vi) provide key messages on Ebola prevention to families.

Summary Analysis of Programme Response

Overview of the key elements in the response, with a special emphasis on UNICEF’s response in the affected health zones, is detailed below.

Communication and social mobilization (C4D) The Risk Communications and Community Engagement (RCCE) teams set out to intensify discussions with leaders and civil society groups in all of Beni’s 15 affected districts due to the increasing insecurity. Meetings with 124 community chiefs were conducted to inform and encourage collective action and bring back the calm and regain confidence in the institutions and partners involved in the response. Following discussions, community leaders agreed on the importance of local leadership and ownership of the recommended process, which includes the oversight of local alerts and surveillance committees, managed by the community chief themselves. ‘We must first protect ourselves, so we can protect our community, and by protecting our communities, we also protect ourselves’, said the deputy Mayor of Beni during a visit to a local Safe and Dignified Burial (SDB) ceremony in his district. He added that ‘Creating multi-disciplinary teams is key, by involving women, youth and representatives from all influential groups’. Since the beginning of the response, 7,684 (100% coverage) influential members and groups were reached through community engagement and discussions in order to promote Ebola prevention messages, reaching 289 influential leaders during the reporting period.

The urgent necessity to upscale activities in Beni town and put into practice community surveillance systems also required establishing local partnerships with 8 new civil society groups, who pledged stronger engagement of women and youth. In all, 66 associations were engaged in the response this week in Beni health zone, Butembo health zone and Mangina health area. Since the beginning of the response, 4,637 (99% coverage) frontline workers in the affected zones were mobilized on Ebola response and participatory community engagement approaches. Building capacities and widening the terms of reference (to include improved Interpersonal Communications, addressing rumors and surveillance of suspects) of 820 front line workers in Beni, is ‘key to community engagement in such emergencies and require our full investment and attention’ said 4

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

Astrid Muzita, a UNICEF C4D specialist. Astrid accompanied the Deputy Mayor of Beni in visiting three prominent churches and influential religious leaders that have expressed some concerns over local procedures of sending suspects to Ebola Treatment Units (ETUs). Following these meetings, four influential community leaders were accompanied to visit the ETU for the first time. The local radio station also interviewed participants of the visit and broadcasted their testimonies the same day. As a result, the communications team successfully negotiated with managers to announce open-house visits to ETU each Wednesday and Saturday, of which Ebola flyers were distributed announcing this service. During the reporting period, 16 radio stations in Beni have signed Ebola-engagement contracts, of which all have successfully broadcasted 2,232 Ebola songs (7 songs were recorded by popular artists), 5,239 peer-to-peer testimonials (in 2 languages), 1,736 mini-programs (8-10 min each), and 196 positive community activities. A radio survey in Beni showing the impact of these broadcasts and other listening habits was conducted this week. Results will be shared in next week’s report. Through mass communication approaches, 4,634,907 (81% coverage) at risk population were reached with Ebola prevention messages, of which 186,555 were reached during the reporting period. The Deputy in Butembo Health Zone was recently classified as an Ebola contact and following to prior resistance to receiving treatment, he has accepted to receive the preventive Ebola vaccine and since then, has also expressed periodic commitment and respect for the recommended Ebola protocols. The Communications Commission aims to break down further community resistance through his support. Challenges faced by the Communication Commissions this week is the growing interest of families to seek private and home-based health-care providers (instead of going to Ebola Treatment Units), delays in communicating test results to respective families, perception of ETUs as a place where their loved ones go to die, conviction that the new Ebola vaccine is only for elites, and the perception of strong political association of response teams. This analysis is reported by Oxfam field staff, engaged with communities in Beni on a daily basis. In response, continuous meetings with leaders and local structures are planned to address such barriers and strengthen linkages between positive deviance groups and other resistant groups. During the reporting period, 67 households presenting reluctance on Ebola vaccination, treatment in ETCs or refusal of secure and dignified burials were reached, adding to a total of 437 (100% coverage) households since the beginning of the response. The Communication commission acknowledge the need to reinforce working with health authorities in reaching out to private health care providers who are seeking economic opportunities. Following the mobilization of local leaders and social committees, reluctance to Ebola treatment and vaccination has significantly decreased in the hotspot of Ndindi neighborhood, Beni town. 16,973 (98% coverage) eligible persons out of the 17,405 targeted were informed of the benefits of the vaccine and convinced to receive the vaccine within required protocols. Questions and concerns by community members are mapped out and fed back to the coordination commission to include in daily activities with partners.

Water, Hygiene and Sanitation (WASH) During the reporting period, an evaluation of 45 health centers and schools was completed in the four areas with the most confirmed Ebola cases in Beni health zone. UNICEF and implementing partner OXFAM are finalizing the plan of intervention and the locations where activities will start this week. As of 12 October, 18 new health facilities in the affected health zones in North Kivu and Ituri provinces benefitted from essential WASH activities; these include the provision of handwashing points, briefing of staff on hygiene promotion, and disinfection, and the installation of chlorination points, reaching a total of 154 (48% coverage) out of the 320 targeted since the beginning of the response. In Tchomia Health Zone, UNICEF continued the distribution of WASH package in 7 health centers and WASH kits in 16 schools. In addition, 89 handwashing stations were installed in public areas, reaching a total of 125 since the beginning of the response.

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

This week, a collaborative workshop between WASH/PCI and Communications commission’s took place in Beni health zone to do a mapping of actors working in public health and communities, and scale up community engagement activities. Following the workshop, trainings have continued for all WASH partners in scaling up of community engagement and dialogue activities. As of 12 October, 575 (68% coverage) community sites (ports, market places, local restaurants, churches) out of the targeted 900 were provided with handwashing facilities for Ebola infection control in Beni, Mandima, Mabalako, Butembo and Tchomia Health zones in partnership with Oxfam, Programme de Promotion des Soins de Sante Primaire (PPSSP) and Centre de Promotion Socio-Sanitaire (CEPROSSAN). Since the beginning of the response, a total of 740,991 (78% coverage) persons have gained access to safe water in the affected health zones, out of the targeted 952,946.

Key activities in the last seven days:

- In Beni Health Zone, 11 community sites and 47 schools were followed up1 for water supply for handwashing stations in the health areas of Butsuli, Ndindi and Kasanga. In addition, 200 teachers and 300 community leaders were briefed on WASH messages this week. - During the reporting period, 35 community engagement and public health teams from Medair, Mercy Corps, PPSSP received WASH training, which includes specific scale up activities in health centres and schools, to set up community dialogue sessions on Ebola, responding to barriers to treatment seeking.

Education During the reporting period, UNICEF and the Ministry of Health continued the monitoring of 35 schools for the implementation of prevention measures. In all visited schools, children provided correct answers to the questions regarding the main prevention measures such (1) handwashing practices and key moments for handwashing (2) probable signs of Ebola Virus Disease (EVD) and means of contaminations and (3) good behavior that need to be adopted during the epidemic period. Insecurity remains a challenge for school functioning in Beni town, which led to the closing of schools from the 8-13th of October. Students and teachers from two districts, Beu and Rwenzori in Beni, decided to boycott classes in all other schools as a result of the insecurity. Students and teachers from relatively secured districts, such as Mulekera and Bungulu in Beni, also supported the initiative, further affecting the school system. As of 15 October, 71,363 (24% coverage) school children, of which 34,250 girls, were reached with Ebola prevention messages. 2,025 school children were reached during the reporting period. In addition, 3,629 (50% coverage) teachers, of which 1,270 women, were briefed on Ebola prevention measures. During the reporting period, 25 schools in high risk areas were provided with handwashing facilities, reaching a total of 390 (65% coverage) schools since the beginning of the response. UNICEF Education team is working with the Ministry of Education authorities to come-up with adequate statistics regarding students, teachers in all schools from highly affected areas as well as neighboring zones.

Psychosocial and Child Protection During the reporting period, 55 children affected by Ebola (17 confirmed, 38 suspects cases) went through Ebola Treatment Centers and received specific psychological assistance. Among them, 45 children (15 confirmed, 30 suspects cases) were in the Ebola Treatment Centers (ETC) of Beni Health Zone. Their families also received a psycho-social assistance.

1 Follow up visits were conducted to ensure the utilization of the handwashing station, their status, and if enough soap was available, it not more soap was provided. 6

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

130 affected families by EVD received psychosocial support and 77 affected families received material assistance in 9 health zones. 63 hygiene kits have been distributed to discharged and cured patients, 6 families received funeral kits, 65 families received food assistance and 5 families received Non Food Items (NFIs) kits. For all community reintegration of discharged and cured patients, a psycho-education is systematically conducted with the neighborhood and communities to avoid stigmatization of the affected families. 11 new separated/orphan children due to the Ebola epidemic has been identified and received appropriate care, reaching a total of 184 out of the targeted 300. 10 children are from Beni health zone. 29 separated/orphan children (new and former identified) received material assistance which includes: 17 NFI kits, 9 school kits, 3 newborn kits. A total of 519 contacts families; 424 in Beni health zone, 14 in Mangina health area, and 81 in Butembo health zone, received a psycho-social support. In Beni and Tchomia health zone, 84 psychosocial agents have been trained on the nutritional care of separated/orphan children as well as on detection and referral of children with acute malnutrition. Several teams of psychosocial agents are deployed within the different commissions (vaccination, prevention, surveillance, communication) to include a psychosocial component in the interventions. The role of psychologists/psychosocial agents is particularly key to convince suspect cases to join the ETC and families to organize safe and dignified burial (SDB).

Nutrition During the reporting period, 165 pregnant and lactating women were sensitized on the infant feeding and young children in emergency (IYCF-E) keys practices by nutritionists in three ETCs, Mangina, Beni and Butembo, reaching a total of 885 (9% coverage) persons since the beginning of the response. In collaboration with psycho social community workers, 16 orphan children received nutritional support, of which 4 orphans under 6 months old received Powdered Infant Formula (PIF) and 12 received milk as a complement. During this week, 22 psychosocial community workers were trained on nutrition care for orphaned children in Tchomia health zone. Medical care committee also organized a meeting chaired by the national coordinator to validate keys nutrition indicators to monitor nutrition activities in the ETCs. Those indicators include (i) number of under 6 months old children orphans and/or separated from mothers and whom are under adequate BMS, (ii) number of pregnant and lactating women sensitized on IYCF-E and (iii) number of hypoglycemia patients corrected with diet prescribed by nutritionists in ETC. Finally, with the support of UNICEF this week, the North Kivu provincial Nutrition coordinator has arrived in Beni to support the team in coordinating interventions.

Supply & Logistics Since the beginning of the response, $2,251,026 worth of items composed of WASH, C4D, Child Protection, Health and Education supplies have been procured for the Ebola response in Ituri and North Kivu province. Offshore procurement represents a total value of $824,527 (37%) and local procurement represents a total value of $1,426,500 (63%). During the reported week, Supply & Logistics section in Goma is finalizing local solicitations process for a total value of $216,344 related to local procurement of wash items (Ebola response). Supplies being procured are composed of: Calcium Hypochlorite (HTH), drum 45kg, buckets 20 liters, boot rubber, soap, water tanks, sprayers 16 liters, etc.

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

Human Resources As of 15 October, 62 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri provinces. In addition, UNICEF is reviewing the HR strategy for a sustained response to the epidemic.

External Communication One month after the start of the school year in the DRC, the CO issued a press release focused on the status of education in the Ebola affected regions. The press release was supported with new video and photo material posted on WeShare. The issue of education was covered at the UN press briefing in Geneva. Since the beginning of the outbreak, CO published in total 35 articles on its blog www.ponabana.com, as well as 31 Facebook posts, 23 Instagram posts and almost 200 tweets.

Funding The Response Plan developed jointly with the Ministry of Health, United Nations Agencies and in coordination with other actors, has an estimated need of US$ 43.837 million. Based on the joint response plan, UNICEF estimated amount required for immediate response is US$ 7.624 million. A revision of the plan is currently on-going under the leadership of MoH. Funds available include funds reprogrammed from Equateur Response in consultation with World Bank (PEF), USAID, ECHO and Japan. At present, funds from Gavi (US$ 120,000), CERF (US$ 900,000), USAID (US$ 2 million), and UNICEF National Committee in Germany -German Natcom (US$503,147), World Bank (US$ 3,947,688) have been allocated to support the Ebola response in North Kivu and Ituri province. Funding for education ensures UNICEF’s visibility for safe running of schools during the Ebola epidemic, reaching Ebola affected out of school children, and highlighting the important role of education to fight Ebola. The Strategic Response Plan is currently being revised and will be validated during the upcoming week.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018)

Reprogrammed Funds Received for Requirements Funds available Appeal Sector funds from Equateur North Kivu $ $ Response $ $

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

Next Sitrep: October 22, 2018

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

Ebola Response Tracking Indicators (15 October 2018) Change since last Target Total results report ▲▼

RESPONSE COORDINATION # of affected localities with functioning partner coordination mechanism 5 5 0 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, 7,684 7,684 289 religious /traditional leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on Ebola response and 4,650 4,637 211 participatory community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church 5,750,000 4,634,907 186355 meetings, schools, adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious misperception about Ebola, refusals to secure burials or resistance to 437 437 67 vaccination. # of listed eligible people for ring vaccination informed of the benefits of the 17,405† 16,973 1859 vaccine and convinced to receive the vaccine within required protocols.

# of target schools in high risk areas provided with handwashing facilities 600 390 25 # of community sites (port, market places, local restaurant, churches) with hand 900 575 98 washing facilities in the affected areas # of people with access to safe water source in the affected areas 952,946 740,991 96,908 EDUCATION # of students reached with Ebola prevention information in schools 297,000 71,363 2025

# of teachers briefed on Ebola prevention information in schools 7,200 3,629 63

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of affected families with confirmed, suspects, probable cases who received one or 214* 214 0 several kits of assistance to support their children # of affected families, including children, with confirmed, suspects and probable 214* 214 34 cases who received continuous psycho-social support in their community # of contact family members, including children, who receive psycho-social support 4,195** 3,348 1387 and/or material assistance # of unaccompanied children and orphans* identified who received appropriate 300 200 11 care and psycho-social support NUTRITION # of < 23 months children caregivers who received appropriate counseling on IYCF 9,756 885 165 in emergency † The target is dynamic as listing of eligible persons is defined *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures ** The target is dynamic and 100% of listed contacts is the identified target

DRC EBOLA SITUATION REPORT 22 October 2018

Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

Photo Credit: Nybo

22 October, 2018 SITUATION IN NUMBER SITUATION IN NUMBER Highlights 238 total reported cases • The revised Joint Response Plan for the Ebola outbreak in North Kivu and Ituri was (MoH, 21 October 2018)

released on 17 October, 2018 by the Ministry of Health with an additional US$ 61.3 million to cover activities between November 2018 to January 2019. The 203 confirmed cases revised plan was developed jointly by the Ministry of Health, WHO, UNICEF, World (MoH, 21 October 2018) Bank and other partners, and include preparedness activities. UNICEF areas of responsibility in the new plan is estimated at additional US$ 13.0 million over the 155 deaths recorded next three months. (MoH, 21 October 2018) • October 17: A high-level mission that included the Minister of Health, the UN SRSG and the DSRSG/RC visited Beni to re-assure the response team on existing 4,792 contacts under surveillance medical and security protocol in place for the team. The mission was preceded on (MoH, 21 October 2018) October 15 – 16 by a joint mission of the UNICEF Deputy Representative and the WHO Representative to review ongoing response with a focus on the implication for children. UNICEF Ebola Response Appeal • October 17: The International Health Regulations Emergency Committee met to US$ 21.8M review the Ebola outbreak in the DRC, and concluded that Public Health Emergency of International Concern (PHEIC) should not be declared at this time.

But the Committee remains deeply concerned by the outbreak and emphasized that response activities need to be intensified and ongoing vigilance is critical. The Committee also noted the very complex security situation. Ebola Response Funding • UNICEF’s Response Status 2018 Target Result

# of at-risk people reached through community engagement and interpersonal communication approaches. (door-to-door, church 8,200,000++ 4,874,907 meetings, small-group training sessions, school classes, briefings Total with leaders and journalists, other) funding # of listed eligible people for ring vaccination informed of the Ebola NK and Ituri 22,005† 20,849 Total Funding available* benefits of the vaccine and convinced to receive the vaccine 42% Funding requirements* : within required protocols. $ 21,830,204 # of people with access to safe water in the affected health 952,946 798,150 Gap zones 58% # of teachers briefed on Ebola prevention information 7,200 3,647 # of affected families with confirmed, suspects, probable cases who received one or several kits of assistance to support their 270* 270 children † The target is dynamic as listing of eligible persons is defined * Funding requirement includes budget for phase I ($ *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response 8,798,899) and budget for phase II ($ 13,031,305) matures ++ Target increased to include new affected areas 1

DRC EBOLA SITUATION REPORT 22 October 2018

Epidemiological Overview Summary Table (21.10.18): Province Health Zone Confirmed and Probable Cases Total Deaths Suspect Cases under Recorded investigation Confirmed Probable Total Mabalako 71 21 92 67 1 Beni 96 8 104 70 8 Oicha 2 1 3 1 0 Nord-Kivu Butembo 16 2 18 9 2 Musienene 0 1 1 1 0 Masereka 4 0 4 1 0 Kalunguta 2 0 2 1 0 Ituri Mandima 9 2 11 3 3 Komanda 1 0 1 0 0 Tchomia 2 0 2 2 0 TOTAL 203 35 238 155 14 Previous Total 14 October 2018 179 35 214 139 25

Humanitarian leadership and coordination

DRC EBOLA SITUATION REPORT 22 October 2018 Beni and Butembo health zones are the most concerning areas for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused around five coordination hubs based in Beni, Butembo, Tchomia, and Mabalako Health Zone. And one sub- coordination hub is operational in Bunia city.

The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases in Makeke, Mandima Health zone, Oicha Health Zone, Butembo, Masereka, and Tchomia Health Zone. UNICEF coordinates Makeke’s Ebola response from the coordination team based in Mangina Health Area and the coordination response for Oicha Health Zone. A coordination hub is put in place in Butembo Health Zone, which will also support the response in Masereka Health Zone. Due to the security access in Oicha and Masereka Health Zone, UNICEF works through local partners to implement its activities.

The stabilisation of the epidemiological situation in Tchomia Health Zone, Ituri, has been important in the evolution of the Ebola epidemic as the previously confirmed Ebola case was located near Lake Albert, which is in close proximity to Uganda. This increased the risk of disease spill over to Uganda due to high movements of population across the lake and in the vicinity.

An epidemiological analysis of the Ebola outbreak indicate that the proportion of children and adolescents affected by Ebola virus is increasing, especially in Beni town, where children aged less than 18-year account for 45% of new confirmed cases between 1 and 14 October, 2018. Further review of the situation indicates that most of the children were identified in Butanaka neighbourhood of Beni, and were not known contacts. Response efforts are being intensified to redress this situation. Response Strategy The joint response plan of the government and partners is currently under review, to identify key progress, challenges and modifications to upscale the response and respond to the current epidemiology. In support of the joint response plan, the UNICEF response strategy will continue to focus on communication, WASH, and Psycho-social care, nutrition and cross-cutting education sector response.

• Risk communication, social mobilization and community engagement with the aim to (1) proactively engage with affected and at risk communities, (2) provide timely and accurate health advice to encourage positive health seeking behaviors and (3) address community concerns and rumors. The strategy is implemented through 5 pillars that include (i) community engagement; (ii) promotion of preventive behaviors; (iii) responding to resistance; (iv) advocacy and capacity building of actors and (v) communication in support of ring vaccination. • The WASH strategy, as part of the Infection Prevention and Control (IPC), aims to stop the spread of the disease through the availability of 1) WASH in health care facilities, which includes providing water and WASH kits, 2) hygiene promotion and the provision of WASH kits in schools, including handwashing station and soap/temperature check points, and 3) WASH in communities, through mass outreach on hygiene promotion to vulnerable communities and the setup of handwashing stations/temperature control in strategic transit locations. • The child protection and psycho-social support to EVD survivors and family members of EVD cases as well as contact families seeks to (1) provide psycho-social support; (2) establish or re-establish social and community networks and support systems; (3) provide social kits to EVD affected families (4) identify and provide appropriate care to orphans and unaccompanied children due to the Ebola epidemic. The key element of the strategy includes (i) psychosocial support activities for children and their families; (ii) material assistance to affected families to better support children; (iii) facilitation of professions help to children and families with more severe psychological or social problems / needs; (iv) coordinate mental health and psychosocial support (MHPSS); (vi) psycho-social assistance, appropriate care and research of long-term solution to orphans and unaccompanied children. • The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases to the six health

DRC EBOLA SITUATION REPORT 22 October 2018 zones affected by Ebola or in situation of nutritional alert in North Kivu province. In addition, address young child and infant feeding practice that is impacted by the increasing number of women affected by the Ebola epidemic • The cross-cutting education sector strategy involve key EVD prevention measures on the school premises, include: (i) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas (ii) training of educational actors (students, teachers, inspectors, school administration agents, head of educational provinces) on Ebola including WASH in school, psychosocial support and against discrimination, (iii) provision of infrared thermometers and handwashing facilities, clean water, soap, and capacity reinforcement on hygiene behaviours in schools (iv) provision of specific documentation and protocol for prevention, guidance and management of suspected cases in school1 (vi) provide key messages on Ebola prevention to families. Summary Analysis of Programme Response

Overview of the key elements in the response, with a special emphasis on UNICEF’s response in the affected health zones, is detailed below. Communication and social mobilization (C4D) During the reporting period in Beni town, a radio survey was conducted to better understand the listening habits of the population and assess the effectiveness and retention of Ebola prevention messages. There are 15 local radio stations in the Beni area, all engaged in the fight against Ebola. The survey will help us improve our media strategy and planning. Relevant results include:

• 95% of listeners said they learned new information on Ebola from local radio stations and 82% of listeners said local radio has been their key source of information on Ebola (6% Social Media). 47% listened to the radio via their cell phones. UNICEF Action: Popularity of local radio is high and we must continue our focus on using this medium with more creative and updated messages that address current concerns and events.

• 90% acknowledged that due to radio messages, their behavior towards Ebola has changed. UNICEF Action: Continuous broadcasts and affirmation of positive and model behaviors must be increased and reinforced.

• 57% of radio listeners are ages 26 and up, 39% ages 16-25. UNICEF Action: Youth listened to local radio less, and we must therefore focus more on other means to reach youth. Radio however remains effective in influencing social norms and promoting an enabling environment for youth to engage.

• Among the 16 radio stations, only 4 are the most listened to. UNICEF Action: The less popular radio stations have been clearly identified, and will soon be approached to further analyze and take action to train and monitor.

• 76% listened to the radio between 5-7 am, and 72% listened between 19-23:00 pm. UNICEF Action: Media planning should focus mostly on these time schedules. These mass media approaches have reached 4,874,907 (59% coverage) at risk persons with Ebola prevention messages since the beginning of the response, of which 240,000 persons were reached during the reporting period. During the reporting period, 411 members of influential groups and community leaders were reached to promote community engagement and interpersonal activities, reaching a total of 8,095 (72% coverage) leaders since the beginning of the response. In addition, 503 frontline workers (RECOs) were mobilized on the Ebola response and initiated participatory community engagement approaches, reaching a total of 5,140 (66% coverage) since the beginning of the response. To further upscale and reinforce established community alert systems in Butembo and Masereka Health Zone, 255 telephones were additionally distributed this week to Community Chiefs and Civil Society influencers in each of the 87 at-risk communities. To reinforce their collective commitment, weekly meetings are held with all community leaders to evaluate and discuss potential threats or issues. With these new phones and credit, community chiefs continued to conduct auto-surveillance and make daily calls to both the surveillance and communications teams. Two journalists were hired to monitor and report on all telephone calls.

1 Ebola concept note for Ebola prevention in schools was approved and will be presented to the national committee this week. 4

DRC EBOLA SITUATION REPORT 22 October 2018 During the first day, 13 serious alerts were recorded, including two community deaths, two suspect cases and two resistance cases. In three Ndindi neighborhoods in Beni Health Zone, Kanzuli, Butsili and Kasagatua, 133 telephone calls were reported by members of the Community-alert system this week, including one reported death in Kasangatua, for which a Signified and Dignified Burial (SDB) was carried out. According to community reports, most of these alerts were negative. In relation to youth engagement, a resistant youth group was reported in the village of Musimba. The group approached a Safe & Dignified Burial team and wanted to see for themselves the corpse inside the bag. As they approached the SDB team unprotected, they were stopped by village elders and were shortly after convinced that it was too risky to open the bag. Upon further discussions with the communications team, the youth group accepted to participate in a briefing on SDB and were invited to visit an Ebola Treatment Unit (ETU) the same day. As they technically became contacts for approaching the SDB team unprotected, the group accepted to receive the Ebola vaccine. During the reporting period, 3,816 eligible people were informed of the benefits of the vaccine and convinced to receive the vaccine within required protocols, reaching a total of 20,849 (95% coverage) eligible persons since the beginning of the response. Furthermore, 474 (76% coverage) households presenting reluctance on Ebola vaccination, treatment in ETCs, or refusal of secure and dignified burials were reached since the beginning of the response. Despite high security issues in Beni town, other important interventions were conducted in the Health Zone. 163 traditional healers were briefed over a period of 3 days, and collectively engaged themselves to refer all Ebola suspects to the closest ETU, 25 media professionals were accompanied to an ETU visit, 2 survivors were accompanied back home by the communications team, 311 no-case suspects were visited in their homes and many of their testimonies recorded for broadcast on local radio. In Mahili school district, were one of their students became an Ebola victim, several community dialogue sessions were organized for 75 teachers and 253 parents to address their concerns. This was carried collectively out by the Education, Communications and Psycho-Social teams. Water, Hygiene and Sanitation (WASH) During the reporting period, UNICF has scaled up interventions in health centers in the areas with most cases in Beni town. In collaboration with World Health Organisation (WHO) and World Food Programme (WFP), 79 Health Centers were equipped with WASH/IPC kits. Training of staff in these facilities was completed last week. As of 19 October, 86 new health facilities in the affected health zones in North Kivu and Ituri provinces benefitted from essential WASH activities; these include the provision of handwashing points, briefing of staff on hygiene promotion, and disinfection, and the installation of chlorination points, reaching a total of 240 (75% coverage) out of the 320 targeted2 since the beginning of the response. This week, training of WASH and Communications partners continued on dialogue, health promotion and community engagement. The trainings ensure that teams can work with community health workers to better answer rumours and facilitate treatment seeking at health centres. As of 19 October, 770 (86% coverage) community sites (ports, market places, local restaurants, churches) out of the targeted 900 were provided with handwashing facilities for Ebola infection control in Beni, Mandima, Mabalako, Butembo and Tchomia Health zones in partnership with Oxfam, Programme de Promotion des Soins de Sante Primaire (PPSSP) and Centre de Promotion Socio-Sanitaire (CEPROSSAN). Since the beginning of the response, a total of 798,150 (84% coverage) persons have gained access to safe water in the affected health zones, out of the targeted 952,946.

2 UNICEF target only, calculation based on the number of targeted areas affected by Ebola, prioritised by the WASH/IPC commission. 5

DRC EBOLA SITUATION REPORT 22 October 2018

Key activities in the last seven days:

• In Beni town, UNICEF continued distribution of WASH package in 6 schools and 79 Health Centers most of each private centers. These centers benefited from WASH and IPC package provided by UNICEF and WHO. The kits were prepared by WFP as part of a multi-agency response plan.

• In Tchomia Health Zone, UNICEF continued distribution of WASH package in 4 Health Centers and WASH kits in 4 Schools. Also, 27 handwashing stations were installed in public areas bringing the total number to 152 since the beginning of activities.

• During the reporting, WASH/C4D conducted a community analysis on the use of private and public health centers in Rwangoma where there have been multiple cases of Ebola not transferred to the ETC (Ebola Treatment Centers) from private healthcare. The analysis identified a positive influence of recent WASH/IPC distributions of triage and prevention items. WASH preparedness As part of the Ebola preparedness plan, WASH strategy includes pre-emptively strengthening access to WASH services in communities, schools and health centers on the areas affected by the Ebola Virus Disease (EVD) outbreak. The strategy aligns with the infection prevention and control guidelines to stop the spread of Ebola through access to water, sanitation and hygiene services, and includes:

• Provision and construction of water points, latrines, hand washing stations and temperature control in schools

• Hygiene promotion, installation of hand washing stations and temperature control in public places and major transport road axes. Education 19 October, with technical and financial support from UNICEF, the Ministry of Education (MoE) organized a workshop for the validation of EVD prevention protocol in Kinshasa. With the endorsement of this protocol, DRC MoE will have a strategic document to guide and inform the standards for school functioning during EVD epidemics, including strict rules for access, and referral of children and adults with symptoms to health facilities. UNICEF and the MoE are monitoring the implementation of EVD prevention measures in 20 schools located in Butembo, Tchomia, and Kasenyi. Children from visited schools demonstrated their capacity for capturing main prevention measures given by their teachers during classes. As of the reporting period, 326,190 children (80% of last year’s attendance), of which 156,571 girls, resumed classes in 1,623 schools located in EVD highly affected health zones in North Kivu and Ituri provinces. All 248 schools in Beni are still closed due to security issues. UNICEF EVD preventive messages reached 72,058 (24% coverage) school children, of which 34,750 girls. A total of 695 school children, of which 330 girls, were reached during the reporting period and a total of 3,647 (51% coverage) teachers, of which 1,275 women, were briefed on Ebola prevention measures. During the reporting period, 10 schools in high risk areas were provided with handwashing facilities, reaching a total of 400 (67% coverage) schools since the beginning of the response.

Psychosocial and Child Protection During the reporting period, 38 children (11 confirmed, 27 suspects cases) went through Ebola Treatment Centers and received an individual psychological assistance. Among them, 29 children (9 confirmed, 20 suspects cases) were in the ETC of Beni Health Zone. Adapted recreational kits have been distributed for the children in the ETC. 6

DRC EBOLA SITUATION REPORT 22 October 2018 81 new affected families by EVD received psychosocial support and/or material assistance3 in seven health zones in North Kivu Province and three health zones in Ituri Province. 39 hygiene kits have been distributed to discharged and cured patients, 18 families received funeral kits, 4 families received newborn kits, 49 families received food assistance and 6 families received Non-Food Items (NFIs) kits. 335 affected families by EVD (previously identified) received a continuous psychosocial support through regular visits of psychosocial agents in their communities. Among them, 53 persons cured of EVD were visited by psychologists. Some of them suffered from psychological and sexual disorders. An individual psychotherapy plan has been developed for each person. Stigmatization also remains an important issue. For example, a 17 years old cured boy received a specific psychosocial support due to the stigma he is subjected to in his school. The Psycho-Social Commission continues to conduct psycho-education in the communities to reduce stigmatization of the affected families. In this regard, a session was organized with parents of students of a primary school in the Mandima health zone. 10 new orphans and 10 separated children due to the Ebola epidemic has been identified and received appropriate care, reaching a total of 204 out of the targeted 300. They received material assistance which includes: 4 NFI kits, 3 school kits, 7 newborn kits, 4 food assistances. All the new orphans are from Beni health zone. 54 orphans previously identified received a follow up visit by psycho-social agents and 46 benefited from additional school support (especially for the purchase of uniforms). A total of 876 contacts families4; 553 in Beni health zone, 34 in Tchomia health zone, and 289 in Butembo health zone, received a psycho-social support, reaching a total of 3356 out of the targeted 47985. Nutrition During the reporting period, 97 people, including pregnant and lactating women, were sensitized on infant feeding and young children in emergency (IYCF-E) keys practices by nutritionists in 3 ETCs, Mangina, Beni and Butembo health zone, reaching a total of 982 (10% coverage) persons since the beginning of the response. The Ministry of Health (MoH) and UNICEF reinforced capacities in affected health zones to ensure adequate case management of acute malnutrition. During the week, 70 health workers have been trained on community management concerning acute malnutrition national protocol in the health zones of Mabalako (31) and Kalunguta (39). In addition to this figure, 44 community workers, including community health workers and psychosocial community actors, received training on screening and referral of acute malnutrition cases to health facilities. One nutritionist was re-deployed in Beni ETC to strengthen nutrition activities during the reporting period as bed occupation has reached 83% (34 out of 41). Nutritionists and psycho social community workers are monitoring 16 orphaned children under the Powdered Infant Formula (PIF). Supply & Logistics Since the beginning of the response, a total value of supplies amounting US$2,724,920.34 composed of WASH, C4D, Child Protection, Health, Education and finally ICT supplies have been procured for the Ebola response in Ituri and North Kivu province.

3 Directly affected families (a family which a member has died of Ebola/ or among which a member went through a care center can receive material assistance, on a case by case basis, according to the specific needs of the family. Assistance can be composed of different kits 1) food assistance (systematically distributed to affected families) 2) hygiene and dignity kits (systematically distributed to cured or discharged patients) 3) newborn kits 4) school kits 5) assistance to organize funerals (cash or food assistance) 4 UNICEF provides psychosocial assistance to contacts of contacts. Contacts receive food assistance from WFP. 5 http://www.who.int/csr/don/18-october-2018-ebola-drc/en/ 7

DRC EBOLA SITUATION REPORT 22 October 2018 Offshore procurement represents a total value of US$1,005,847.08 (37%) and local procurement represents a total value of US$1,719,073.26 (63 %). US$169,163 of the total of value of $2,724,920.34 was used for the purchase of ICT equipment for staffs. Human Resources As of 22 October, 58 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri provinces. In addition, UNICEF is reviewing the HR strategy for a sustained response to the epidemic. External Communication The CO issued 10 press releases on the impact of the Ebola-crisis and UNICEF’s response since the declaration of the epidemic early August, and shared video and photo material via WeShare. New press coverage during the reporting period included VOA, CGTN Africa, ADIAC, All Africa, Radio Okapi, Digital Congo, Media Congo, Congo Actuel, UN News, UN multimedia and Relief web. Since the beginning of the outbreak, CO published in total 35 articles on its blog www.ponabana.com, as well as 33 Facebook posts, 23 Instagram posts and more than 200 tweets. Funding Based on the Joint Response plan of the Ministry of Health and partners, the total funding required for the response is estimated at USD 105 million (i.e. USD 43.8 million for August to October, 2018; and USD 61.3 Million for November 2018 to January 2019). As part of the joint response plan, UNICEF response strategy focused on Communication, WASH and Psycho- social care, nutrition and cross-cutting education sector response is estimated at US$21.8 Million. At present, the UNICEF response has a funding shortfall of USD 12.7 Million. Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018) Funds available Funding gap Requirements* Appeal Sector Funds Received $ $ % Current Year** Water, Hygiene and Sanitation - WASH / IPC 10,536,519 2,962,719 7,573,800 72%

Communication for Development (C4D) - Community 6,097,005 3,333,405 2,763,600 45% engagement and Communication for Campaigns

Child protection and Psychosocial Support 1,851,200 648,800 1,202,400 65% Medical Care : Management of Severe Acute 749,800 749,800 0 0% Malnutrition in Ebola Treatment Center

Operations support, Security and Coordination costs 2,273,680 1,404,175 869,505 38% and Information and Communications Technology

Prepardness Plan 322,000 0 322,000 100% Total 21,830,204 9,098,899 12,731,305 58%

* Funding requirement includes budget for phase I ($ 8,798,899) and budget for phase II ($ 13,031,305) **Funds available include reprogrammed funds from Equateur Response

Next Sitrep: October 29, 2018

Who to contact Gianfranco Rotigliano Tajudeen Oyewale Pierre Bry for further Representative a.i. Deputy Representative8 Chief Field Operations UNICEF DRC UNICEF DRC UNICEF DRC information: Tel: + (243) 996 050 399 Tel : +(243) 996 050 200 Tel: + (243) 817 045 473 E-mail: [email protected] E-mail : [email protected] E-mail: [email protected]

DRC EBOLA SITUATION REPORT 22 October 2018

Ebola Response Tracking Indicators (22 October 2018) Change since last Target Total results report ▲▼

RESPONSE COORDINATION # of affected localities with functioning partner coordination mechanism 5 5 0 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, 11,200++ 8,095 411 religious /traditional leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on Ebola response and 7,800++ 5,140 503 participatory community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church 8,200,000++ 4,874,907 240000 meetings, schools, adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious misperception about Ebola, refusals to secure burials or resistance to 620++ 474 37 vaccination. # of listed eligible people for ring vaccination informed of the benefits of the 22,005† 20,849 3876 vaccine and convinced to receive the vaccine within required protocols.

# of target schools in high risk areas provided with handwashing facilities 600 400 10 # of community sites (port, market places, local restaurant, churches) with hand 900 770 195 washing facilities in the affected areas # of people with access to safe water source in the affected areas 952,946 798,150 57,159 EDUCATION # of students reached with Ebola prevention information in schools 297,000 72,058 695

# of teachers briefed on Ebola prevention information in schools 7,200 3,647 18

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of affected families with confirmed, suspects, probable cases who received one or 270* 270 56 several kits of assistance to support their children # of affected families, including children, with confirmed, suspects and probable 270* 270 56 cases who received continuous psycho-social support in their community # of contact family members, including children, who receive psycho-social support 5,518** 4916 1568 and/or material assistance # of unaccompanied children and orphans* identified who received appropriate 300 204 20 care and psycho-social support NUTRITION # of < 23 months children caregivers who received appropriate counseling on IYCF 9,756 982 97 in emergency † The target is dynamic as listing of eligible persons is defined ++ Target increased to include new affected areas *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures ** The target is dynamic and 100% of listed contacts is the identified target

DRC EBOLA SITUATION REPORT 29 October 2018

Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

Photo Credit: Anne Herrmann

29 October 2018 SITUATION IN NUMBER SITUATION IN NUMBER Highlights 274 total reported cases (MoH, 28 October 2018) • During the reporting period, a Knowledge, Attitude, and Practice survey was conducted in Butembo Health Zone, which to identify gaps 239 confirmed cases and lessons to improve the communication team’s interventions in the (MoH, 28 October 2018) affected areas 174 deaths recorded • UNICEF has submitted a proposal to the World Bank to support the (MoH, 28 October 2018)

revised joint response plan for UNICEF’s areas of responsibility. 5,503 contacts under surveillance (MoH, 28 October 2018)

UNICEF Ebola Response Appeal

US$ 21.8M

Ebola Response Funding UNICEF’s Response Status 2018 Target Result

# of at-risk people reached through community engagement and interpersonal communication approaches. (door-to-door, church 8,200,000 5,184,907 meetings, small-group training sessions, school classes, briefings with leaders and journalists, other) Total funding # of listed eligible people for ring vaccination informed of the Ebola NK and Ituri available* benefits of the vaccine and convinced to receive the vaccine 25,343† 24,142 Total Funding 42% within required protocols. Funding requirements* : $ 21,830,204 # of people with access to safe water in the affected health 952,946 813,623 Gap zones 58% # of teachers briefed on Ebola prevention information 7,200 3,757 # of affected families with confirmed, suspects, probable cases who received one or several kits of assistance to support their 296* 296 children † The target is dynamic as listing of eligible persons is defined * Funding requirement includes budget for phase I ($ *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures 8,798,899) and budget for phase II ($ 13,031,305)

DRC EBOLA SITUATION REPORT 29 October 2018

Epidemiological Overview Summary Table (28.10.18): Province Health Zone Confirmed and Probable Cases Total Deaths Suspect Cases under Recorded investigation Confirmed Probable Total Mabalako 71 21 92 67 3 Beni 124 8 132 84 22 Oicha 2 1 3 1 0 Nord-Kivu Butembo 24 2 26 14 3 Musienene 0 1 1 1 0 Masereka 4 0 4 1 1 Kalunguta 2 0 2 1 1 Ituri Mandima 9 2 11 3 2 Komanda 1 0 1 0 0 Tchomia 2 0 2 2 0 TOTAL 239 35 274 174 32 Previous Total 21 October 2018 203 35 238 155 14

Humanitarian leadership and coordination

DRC EBOLA SITUATION REPORT 29 October 2018 Beni and Butembo health zones are the most concerning areas for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused around five coordination hubs based in Beni, Butembo, Tchomia, and Mabalako Health Zone. And one sub- coordination hub is operational in Bunia city.

The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases in Makeke, Mandima Health zone, Oicha Health Zone, Butembo, Masereka, and Tchomia Health Zone. UNICEF coordinates Makeke’s Ebola response from the coordination team based in Mangina Health Area and the coordination response for Oicha Health Zone. A coordination hub is put in place in Butembo Health Zone, which will also support the response in Masereka Health Zone. Due to the security access in Oicha and Masereka Health Zone, UNICEF works through local partners to implement its activities.

The stabilisation of the epidemiological situation in Tchomia Health Zone, Ituri, has been important in the evolution of the Ebola epidemic as the previously confirmed Ebola case was located near Lake Albert, which is in close proximity to Uganda. This increased the risk of disease spill over to Uganda due to high movements of population across the lake and in the vicinity.

Response Strategy The joint response plan of the government and partners has been revised to upscale the response and respond to the current epidemiology. In support of the joint response plan, the UNICEF response strategy will continue to focus on communication, WASH, and Psycho-social care, nutrition and cross-cutting education sector response.

• Risk communication, social mobilization and community engagement with the aim to (1) proactively engage with affected and at risk communities, (2) provide timely and accurate health advice to encourage positive health seeking behaviors and (3) address community concerns and rumors. The strategy is implemented through 5 pillars that include (i) community engagement; (ii) promotion of preventive behaviors; (iii) responding to resistance; (iv) advocacy and capacity building of actors and (v) communication in support of ring vaccination. • The WASH strategy, as part of the Infection Prevention and Control (IPC), aims to stop the spread of the disease through the availability of 1) WASH in health care facilities, which includes providing water and WASH kits, 2) hygiene promotion and the provision of WASH kits in schools, including handwashing station and soap/temperature check points, and 3) WASH in communities, through mass outreach on hygiene promotion to vulnerable communities and the setup of handwashing stations/temperature control in strategic transit locations. • The child protection and psycho-social support to EVD survivors and family members of EVD cases as well as contact families seeks to (1) provide psycho-social support; (2) establish or re-establish social and community networks and support systems; (3) provide social kits to EVD affected families (4) identify and provide appropriate care to orphans and unaccompanied children due to the Ebola epidemic. The key element of the strategy includes (i) psychosocial support activities for children and their families; (ii) material assistance to affected families to better support children; (iii) facilitation of professions help to children and families with more severe psychological or social problems / needs; (iv) coordinate mental health and psychosocial support (MHPSS); (vi) psycho-social assistance, appropriate care and research of long-term solution to orphans and unaccompanied children. • The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases to the six health zones affected by Ebola or in situation of nutritional alert in North Kivu province. In addition, address young child and infant feeding practice that is impacted by the increasing number of women affected by the Ebola epidemic • The cross-cutting education sector strategy involve key EVD prevention measures on the school premises, include: (i) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas (ii) training of educational actors (students, teachers, inspectors, school administration agents, head of

DRC EBOLA SITUATION REPORT 29 October 2018 educational provinces) on Ebola including WASH in school, psychosocial support and against discrimination, (iii) provision of infrared thermometers and handwashing facilities, clean water, soap, and capacity reinforcement on hygiene behaviours in schools (iv) provision of specific documentation and protocol for prevention, guidance and management of suspected cases in school1 (vi) provide key messages on Ebola prevention to families.

Summary Analysis of Programme Response

Overview of the key elements in the response, with a special emphasis on UNICEF’s response in the affected health zones, is detailed below. Communication and social mobilization (C4D) Community engagement: During the reporting period, additional 377 influential leaders and group members were reached with Ebola prevention messages through community engagement and interpersonal communication, reaching a total of 8,472 (76% coverage) leaders since the beginning of the response. In order to increase community engagement interventions in Beni town, communication activities were scaled-up in all 18 health districts (AS). For this, 36 additional local influencers were engaged to reinforce the Surveillance, Vaccination, Safe and Dignified Burials (SDB), Prevention and Psycho-Social teams. In addition, 214 frontline workers were mobilized during the reporting period to support community engagement approaches, bringing the total number to 5,354 (69% coverage). Other actions implemented this week included community engagement for community surveillance of private structures, which was completed in Kanzuli health zone with the backing of the chief doctor in the zone. The community team continued to implement the Ebola response through social dialogues with the community, which ensured the community that their perspectives are voiced and shared with the Ebola response managers. Promotion of preventive behaviors: Since the beginning of the response, 5,184,907 (63% coverage) of at- risks persons were reached with Ebola-preventive messages via mass-communication and interpersonal communication, out if which 310,000 were reached during the reporting period. Of those reached in Beni town during the reporting period, over 8,000 were followers of 24 churches participated in sessions on SDB and Surveillance and over 2,500 participated and listened to testimonies from four Ebola survivors. In addition, 17 film projections were conducted in 7 high risk districts, and a professional encounter with 93 traditional healers concluded with a strong collective engagement to abide by all Ebola protocols of preventive measures and referrals. Responding to rumors and resistance: During the reporting period, 37 households received personalized house visits to address strong reluctance to Ebola vaccination, treatment in ETCs or refusal of secure and dignified burials, reaching a total of 511 households (82% coverage) since the beginning of the response. The latest Knowledge, Attitude and Practice (KAP) survey has covered for the first time the Butembo health zone and provided critical information on where and how to better focus the communication team’s interventions. The KAP was conducted in 19 random villages in Butembo health zone and 487 persons participated in the survey. Results include:

• 99% of respondents confirmed they were informed about Ebola. 83% participants received Ebola information from local radio, 65% from their religious leaders, and 26% from print materials. • 55% of respondents participated in at least one community dialogue session. • 89% of respondents correctly named at least two symptoms of Ebola.

1 Ebola concept note for Ebola prevention in schools was approved and will be presented to the national committee this week. 4

DRC EBOLA SITUATION REPORT 29 October 2018 • 91% of respondents can name at least two modes of Ebola prevention (for 93% frequent washing of hands is the best means to protect against Ebola and for 88% - avoiding shaking hands). • 82% of respondents consider that most at risk are family members, 50% - frontline workers, 43% - taxi-moto drivers, and 30% - meat hunters. • 78% of respondent believe that Ebola victims can be treated and fully healed. • 87% of respondents said that burying an Ebola victim differently than others is necessary to avoid contamination and avoid propagation. Only 34% say Safe and Dignified Burials (SDB) can be conducted without compromise of cultural and traditional practices. This is critical and our attention must be focused more to address this gap. • 96% of respondents are aware of the Ebola vaccine, but only 49% can correctly explain who the eligible beneficiaries of the vaccine are. • 90% of respondents said their behaviors changed significantly following reception of further info on Ebola. • 59% of respondents said if someone has Ebola symptoms, they should immediately go to an Ebola Treatment Unit (ETU), 30% say they should go to the nearest health centre. Key recommendations from the study include the urgency to re-focus our attention on the districts (AS) with lowest levels of knowledge, namely Wayene, Vuteste, Matsuli, Mutsanga, Kyahali, Mitoya, Vighole, and Kambuli districts. Other key lessons included the need to orient the radio programing to reflect actual field events and situations, upscale community dialogues around Safe and Dignified Burials, encourage visits to Ebola Treatment Units, and the importance to report all cases with symptoms of Ebola to authorities. Knowledge on who is eligible for the Ebola vaccine remains low and the targeted communication on this needs to be intensified. C4D preparedness: By assessing the potential risk to neighboring provinces, the communication team identified the need to reinforce critical C4D ‘preparedness’ measures. The C4D team widened its scope of preventive interventions to include the surrounding provinces of Tshopo, Ituri, North Kivu, South Kivu, Tanganika, Haut Katanga, and Maniema. Through the partnerships with Oxfam, Caritas and Search for Common Ground, strategic interventions will target most cities along all major roads between Beni, Goma, Bunia and Kisangani. Activities include engagement of local radio stations, religious leaders, and key youth associations to promote Ebola preventative messages. These preparedness interventions will not only ensure a collective and timely response, but the activities will contribute to raising awareness on Ebola and enable the populations to monitor new arrivals to their communities from affected health zones and quickly report suspected cases to their health authorities. Water, Hygiene and Sanitation (WASH) During the reporting period, UNICF continued the distribution of WASH kits in Health Centers in the areas with most cases in Beni health zone. In collaboration with the World Health Organisation (WHO) and World Food Programme (WFP), 74 health centers were equipped with WASH/IPC kits in Beni health zone. As of 28 October, 84 new health facilities in the affected health zones in North Kivu and Ituri provinces benefitted from essential WASH activities; these include the provision of handwashing points, briefing of staff on hygiene promotion, and disinfection, and the installation of chlorination points, reaching a total of 324 (100% coverage) out of the 324 targeted since the beginning of the response. This week, in collaboration with WHO, UNICEF launched a qualitative research to conduct an analysis with parents located in high risk communities in order to better understand the provision of Ebola treatment and care for children. This analysis will allow a better understanding of the recent cases of infection among children. As of 28 October, 786 community sites (ports, market places, local restaurants, churches) out of the targeted 900 community sites were provided with handwashing facilities for Ebola infection control in Beni, Mandima, Mabalako, Butembo and Tchomia Health zones in partnership with Oxfam, Programme de Promotion des Soins de Sante Primaire (PPSSP) and Centre de Promotion Socio-Sanitaire (CEPROSSAN).

DRC EBOLA SITUATION REPORT 29 October 2018 Since the beginning of the response, a total of 813,623 (85% coverage) persons have gained access to safe water in the affected health zones, out of the targeted 952,946, of which 6,973 new people benefited from drinking water treated through 14 functional chlorination points in Beni health zone. In addition, 8,500 new people benefited from drinking water treated through 17 functional chlorination points in Tchomia health zone. Follow up and distribution of 44,800 liters of chlorinated water was completed for 40 handwashing facilities in public areas in Tchomia health zone. Key activities in the last seven days:

• During the reporting period, as part of WASH/Community Engagement activities, UNICEF conducted training for 6 anthropologists and 20 community focal points on Ebola Community Engagement and Dialogue. WASH preparedness As part of the Ebola preparedness plan, WASH strategy includes pre-emptively strengthening access to WASH services in communities, schools and health centers on the areas affected by the Ebola Virus Disease (EVD) outbreak. The strategy aligns with the infection prevention and control guidelines to stop the spread of Ebola through access to water, sanitation and hygiene services, and includes:

• Following the methodology established by UNICEF and GoDRC, a sustainable / community approach to providing WASH infrastructure in health facilities including incinerators, latrines and water facilities; • Provision and construction of water points, latrines, hand washing stations and temperature control in schools • Hygiene promotion, installation of hand washing stations and temperature control in public places and major transport road axes.

Education During the reporting period, UNICEF and the Ministry of Education (MoE) local authorities continued monitoring the implementation of Ebola Virus Disease (EVD) prevention measures in five schools located in Butembo health zone, out of which three were primary schools and two were secondary schools. The total number of children in all five monitored schools is 3,812, out of whom 1,757 were girls, received training on Ebola prevention messages by 108 teachers, of whom 61 from primary school teachers and 47 were secondary school teachers. Children randomly chosen from visited schools were able to demonstrate their capacities on identifying main prevention measures given by their teachers during classes. This level of knowledge would be validated in subsequent KAP survey. In Beni town, while schools are still closed due insecurity reasons, UNICEF C4D mobilisers and community workers continued working with parents, sensitizing them on EVD prevention measures and on how to mitigate risks on children exposure to the epidemics while they are at home. It is important to point out in such an epidemic period, schools remain the most secured and protective environment for children. In Ituri province, UNICEF supported the MoE local authorities in undertaking data collection from 100 schools in affected health zones, out of which 65 schools were covered by October 24th, 2018. As data availability and coherence in the EVD affected areas continue to be a challenge for the response, results of the data collection will enable UNICEF to improve its response in terms of EVD preventions measures and monitoring process in schools. Since the beginning of the response, 414 (69% coverage) schools were provided with handwashing facilities, of which 14 schools were reached during the reporting period. As of the reporting period, UNICEF EVD preventive messages have reached 77,558 (26% coverage) school children, of which 37,190 girls. A total of 5,500 school children, of which 2,640 girls, were reached during the reporting period and a total of 3,757 (52% coverage) teachers, were briefed on Ebola prevention measures.

DRC EBOLA SITUATION REPORT 29 October 2018 Psychosocial and Child Protection During the reporting period, 41 children (6 confirmed, 35 suspects cases) went through Ebola Treatment Centers (ETC) and received an individual psychological assistance. Among them, 29 children (3 confirmed, 26 suspects cases) were in the ETC of Beni health zone. Since the beginning of the response, 8 children cured of EVD (among 83 cured persons) have been identified and are followed up by psychologists. They also received specific assistance, such as food assistance, NFI kits, adapted recreational kits, and school support. 30 new affected families by EVD received psychosocial support and/or material assistance in seven health zones in North Kivu Province and three health zones in Ituri Province. 81 hygiene kits and 55 food assistance have been distributed to discharged and cured patients, 5 families received funeral kits, 6 families received newborn kit and 30 families received NFI kits. 143 affected families by EVD (previously identified) received a continuous psychosocial support through regular visits of psychosocial agents in their communities. The psychosocial commission is also supporting the families affected by community deaths (which are confirmed Ebola) by providing psychosocial support and food assistance or cash transfer to organize the funerals. In Butembo health zone, following the death of an EVD confirmed case of a 13-year-old girl, a psycho-education session was organized with the students, the parents of students and the teachers of her school. 7 new orphans and separated children due to the Ebola epidemic has been identified and received appropriate care, reaching a total of 211 out of the targeted 300. They received material assistance which includes newborns and NFI kits as well as food assistance. All of them are from Beni. 78 orphans previously identified received a follow up visit by psycho-social agents and received additional assistance (11 NFI kits and 16 school supports). One orphan has been identified as malnourished and was referred to a medical center for appropriate care (in collaboration with the nutrition section). A total of 1,038 contacts families; 782 in Beni, 77 in Tchomia, and 179 in Butembo, received a psycho-social support, reaching a total of 4,546 out of the targeted 5,341 contact families. Nutrition During the reporting period, 215 children caretakers, including pregnant and lactating women, were sensitized by three nutritionists in the Mangina, Beni, and Butembo ETCs on the key practices related to Infant and Young Child Feeding in emergencies (IYCF -E) approach, reaching a total of 1,197 (12% coverage) persons since the beginning of the response. In collaboration with UNICEF, nine orphans and/or separated children under the age of six months received Breast Milk Substitutes (BMS) through NGO Danish Refugee Council (DRC) and the National Nutrition Program (PRONANUT) in all Ebola affected areas. These children received daily basis monitoring by nutritionists and psychosocial agents in terms of milk preparation, nutritional and health status. UNICEF supported the National Nutrition Program of North Kivu in training 89 health workers (41 in Beni Health Zone, 45 in OICHA Health Zone and 3 in Mutwanga Health Zone) to promote community management for acute malnutrition (CMAM) national protocol in order to increase the number of health facilities that provides adequate treatment of acute malnutrition cases in the affected areas. In addition, UNICEF nutrition expert provided training to three nutritionists in Beni ETC on the provision of nutritional care to patients affected by EVD, particularly for children affected by the virus. Supply & Logistics Since the beginning of the response, $ 2,730,920.34 worth of items composed of WASH, C4D, Child Protection, Health, Education and finally ICT supplies have been procured for the Ebola response in Ituri and North Kivu province. Out of the total value of items, $169,163.00 are ICT equipment for staffs. Offshore procurement represents a total value of $1,043,347.08 (38%) and local procurement represents a total value of $1,687,573.26 (62%). 7

DRC EBOLA SITUATION REPORT 29 October 2018 During the reporting period, 37 drums of 45kg calcium hypochlorite, 152 clinic thermometers, 994 tap, plastic and accessories, 76 chlorine pool tester, and 84 20 liters plastic buckets have been deployed from Goma city to Beni city. Human Resources As of 29 October, 62 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri provinces. In addition, UNICEF is reviewing the HR strategy for a sustained response to the epidemic. External Communication The CO focused its digital communication on Ebola prevention measures, especially the importance of handwashing. Communication activities included “A teacher involved in handwashing in Beni” and “Returning to school despite the Ebola epidemic”. The CO also published a blogpost “A nutritionist in the Ebola Treatment Centre”. Since the beginning of the outbreak, CO published in total 37 articles on its blog www.ponabana.com, as well as 36 Facebook posts, 25 Instagram posts and more than 228 tweets. Funding Based on the Joint Response plan of the Ministry of Health and partners, the total funding required for the response is estimated at USD 105 million (i.e. USD 43.8 million for August to October 2018; and USD 61.3 Million for November 2018 to January 2019). As part of the joint response plan, UNICEF response strategy focused on Communication, WASH and Psycho- social care, nutrition and cross-cutting education sector response is estimated at US$21.8 Million. At present, the UNICEF response has a funding shortfall of USD 12.7 Million.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018) Funds available Funding gap Requirements* Appeal Sector Funds Received $ $ % Current Year** Water, Hygiene and Sanitation - WASH / IPC 10,536,519 2,962,719 7,573,800 72%

Communication for Development (C4D) - Community 6,097,005 3,333,405 2,763,600 45% engagement and Communication for Campaigns

Child protection and Psychosocial Support 1,851,200 648,800 1,202,400 65% Medical Care : Management of Severe Acute 749,800 749,800 0 0% Malnutrition in Ebola Treatment Center

Operations support, Security and Coordination costs 2,273,680 1,404,175 869,505 38% and Information and Communications Technology

Preparedness Plan 322,000 0 322,000 100% Total 21,830,204 9,098,899 12,731,305 58%

* Funding requirement includes budget for phase I ($ 8,798,899) and budget for phase II ($ 13,031,305) **Funds available include reprogrammed funds from Equateur Response

Next Sitrep: November 5, 2018

Who to contact Gianfranco Rotigliano Tajudeen Oyewale Pierre Bry for further Representative a.i. Deputy Representative Chief Field Operations UNICEF DRC UNICEF DRC 8 UNICEF DRC information: Tel: + (243) 996 050 399 Tel : +(243) 996 050 200 Tel: + (243) 817 045 473 E-mail: [email protected] E-mail : [email protected] E-mail: [email protected]

DRC EBOLA SITUATION REPORT 29 October 2018

Ebola Response Tracking Indicators (29 October 2018) Change since last Target Total results report ▲▼

RESPONSE COORDINATION # of affected localities with functioning partner coordination mechanism 5 5 0 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, 11,200 8,472 377 religious /traditional leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on Ebola response and 7,800 5,354 214 participatory community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church 8,200,000 5,184,907 310,000 meetings, schools, adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious misperception about Ebola, refusals to secure burials or resistance to 620 511 37 vaccination. # of listed eligible people for ring vaccination informed of the benefits of the 22,005† 20,849 3876 vaccine and convinced to receive the vaccine within required protocols.

% of respondents who know at least 3 ways to prevent Ebola infection in the 80% 83% 83% affected communities (from Rapid KAP studies) WATER, SANITATION & HYGIENE # of health facilities in affected health zones provided with essential WASH services. 324+ 324 84

# of target schools in high risk areas provided with handwashing facilities 600 414 14 # of community sites (port, market places, local restaurant, churches) with hand 900 786 16 washing facilities in the affected areas # of people with access to safe water source in the affected areas 952,946 813,623 15,473 EDUCATION # of students reached with Ebola prevention information in schools 297,000 77,558 5,500

# of teachers briefed on Ebola prevention information in schools 7,200 3,757 110

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of affected families with confirmed, suspects, probable cases who received one or 296* 296 26 several kits of assistance to support their children # of affected families, including children, with confirmed, suspects and probable 296* 296 26 cases who received continuous psycho-social support in their community # of contact family members, including children, who receive psycho-social support 5,991** 5,503 587 and/or material assistance # of unaccompanied children and orphans* identified who received appropriate 300 211 7 care and psycho-social support NUTRITION # of < 23 months children caregivers who received appropriate counseling on IYCF 9,756 1,197 215 in emergency † The target is dynamic as listing of eligible persons is defined +The target changes with changes in the epidemiology

*The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures ** The target is dynamic and 100% of listed contacts is the identified target

DRC EBOLA SITUATION REPORT 5 November 2018

Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

Photo Credit: Thomas Nybo

5 November 2018 SITUATION IN NUMBER SITUATION IN NUMBER Highlights 305 total reported cases (MoH, 5 November 2018)

 A new Ebola case has been confirmed in Vuhovi Health Zone, North Kivu Province 270 confirmed cases (MoH, 5 November 2018)

 UNICEF and WHO have developed a joint strategy for Infection deaths recorded Prevention and Control with a focus on increasing coverage of 189 (MoH, 5 November 2018) health facilities (public and private) with health workers training and WASH facility installation 5,165 contacts under surveillance (MoH, 5 November 2018)  A radio communication survey conducted by UNICEF in Butembo

town revealed that 87% of participants responded that listening UNICEF Ebola Response Appeal to local radio stations has positively changed their behaviour towards Ebola US$ 21.8M

UNICEF’s Response

Target Result

# of at-risk people reached through community engagement and Ebola Response Funding interpersonal communication approaches. (door-to-door, church 8,200,000 5,619,907 Status 2018 meetings, small-group training sessions, school classes, briefings with leaders and journalists, other) # of listed eligible people for ring vaccination informed of the benefits of the vaccine and convinced to receive the vaccine 28,107† 26,463 within required protocols. Total # of people with access to safe water in the affected health 952,946 844,637 Ebola NK and Ituri funding zones Total Funding available* # of teachers briefed on Ebola prevention information 7,200 3,929 40% Funding requirements* : $ 21,830,204 # of affected families with confirmed, suspects, probable cases Gap who received one or several kits of assistance to support their 355* 355 60% children † The target is dynamic as listing of eligible persons is defined *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures

* Funding requirement includes budget for phase I ($ 8,798,899) and budget for phase II ($ 13,031,305)

DRC EBOLA SITUATION REPORT 5 November 2018

Epidemiological Overview Summary Table (05.11.18): Province Health Zone Confirmed and Probable Cases Total Deaths Suspect Cases under Recorded investigation Confirmed Probable Total Mabalako 73 21 94 68 4 Beni 141 8 149 92 31 Oicha 2 1 3 1 0 Butembo 32 2 34 19 15 Nord-Kivu Musienene 0 1 1 1 0 Masereka 4 0 4 1 4 Kalunguta 5 0 5 1 2 Vuhovi 1 0 1 1 0 Goma 0 0 0 0 0 Ituri Mandima 9 2 11 3 3 Komanda 1 0 1 0 0 Tchomia 2 0 2 2 1 TOTAL 270 35 305 189 60 Previous Total 28 October 2018 239 35 274 174 32

Humanitarian leadership and coordination

DRC EBOLA SITUATION REPORT 5 November 2018 Beni and Butembo health zones are the most concerning areas for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused around five coordination hubs based in Beni, Butembo, Tchomia, and Mabalako Health Zone. And one sub- coordination hub is operational in Bunia city.

The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases in Makeke, Mandima Health zone, Oicha Health Zone, Butembo, Masereka, and Tchomia Health Zone. UNICEF coordinates Makeke’s Ebola response from the coordination team based in Mangina Health Area and the coordination response for Oicha Health Zone. A coordination hub is put in place in Butembo Health Zone, which will also support the response in Masereka Health Zone. Due to the security access in Oicha and Masereka Health Zone, UNICEF works through local partners to implement its activities.

 Risk communication, social mobilization and community engagement with the aim to (1) proactively engage with affected and at risk communities, (2) provide timely and accurate health advice to encourage positive health seeking behaviors and (3) address community concerns and rumors. The strategy is implemented through 5 pillars that include (i) community engagement; (ii) promotion of preventive behaviors; (iii) responding to resistance; (iv) advocacy and capacity building of actors and (v) communication in support of ring vaccination.  The WASH strategy, as part of the Infection Prevention and Control (IPC), aims to stop the spread of the disease through the availability of 1) WASH in health care facilities, which includes providing water and WASH kits, 2) hygiene promotion and the provision of WASH kits in schools, including handwashing station and soap/temperature check points, and 3) WASH in communities, through mass outreach on hygiene promotion to vulnerable communities and the setup of handwashing stations/temperature control in strategic transit locations.  The child protection and psycho-social support to EVD survivors and family members of EVD cases as well as contact families seeks to (1) provide psycho-social support; (2) establish or re-establish social and community networks and support systems; (3) provide social kits to EVD affected families (4) identify and provide appropriate care to orphans and unaccompanied children due to the Ebola epidemic. The key element of the strategy includes (i) psychosocial support activities for children and their families; (ii) material assistance to affected families to better support children; (iii) facilitation of professions help to children and families with more severe psychological or social problems / needs; (iv) coordinate mental health and psychosocial support (MHPSS); (vi) psycho-social assistance, appropriate care and research of long-term solution to orphans and unaccompanied children.  The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases to the six health zones affected by Ebola or in situation of nutritional alert in North Kivu province. In addition, address young child and infant feeding practice that is impacted by the increasing number of women affected by the Ebola epidemic  The cross-cutting education sector strategy involve key EVD prevention measures on the school premises, include: (i) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas (ii) training of educational actors (students, teachers, inspectors, school administration agents, head of educational provinces) on Ebola including WASH in school, psychosocial support and against discrimination, (iii) provision of infrared thermometers and handwashing facilities, clean water, soap, and capacity reinforcement on

DRC EBOLA SITUATION REPORT 5 November 2018 hygiene behaviours in schools (iv) provision of specific documentation and protocol for prevention, guidance and management of suspected cases in school1 (vi) provide key messages on Ebola prevention to families.

Summary Analysis of Programme Response

Overview of the key elements in the response, with a special emphasis on UNICEF’s response in the affected health zones, is detailed below. Communication and social mobilization (C4D) Five dedicated C4D teams in Kinshasa, Beni, Mangina, Butembo and Bunia are actively involved in the response based on daily adjusted communication planning guided by the social anthropological data and the following epidemiological trends. Community Engagement As part of the entire Ebola response, 8,970 (80% coverage) members of influential leaders have been reached through advocacy, community engagement, and interpersonal activities, reaching 498 leaders during the reporting period. In addition, 401 frontline workers (RECOs) were mobilized in the affected zones on the Ebola response and participatory community engagement, reaching 5755 (74% coverage) RECOs since the beginning of the response.

Communication highlights in Beni city include:  15 senior pastors, 33 influential women and 17 members of the Youth Parliament were accompanied to visit an Ebola Treatment Center. They were given a chance to openly express their concerns related to safe and dignified burials, and see for themselves body-bags and discuss how they can see the body prior to burial.  In Malepe neighborhood, a workshop for 135 youth was organized to initiate a dialogue on Safe and Dignified Burials (SDB) and Ebola Treatment Centers. They were strongly influenced by other resistant groups claiming that the deceased body is not in the bag, and that we are not telling the truth concerning Treatment Centers. After responding to their concerns for over 2 hours, the group were finally happy with the responses and joined the response efforts.  In the Butsili neighborhood, Beni health zone, another resistant youth group agreed to participate in a dialogue organized by the communication commission. Present were 110 youth, who viewed 2 Films, flyers were distributed, and they heard a touching testimony from an Ebola survivor who came to speak to them. Despite initial resistance to the facts around Ebola Treatment Centers, the two leaders of the group acknowledged that their concerns were responded to, and that they will fully cooperate with the response teams.  A resistant youth group from Beni’s Benegule neighborhood tried to stop a vaccination team from setting up their equipment in their nearby neighborhood center. To cooperate, they placed a condition that they too will be allowed to receive the Ebola preventive vaccine. Community leaders and a communication team were called to help discuss and sensitize the youth on vaccination protocols and provide answers to their concerns related to vaccination and the Ebola outbreak. One hour later, they agreed to allow the vaccination team to continue their work.  11,343 church members were further sensitized on Ebola prevention, ETC and SDBs in 21 churches.  Targeting women associations in Beni, 4,130 influential women were sensitized and given an opportunity to have their voices heard.  A concert was organized by the Barca Football fan club, where they used testimonies from survivors as their key strategy to promote ETCs, SDBs and the importance for early testing and treatment.  160 community leaders from 28 communities in Beni signed their declaration and engagement to fight Ebola in their respective communities.

1 Ebola concept note for Ebola prevention in schools was approved and will be presented to the national committee this week. 4

DRC EBOLA SITUATION REPORT 5 November 2018  The communications team accompanied 2 survivors and 21 negative Ebola cases back to their households. This was very effective to encourage acceptance of their return without rejection, fear or stigmatization.

Responding to Rumors and Resistance The response has seen a significant impact following the integration of C4D expertise into the surveillance teams. Personalized visits were jointly conducted with the surveillance team to persuade six contacts in Beneguli and seven family contacts in Rwangoma, Beni health zone, who refused to go to Ebola Treatment Centres (ETC) to seek treatment. Upon meeting with the contacts and discussing the risk of not getting tested, the six contacts finally agreed and went to the ETC the same day, sending a positive message to their neighbors. Furthermore, in Mandradele, a probable case ran away as the surveillance team approached. With immediate cooperation from the family, the C4D and Surveillance team were able to quickly find him and convinced him to go to the Ebola Treatment Units (ETUs) for testing. During the reporting period, 47 households received personalized visits to address misperceptions on Ebola vaccination, treatment, and SDBs, reaching a total of 558 (90% coverage) households since the beginning of the response. A radio communication survey conducted in the city of Butembo among 435 households. Butembo is a city of over 1.2 million inhabitants, and has 27 local radio stations, which are all engaged in the fight against Ebola. Each radio station has agreed to broadcast over 20 Ebola messages each day, including coverage of activites in the field and testimonials of Ebola survivors and of participants in the response. Some results of the radio communication survey in Butembo include:

 94% respondents actively listened to local radio stations. 68% respondents listened to the radio 1-3 days per day. Action: Radio plays a key factor in the Ebola response, we need to further reinforce their capacities and promote more interactive radio programing to gain more listeners and trust in the response teams.  64% respondents listened to the radio from 5-7 a.m., and from 7-11 p.m. Action: Continue to focus radio programing during these favorite time slots.  65% respondents listened to radio with family members. Action: Produce family-centered radio programs, and promoting a more collective approach to engagement.  16% respondents said social media is their preferred source for information on Ebola. Action: Further include social media programing in the response. An Ebola App ‘Epuka Ebola’, (in Swahili, ‘Avoid Ebola’) is being launched targeting the youth groups.  87% respondents said listening to local radio has positively changed their behavior towards Ebola. Action: Continue to promote individual positive behavior change communications through peer-to-peer testimonials. Through mass communication approaches, 5,619,907 (69% coverage) at risk persons were reached on Ebola prevention messages, seeking treatment, and SBDs, reaching 435,000 persons during the reporting period. However, certain challenges remain as field communication teams revealed an increasing trend of people hiding when they show signs and symptoms of Ebola, which is mainly due to the fear of being poorly treated at the Ebola Treatment Centres. The loss of credibility by ETCs through false negatives during Ebola testing further reinforced the trend of treatment seeking at private and informal health care levels. In the neighborhood of Buthili, religious leaders informed the communications team of a specific traditional doctor who was claiming to have a ‘magic ring’ to heal people with Ebola. The Ebola team has organized a meeting with the traditional doctor to discuss Ebola prevention mechanisms.

C4D Preparedness An agreement with civil society groups was signed to cover preparedness activities in Goma city and Maniema province. Activities include Ebola awareness for all leaders in the communities and the broadcasting of radio programs in local languages. UNICEF partners, Search for Common Ground and Caritas, are also preparing to provide preparedness activities in the provinces of South Kivu, Haut Katanga, Tchopo, Ituri, and Tanganyika.

DRC EBOLA SITUATION REPORT 5 November 2018 Water, Hygiene and Sanitation (WASH) UNICEF and World Health Organisation (WHO) are collaborating to develop a strategy aiming to ensure the continuous supervision of activities in health structures and to provide a high quality services to break nosocomial infection transmission. As of November 4, a total of 835 (93% coverage) community sites (ports, market places, local restaurants, churches) out of the targeted 900 were provided with handwashing facilities for Ebola infection control in Beni, Mandima, Mabalako, Butembo and Tchomia Health zones in partnership with Oxfam, Programme de Promotion des Soins de Sante Primaire (PPSSP), NGO MEDAIR, Action Contre la Faim (ACF) and Centre de Promotion Socio-Sanitaire (CEPROSSAN). Since the beginning of the response, a total of 844,637 (89% coverage) persons have gained access to safe water in the affected health zones, out of the targeted 952,946. Since the beginning of the response, 362 (100% coverage) health facilities have been provided with essential WASH services, reaching 38 facilities during the reporting period.

Key activities in the last seven days:  In collaboration with WHO and World Food Programme (WFP), UNICEF finalized the distribution of WASH/IPC kits in 37 Formation Sanitaire (FOSA) located in areas who have reported high number of cases

 In Beni health zone, UNICEF is working with the REGIDESO to construct two waterpoints in the vicinity of the new Ebola Treatment Centers (ETCs) in order to provide access to safe water to local communities. Furthermore, 16 new chlorination points in Beni health zone have been set-up to provide safe water to communities who do not have access to REGIDESO infrastructures.  In partnership with MercyCorps, UNICEF is constructing ten emergency latrines and ten showers at the Regional General Hospital in Beni Health Zone. As a temporary solution, UNICEF is also providing water to the ETC through water trucking.

 In partnership with NGO ACF and MUZAKA, UNICEF continues to implement WASH activities, with a focus on the sustainability of infrastructures developed during the response in Tchomia health zone.

 In Bukavu, Goma and Bunia, UNICEF is collaborating and coordinating with partners for the development of a preparedness plan and contingency supplies in health facilities, schools and communities.

Education UNICEF has mapped 2,476 schools2 according to their proximity to confirmed cases to strengthen Ebola prevention measures. In Ituri and North Kivu province, 340 schools were identified around the EVD epicenter with substantial risk, 650 schools with medium risk and 1,486 with less significant risk. In collaboration with the Ministry of Education, UNICEF set up a monitoring mechanism covering the 6 Sub Educational Provinces in North Kivu to help monitor confirmed cases near schools. A communication system is currently being developed to facilitate communication and discussions. During the reporting period, UNICEF supported the briefing of 172 teachers from 16 schools in Butembo health zone. Follow- up on the use of handwashing kits was conducted in 7 schools in Luotu and Lubero and their students benefited from hand washing briefing. In addition, 35 handwashing kits were distributed in Masereka Health Zone, reaching a total of 419 (70% coverage) schools in all affected areas since the beginning of the response. Since the beginning of the response, 3,929 (55% coverage) teachers and 77,558 (26% coverage) students were briefed with Ebola prevention messages.

2 From preschool to secondary schools, including vocation centers 6

DRC EBOLA SITUATION REPORT 5 November 2018 Despite the closure of schools in areas affected by high insecurities, UNICEF remains active in supporting schools, while ensuring an active surveillance in case of school reopening. UNICEF aims to cover the identified 900 schools mapped as high and medium risk with handwashing facilities, thermo-flashes, and educational and communication media on the EVD prevention. Finally, the DRC protocol of EVD prevention in schools has been validated and the protocol will presented to the national commission of crisis.

Psychosocial and Child Protection During the reporting period, 47 children (7 confirmed, 40 suspects cases) went through Ebola Treatment Centers and received an individual psychological assistance. Among them, 37 children (4 confirmed, 33 suspects cases) were in the ETC of Beni. A nursery was opened in the ETC of Beni. Three cured persons were assigned the responsibility to provide care for the children, whose parents are at the ETC. They are trained and supervised by a psychosocial agent. One newborn and two babies under 10 months are currently in this nursery (suspect cases). In Mangina, one cured youth (18 years old) received school support through catch up classes. 59 new families affected by EVD received psychosocial support and/or material assistance in seven health zones in North Kivu Province and three health zones in Ituri Province. 67 hygiene kits and 51 food assistance have been distributed to discharged and cured patients, 11 families received funeral kits, 11 families received newborn kit and 32 families received NFI kits. 82 families affected by EVD (previously identified) received a continuous psychosocial support through regular visits of psychosocial agents in their communities. The psychosocial commission was closely associated with the surveillance commission to provide psychosocial support to 35 suspected cases (15 of which were confirmed) in order to encourage them to join the Ebola Treatments Centers. The psychosocial commission has also prepared 4 families to accept the decontamination of their homes. 19 new orphans and 40 new separated children due to the Ebola epidemic has been identified and received appropriate care, reaching a total of 267 out of the targeted 300. The high number of separated children is linked to the increase of suspect and confirmed cases in the ETCs of Beni and Butembo. 13 children received a school support, 5 were supported with NFI kits and 8 received food assistance. 92 orphans and separated children, previously identified, received a follow up visits by psychosocial agents. A total of 587 contacts families; 340 in Beni, 55 in Tchomia, 84 in Mangina and 108 in Butembo, received a psycho-social support, reaching a total of 5133 out of the targeted 5813.

Nutrition During the reporting period, 263 children caretakers, including pregnant and lactating women, were sensitized on key Infant and Young Child Feeding practices in emergencies (IYCF-E) by three nutritionists in Mangina, Beni and Butembo ETCs, reaching a total of 1,460 (15% coverage) persons since the beginning of the response. Through implementing partners Danish Refugee Council (DRC) and the National Nutrition Programme (PRONANUT), UNICEF provided nutrition and infant food support to 11 separated/orphans under 6 months, of which two new cases were identified this during the reporting period. Nutritionists and psychosocial agents continuously provide support to these separated/orphaned children. Through UNICEF’s technical and financial support, 97 hospitalized Ebola Virus Disease (EVD) patients received nutritional care during the reporting period. Furthermore, with UNICEF's advocacy efforts in Beni health zone, nutrition indicators were successfully included in daily reports developed by the EVD management care committee.

DRC EBOLA SITUATION REPORT 5 November 2018 Supply & Logistics Since the beginning of the response, $2,780,600.34 worth of items composed of WASH, C4D, Child Protection, Health, Education and finally ICT supplies have been procured for the Ebola response in Ituri and North Kivu province. Out of the total value of items, $ 163,983.00 are ICT equipment for staffs. Offshore procurement represents a total value of $ 1,035,007.08 (37%) and local procurement represents a total value of $1,745,593.26 (63%). UNICEF is processing supply orders worth $ 233.546.75, composed by Wash items (stand, sprayer, coat, calcium hypochlorite, plastics, etc).

Human Resources As of 5 November, 72 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri provinces. Through the network of implementing partners mobilized by UNCIEF for the response, a total of 389 personnel are currently deployed in the affected areas supporting the response.

External Communication The CO issued two press releases in October highlighting the importance of washing hands to stop the spread of the disease and on the status of education in Ebola affected areas. Media coverage included Voice of America, VOA News, Europa Press, UN News, Forbes,Digital Congo and Radio Okapi. New video material and photo material on UNICEF’s response has been regularly posted on WeShare. CO published in 13 articles on its blog https://ponabana.com/ in October 2018, as well as 22 Facebook posts, 7 pictures on Instagram and almost 100 tweets.

Funding Based on the Joint Response plan of the Ministry of Health and partners, the total funding required for the response is estimated at USD 105 million (i.e. USD 43.8 million for August to October 2018; and USD 61.3 Million for November 2018 to January 2019). As part of the joint response plan, UNICEF response strategy focused on Communication, WASH and Psycho- social care, nutrition and cross-cutting education sector response is estimated at US$21.8 Million. At present, the UNICEF response has a funding shortfall of USD 12.03 Million.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018) Funds available Funding gap Requirements* Appeal Sector Funds Received Current $ $ % Year** Water, Hygiene and Sanitation - WASH / IPC 10,536,519 2,962,719 7,573,800 72% Communication for Development (C4D) - Community engagement and Communication 6,097,005 3,333,405 2,763,600 45% for Campaigns

DRC EBOLA SITUATION REPORT 5 November 2018 Child protection and Psychosocial Support 1,851,200 648,800 1,202,400 65% Medical Care : Management of Severe Acute 749,800 549,800 200,000 27% Malnutrition in Ebola Treatment Center Operations support, Security and Coordination costs and Information and Communications 2,273,680 1,304,175 969,505 43% Technology Preparedness Plan 322,000 0 322,000 100% Total 21,830,204 8,798,899 13,031,305 60%

* Funding requirement includes budget for phase I ($ 8,798,899) and budget for phase II ($ 13,031,305) **Funds available include reprogrammed funds from Equateur Response

Next Sitrep: November 12, 2018

DRC EBOLA SITUATION REPORT 5 November 2018

Ebola Response Tracking Indicators (5 November 2018) Change since last Target Total results report ▲▼

RESPONSE COORDINATION # of affected localities with functioning partner coordination mechanism 5 5 0 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, 11,200 8,970 498 religious /traditional leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on Ebola response and 7,800 5,755 401 participatory community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church 8,200,000 5,619,907 435,000 meetings, schools, adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious misperception about Ebola, refusals to secure burials or resistance to 620 558 47 vaccination. # of listed eligible people for ring vaccination informed of the benefits of the 28,107† 26,463 5,614 vaccine and convinced to receive the vaccine within required protocols.

% of respondents who know at least 3 ways to prevent Ebola infection in the 80% 83% 0 affected communities (from Rapid KAP studies) WATER, SANITATION & HYGIENE # of health facilities in affected health zones provided with essential WASH services. 362+ 362 38

# of target schools in high risk areas provided with handwashing facilities 600 419 5 # of community sites (port, market places, local restaurant, churches) with hand 900 835 49 washing facilities in the affected areas # of people with access to safe water source in the affected areas 952,946 844,637 31,014 EDUCATION # of students reached with Ebola prevention information in schools 297,000 77,558 0

# of teachers briefed on Ebola prevention information in schools 7,200 3,929 172

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of affected families with confirmed, suspects, probable cases who received one or 355* 355 59 several kits of assistance to support their children # of affected families, including children, with confirmed, suspects and probable 355* 355 59 cases who received continuous psycho-social support in their community # of contact family members, including children, who receive psycho-social support 5,110** 4,701*** 0 and/or material assistance # of unaccompanied children and orphans* identified who received appropriate 300 267 56 care and psycho-social support NUTRITION # of < 23 months children caregivers who received appropriate counseling on IYCF 9,756 1,460 263 in emergency † The target is dynamic as listing of eligible persons is deﬁned +The target changes with changes in the epidemiology *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures ** The target is dynamic and 100% of listed contacts is the identified target *** Number of contact is on the decline as response proceeds

DRC EBOLA SITUATION REPORT 12 November 2018 Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

Photo Credit: Mark Naftalin

12 November 2018 SITUATION IN NUMBERS

Highlights 340 total reported cases (MoH, 12 November 2018)  12 November, WHO’s Director General Dr. Tedros, head of emergencies Dr. Salama, and head of emergencies in WHO confirmed cases Regional Office for Africa Dr. Soce Fall, visited DRC to meet with the 302 (MoH, 12 November 2018) teams in Beni and with government officials and partners. They were accompanied by the head of the UN Peacekeeping mission 212 deaths recorded USG Jean-Pierre Lacroix. Their mission was to assess what further (MoH, 12 November 2018) support is needed and to recognize the hard work of teams on the ground. They also met with the Prime Minister, the Minister of 4,613 contacts under surveillance (MoH, Health and other government officials. 12 November 2018)  A budget for a broader humanitarian action in the Ebola affected areas is currently being developed that includes education, child UNICEF Ebola Response Appeal protection, essential household items, nutrition and the use of unconditional cash grants. US$ 21.8M

Ebola Response Funding Status 2018

[] Ebola NK and 40% Ituri Total Funding [] requirements* : 60% $ 21,830,204

* Funding requirement includes budget for phase I ($ 8,798,899) and budget for phase II ($ 13,031,305)

DRC EBOLA SITUATION REPORT 12 November 2018

Epidemiological Overview1 Summary Table (12.11.18):

Confirmed and Probable Cases Total Deaths Suspect Cases under Province Health Zone Recorded investigation Confirmed Probable Total Beni 153 9 162 3 Butembo 10 3 13 30 Kalanguta 23 5 28 0 Kyondo 2 2 4 2 Mabalako 67 14 81 0 Nord-Kivu Masereka 6 1 7 3 Musienene 2 1 3 0 Mutwanga 1 0 1 0 Oicha 2 0 2 0 Katwa 14 0 14 0 Vuhovi 2 0 2 0 Ituri Komanda 1 0 1 3 Mandima 16 3 19 0 Tchomia 2 0 2 0 TOTAL 302 38 340 212 43 Previous Total 5 November 2018 270 35 305 189 60

1 Data source: Epidemiological table based on daily CNC numbers 2

DRC EBOLA SITUATION REPORT 12 November 2018 Humanitarian leadership and coordination

Beni and Butembo health zones are the most concerning areas for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities cover communication and prevention, WASH, and psychosocial care around five coordination hubs based in Beni, Butembo, Tchomia, and Mabalako Health Zone and one sub- coordination hub in Bunia city.

The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases and the geographical extension of the epidemic to newly affected health zones. UNICEF coordinates Musienene, Katwa, Masereka, Vuhovi, Kalanguta, and Kyondo’s response from the sub-coordination group based in Butembo health zone. Response Strategy In support of the joint response plan, the UNICEF response strategy will continue to focus on communication, WASH, and psychosocial care, nutrition and a cross-cutting education response.  Risk communication, social mobilization and community engagement with the aim to (1) proactively engage with affected and at-risk communities, (2) provide timely and accurate health advice to encourage positive health seeking behaviors and (3) address community concerns and rumors. The strategy is implemented through 5 pillars that include (i) community engagement; (ii) promotion of preventive behaviors; (iii) responding to resistance; (iv) advocacy and capacity building of actors and (v) communication in support of ring vaccination, surveillance, safe and dignified burials, and Ebola treatment centers  The WASH strategy, as part of the Infection Prevention and Control (IPC), aims to stop the spread of the disease through the availability of 1) WASH in public and private health care facilities, as well as reinforcement of basic WASH services and awareness with traditional practitioners, which includes providing water and WASH kits, 2) hygiene promotion and the provision of WASH kits in schools, including handwashing station and soap/temperature check points, and 3) WASH in communities through mass outreach on hygiene promotion to vulnerable communities and the setup of handwashing stations/temperature control in strategic transit locations 4) joint supervision of health infrastructures to ensure quality and efficient sustainability of programs developed  The child protection and psycho-social support to EVD confirmed and suspect cases and their family members as well as contact families seeks to (1) provide psycho-social support; (2) establish or re-establish social and community networks and support systems; (3) provide social kits to EVD affected families (4) identify and provide appropriate care to orphans and unaccompanied children due to the Ebola epidemic. The key element of the strategy includes (i) psychosocial support for EVD confirm and suspect cases, including children, in the ETCs, psychosocial activities for children and their families; (ii) material assistance to affected families to better support children; (iii) facilitation of professions help to children and families with more severe psychological or social problems / needs; (iv) coordinate mental health and psychosocial support (MHPSS); (vi) psycho-social assistance, appropriate care and research of long-term solution to orphans and unaccompanied children.  The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases to the six health zones affected by Ebola or in situation of nutritional alert in North Kivu province. In addition, address young child and infant feeding practice that is impacted by the increasing number of women affected by the Ebola epidemic

DRC EBOLA SITUATION REPORT 12 November 2018  The education sector strategy involve key EVD prevention measures on the school premises, include: (i) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas (ii) training of educational actors (students, teachers, inspectors, school administration agents, head of educational provinces, parents’ association) on Ebola prevention in schools including WASH in school, psychosocial support in classrooms and against discrimination, (iii) provision of infrared thermometers and handwashing kits in school clean water, soap, and capacity reinforcement on hygiene behaviors in schools, (iv) provision of school cabins for school entry checking (v) provision of specific documentation and protocol for prevention, guidance and management of suspected cases in school (vi) provision of key messages on Ebola prevention to families.(vii) close monitoring of effective use and implementation of the protocol of prevention of EVD in schools

Summary Analysis of Programme Response

Overview of the key elements in the response, with a special emphasis on UNICEF’s response in the affected health zones, is detailed below.

Communication and social mobilization (C4D) Extending and reorganizing the communication team in Butembo was the week’s focus, in response to the geographical spread of the Ebola epidemic to the five neighboring Health Zones. The communication commission teams needed to quickly scale up their capacities and efficiency in implementing as activities through the hiring and training of local experts. During the reporting period, 103 additional local coordinators and social mobilizers were hired and enrolled to integrate the new field response teams (surveillance, vaccination, safe and dignified burials, infection prevention and control). In addition, a stronger emphasis and re-focus was placed on data management, documentation, and the use of a more empathetic approach to reinforce community dialogue. Community mobilization In Beni health zone, 553 alerts coming from 150 community chiefs through the community telephone alert system, were documented. In addition, open visiting hours and tours of ETCs are scheduled every Wednesday and Saturday for local community members, of which 276 leaders and influencers visited the centers this week. It is acknowledged that these visits continue to play a major role in communities accepting ETCs services when people show Ebola symptoms. During the reporting period, 394,647 (73% coverage) at risk population were reached through community engagement and interpersonal communications, of which over 39,000 church goers in 181 churches received messages concerning SDBs and the credibility of Ebola Treatment Units (ETUs). In addition, 21 additional radio stations were engaged in spreading Ebola prevention messages in the affected health zones of Kayina, Ubero, Vuhovi and Alimongo. During the reporting period, 1,073 influential leaders were reached through advocacy. 12 local influencers joined the Butembo communications commission, 91 local social mobilizers were recruited to supervise activities in Beni and Butembo health zones, and 311 youth leaders were trained and engaged in the fight against Ebola. Furthermore, 319 frontline workers (RECOs) were mobilized for the Ebola response, reaching 6,074 (78% coverage) RECOs since the beginning of the response. During the reporting period, 59 households received personalized house to address reluctance to vaccination, immediate referrals to treatment centers, or refusal to respect secure and dignified burial protocol, reaching a total of 617 transformed households since the beginning of the response. In the area of Ebola preparedness to the neighboring provinces of North Kivu, a compilation of 22 radio programs, 7 songs, and 166 testimonials was packaged and shared with partner NGOs working in Sud Kivu, Tchopo, Maniema and Tanganika. UNICEF’s C4D survey team began the preparations to conduct the first KAP survey in Ituri province, with other neighboring provinces soon to follow.

DRC EBOLA SITUATION REPORT 12 November 2018 Water, Hygiene and Sanitation (WASH) During the reporting period, the intervention strategy for the WASH/IPC Commission was revised to better respond, monitor, and follow-up WASH/IPC activities in health centers. The revised strategy was validated by the commission and the implementation is ongoing. UNICEF as co-lead of the WASH/IPC commission has committed to support the monitoring of Health Centers by providing qualified staff and its partners to be part of the monitoring teams. The teams will conduct bi-weekly follow-ups in the health centers evaluating the quality of service based on a pre-defined list of indicators agreed by the Prevention Commission and partners. In order to improve the quality of services provided and eliminate infections in Health Centers, a performance- based financing/payment system will be put in place as part of the revised strategy. Payment will be based on the scoring result of each IPC/WASH indicator. Follow-up will be done every two weeks, and payments increase as scores improve. As of 11 November, four additional health facilities in the affected health zones in North Kivu province benefitted from essential WASH activities; these include the provision of handwashing points, briefing of staff on hygiene promotion, and disinfection, and the installation of chlorination points, reaching a total of 366 (100% coverage health facilities since the beginning of the response. Periodic follow-ups by respective partners in the health centers assures that all aspects of WASH package (handwashing, availability of chlorine) remain functional. This week, UNICEF continued with the Community Engagement interventions in Beni, Butembo, Mangina and Tchomia health zones. The activities included training of staff in Health Centers on WASH/IPC and community briefings on Ebola Virus Disease (EVD). As of 11 November, 866 (96% coverage) community sites (ports, market places, local restaurants, churches) out of the targeted 900 were provided with handwashing facilities for Ebola infection control in Beni, Mandima, Mabalako, Butembo and Tchomia health zones in partnership with Oxfam, Programme de Promotion des Soins de Sante Primaire (PPSSP), and Centre de Promotion Socio-Sanitaire (CEPROSSAN). Private and public health posts are directly targeted by the current strategy, whereas traditional practitioners’ engagement will be reinforced under the new prevention approach. Since the beginning of the response, a total of 856,432 (90% coverage) persons have gained access to safe water in the affected health zones, out of the targeted 952,946. Key activities in the last seven days:

 As of 11 November, 11,795 people benefited from drinking water treated through functional chlorination points, in Beni, Tchomia and Butembo health zones.  In Tchomia health zone this week, UNICEF completed the follow up and distribution of 22,320 liters of chlorinated water for 46 handwashing facilities in public areas.  In Butembo health zone, 11 schools in the health areas of Luotu and Lubero considered as high-risk areas, were provided with handwashing facilities, including thermometers.

Education During the reporting period, UNICEF advocated for the reopening of schools in Beni town as well as continue the support to functioning schools against the spread of the Ebola virus. Thanks to UNICEF's advocacy in Butembo health zone, 73 schools whose classes were disrupted by unidentified youth groups, recovered their normal functioning. UNICEF supported six schools in Butembo, in Lubero and Musienene Health zones2 with handwashing kits, including thermometers, and Ebola prevention messages, benefitting 6,331 children, of which 3,407 are girls, reaching a total of 83,889 children (28% coverage) since the beginning of the response. In these six schools, UNICEF supported the briefing of 172 teachers of which 85 women

2 EP Mihake, EP Jou furu, EP Katolo, EP Ivatama, EP Kimbulu and EP Musimba 5

DRC EBOLA SITUATION REPORT 12 November 2018 on the use of handwashing facilities and thermometers and Ebola prevention messages, reaching a total of 3,929 teachers (55% coverage) since the beginning of the response. UNICEF conducted follow-up visits targeting 68 schools which already received prevention kits to ensure that prevention protocol is well understood and implemented accordingly. During these visits, refresher briefing is organized in all the targeted schools. The follow-up shows that the handwashing devices and thermometers are properly used without any resistance or misunderstanding due to the implication of the schools’ directors and education authorities during briefing activities on EVD prevention and the distribution of handwashing kits in schools. UNICEF supported the Nord Kivu II Provincial Ministry of Education in Ebola risk mapping of schools. A monitoring mechanism covering the seven3 targeted educational sub-provinces with confirmed cases is established to facilitate communication related to all EVD possible cases in schools between teachers, head of schools, inspectors, school administration agents, head of educational provinces and UNICEF. Two representatives of PROVED sit on the daily coordination of the response in Beni and Butembo to share the schools' information related to EVD with other stakeholders, including health actors. In addition, UNICEF supports the EPSP Nord Kivu II Provincial Education on the reopening of schools, training sessions targeting heads of schools, teachers and parents on Ebola including students’ enrollment and access to school, WASH in school, and psycho-social support. During the reporting period, 11 schools (72% coverage) were provided with handwashing facilities, reaching a total of 430 schools since the beginning of the response.

Psychosocial and Child Protection During the reporting period, 54 children (10 confirmed, 44 suspect cases) went through ETCs and received individual psychological assistance. Among them, 33 children (5 confirmed, 28 suspect cases) were in the ETC of Beni and 15 children (4 confirmed, 11 suspect cases) were in the ETC of Butembo. Two babies, 6 and 12 months old, survived Ebola Virus Disease (EVD). One of them is an orphan whose mother died of EVD. They received specific assistance adapted to their needs (food, Non-Food Items, hygiene and recreational kits). A psychosocial agent is also following up with them daily. Nine recreational kits were distributed to the ETC of Beni. In addition, the nursery in the ETC was equipped by UNICEF with Non-Food Items (NFIs), food, recreational kits, tents, and mosquito nets. 15 cured persons received training on psychosocial support for children, with 10 cured persons placed in the ETC and five in the nursery to take care of the children who are confirmed or suspected cases. In Butembo health zone newborn from an orphanage died in a hospital. He is suspected of having developed the EVD (his mother died after delivery and his brother is a confirmed case). The orphanage is at high risk of contamination. In addition to preventive measures such as vaccination and decontamination, the Psychosocial Commission distributed 30 NFI kits and 18 recreational kits. Continuous psychosocial support is given to the other children and contact persons of the orphanage. 146 families newly affected by EVD received psychosocial support and/or material assistance in seven health zones in North Kivu Province and three health zones in Ituri Province. The increase of affected families receiving assistance is linked to the increase of suspected cases, particularly in the ETC of Beni. 107 hygiene kits and 193 food assistance were distributed to discharged and cured patients. Eight families received funeral kits, eight8 families received newborn kits, and 14 families received NFI kits. 327 families previously identified as affected by EVD received continuous psychosocial support through regular visits of psychosocial agents in their communities. 42 new orphans and 52 new separated children due to the Ebola epidemic were identified and have received appropriate care, reaching a total of 309 children. The high number of orphans and separated children is linked to the increase of

3 Beni, Butembo1 and 2, Kyondo, Lubero 1 et 2 and Masereka 6

DRC EBOLA SITUATION REPORT 12 November 2018 suspected and confirmed cases in the ETCs of Beni and Butembo. This figure also includes the number of children assisted in the infected orphanage. 83 previously identified orphans and separated children received follow-up visits by psychosocial agents. Some orphans benefited from reinforced psychological support after losing another member of their families due to EVD. A total of 297 contact families received a psychosocial support in Beni and Butembo health zones, reaching a total of 5,430 families, 100% of targeted contact families. 25 contact persons received a follow-up visit in Tchomia health zone (contacts above 21 days). 22 psychologists and psychosocial agents (8 in Mangina, 8 in Beni and 6 in Butembo) were trained by the World Health Organization on treatments and specific psychological support for cured persons.

Nutrition During the reporting period, 272 pregnant and lactating women were sensitized by nutritionists on infant and young child feeding (IYCF) good practices, reaching a total of 1,732 (18% coverage) persons since the beginning of the response. In addition, quality nutrition care was provided to 105 patients in Ebola Treatment Centers. 13 children, including 12 children under 6 months old and 1 children between 6 and 10 months old, received adequate feeding support in line with IYCF-U guidelines. Key activities in the last seven days:  briefing of health workers and nutritionists on the revised protocol for providing nutritional care in Butembo Ebola Treatment Center;  UNICEF provided support during a feeding practices assessment conducted at Bunyika orphanage, Vuhovi Health Zone and provided recommendations to improve the quality of feeding practices;  Continuous training of nutritionists at Ebola Treatment Center.

Supply & Logistics Since the beginning of the response, $2,812,100.34 worth of items composed of WASH, C4D, Child Protection, Health, Education and ICT supplies have been procured for the Ebola response in Ituri and North Kivu province. Out of the total value of items, $ 163,983.00 are ICT equipment for staffs. Offshore procurement represents a total value of $1,035,007.08 (37%) and local procurement represents a total value of $1,777,093.26 (63%).

Human Resources As of 12 November, 72 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri provinces. Through the network of implementing partners mobilized by UNICEF for the response, a total of 389 personnel are currently deployed in the affected areas supporting the response.

External Communication The CO supported the recruitment for the DRC Government of an external communication officer, who is operating out of Beni, the epicenter of the epidemic. During the reporting period the Ebola crisis and UNICEF’s response got media coverage in Press Agency EFE, All Africa and La Vanguardia. New digital publications include Préférence, a childhood broken by Ebola. The CO published in 43 articles on its blog since the beginning of the crisis, as well as 41 Facebook posts, 27 pictures on Instagram and almost 300 tweets.

DRC EBOLA SITUATION REPORT 12 November 2018 Funding Based on the Joint Response plan of the Ministry of Health and partners, the total funding required for the response is estimated at USD 105 million. As part of the joint response plan, UNICEF response strategy focused on Communication, WASH and Psychosocial care, nutrition and cross-cutting education sector response is estimated at US$21.8 Million. At present, the UNICEF response has a funding shortfall of USD 12.03 Million. Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018)

Funds available Funding gap Requirements Appeal Sector $ Funds Received Current $ % Year Water, Hygiene and Sanitation - WASH / IPC 10,536,519 2,962,719 7,573,800 72% Communication for Development (C4D) - Community engagement and Communication 6,097,005 3,333,405 2,763,600 45% for Campaigns Child protection and Psychosocial Support 1,851,200 648,800 1,202,400 65% Medical Care : Management of Severe Acute 749,800 549,800 200,000 27% Malnutrition in Ebola Treatment Center Operations support, Security and Coordination costs and Information and Communications 2,273,680 1,304,175 969,505 43% Technology Preparedness Plan 322,000 0 322,000 100% Total 21,830,204 8,798,899 13,031,305 60%

Next Sitrep: November 19, 2018

Who to contact Gianfranco Rotigliano Tajudeen Oyewale Pierre Bry for further Representative a.i. Deputy Representative Chief Field Operations UNICEF DRC information: UNICEF DRC UNICEF DRC Tel: + (243) 996 050 399 Tel : +(243) 996 050 200 Tel: + (243) 817 045 473 E-mail: E-mail : [email protected] E-mail: [email protected]

DRC EBOLA SITUATION REPORT 12 November 2018

Ebola Response Tracking Indicators (12 November 2018)

Change since last RESPONSE COORDINATION Target Total Results report  # of affected localities with functioning partner coordination mechanism 5 5 0 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, 11,200 10,043 1073 religious /traditional leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on Ebola response and 7,800 6,074 319 participatory community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church 8,200,000 6,014,554 394,647 meetings, schools, adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious misperception about Ebola, refusals to secure burials or resistance to 620 617 59 vaccination. # of listed eligible people for ring vaccination informed of the benefits of the 29,491† 28,991 2,528 vaccine and convinced to receive the vaccine within required protocols.

# of target schools in high risk areas provided with handwashing facilities 600 430 11 # of community sites (port, market places, local restaurant, churches) with hand 900 866 31 washing facilities in the affected areas # of people with access to safe water source in the affected areas 952,946 856,432 11,795 EDUCATION # of students reached with Ebola prevention information in schools 297,000 83,889 6,331

# of teachers briefed on Ebola prevention information in schools 7,200 3,929 0

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of affected families with confirmed, suspects, probable cases who received one 383* 383 28 or several kits of assistance to support their children # of affected families, including children, with confirmed, suspects and probable 383* 383 28 cases who received continuous psycho-social support in their community # of contact family members, including children, who receive psycho-social support 4,771** 4,393*** 0 and/or material assistance # of unaccompanied children and orphans* identified who received appropriate 309+ 309 42 care and psycho-social support NUTRITION # of < 23 months children caregivers who received appropriate counseling on IYCF 9,756 1,732 272 in emergency † The target is dynamic as listing of eligible persons is defined +The target changes with changes in the epidemiology *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures ** The target is dynamic and 100% of listed contacts is the identified target *** Number of contact is on the decline as response proceeds

DRC EBOLA SITUATION REPORT 24 November 2018

Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

Photo credit: Jonathan Shaddid, UNICEF DRC 2018 24 November 2018 SITUATION IN NUMBERS Highlights 39 5 total reported cases (MoH, 23 November 2018) • 3,875 households were visited through C4D door-to-door sessions. 348 confirmed cases • 1340 persons affected by the EVD received psychosocial (MoH, 23 November 2018) support in the Ebola Treatment Centers. • A malaria prevention plan was developed to address an 184 deaths recorded increase in malaria cases, observed through the many (MoH, 23 November 2018)

fever-related cases in the Ebola-affected health zones. contacts under surveillance The strategy includes the distribution of 275,000 3,929 (MoH, 23 November 2018) insecticide treatment mosquito nets, locally adapted

radio messages on malaria prevention, and training of UNICEF Ebola Response frontline health workers on malaria prevention and Appeal treatment. It is expected that an effective response to the increase in malaria will bring about a drop in Ebola alerts US$ 21.8M and visits to health facilities and ETUs.

UNICEF’s Response

Target Result

# of at-risk people reached through community engagement and interpersonal communication approaches. (door-to-door, church meetings, small-group training sessions, school classes, briefings 11,500,000 6,375,987 with leaders and journalists, other) # of listed eligible people for ring vaccination informed of the benefits of the vaccine and convinced to receive the vaccine 35,105† 34,839 within required protocols. # of people with access to safe water in the affected health 952,946 876,200 zones # of teachers briefed on Ebola prevention information 7,200 4,257 # of affected families with confirmed, suspects, probable cases who received one or several kits of assistance to support their 451* 451 children † The target is dynamic as listing of eligible persons is defined *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures

DRC EBOLA SITUATION REPORT 24 November 2018

Epidemiological Overview1

Summary Table (23.11.18):

Confirmed and Probable Cases Total Deaths Suspect Cases under Province Health Zone Confirmed Probable Total Recorded investigation Beni 168 9 177 93 36 Butembo 11 0 11 12 4 Kalanguta 28 12 40 10 4 Kyondo 2 2 4 1 0 Mabalako 67 16 83 36 0 Nord-Kivu Masereka 6 1 7 1 0 Musienene 3 1 4 3 0 Mutwanga 2 0 2 1 1 Oicha 4 0 4 1 2 Katwa 36 3 39 14 7 Vuhovi 2 0 2 1 0 Ituri Mandima 16 3 19 9 2 Komanda 1 0 1 0 0 Tchomia 2 0 2 2 0 TOTAL 348 47 395 184 56 Previous Total 12 November 2018 302 38 340 2122 43

1 Data source: Epidemiological table based on daily CNC numbers 2 The decrease in the total number of deaths recorded is due to corrections in data following a data verification process conducted by the CNC and the WHO last week. 2

DRC EBOLA SITUATION REPORT 24 November 2018 Humanitarian leadership and coordination The Crisis Management Team continued to meet daily under the leadership of the Ministry of Health with all concerned partners and with the chairs of the different working groups providing thematic updates. UNICEF continues to participate actively in the coordination meetings at the national level and in Beni (operational headquarters) and co-leads the commissions on communication, WASH and psychosocial care. UNICEF is also and active in the working groups on logistics and vaccination. A UNICEF security specialist is also deployed in the field to support security assessment and safety of the operations. Beni and Butembo health zones are the most concerning areas for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused around five coordination hubs based in Beni, Butembo, Tchomia, and Mabalako health zones. One sub-coordination hub is operational in Bunia city. The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases and the geographical extension of the epidemic to newly affected health zones. UNICEF coordinates Musienene, Katwa, Masereka, Vuhovi, Kalanguta, and Kyondo’s response from the sub-coordination group based in Butembo health zone.

Response Strategy In support of the joint response plan, the UNICEF response strategy will continue to focus on communication, WASH, and Psycho-social care, nutrition and cross-cutting education sector response.

• Risk communication, social mobilization and community engagement with the aim to (1) proactively engage with affected and at-risk communities, (2) provide timely and accurate health advice to encourage positive health seeking behaviors, and (3) address community concerns and rumors. The strategy is implemented through 5 pillars that include (i) community engagement; (ii) promotion of preventive behaviors; (iii) responding to resistance; (iv) advocacy and capacity building of actors and (v) communication in support of ring vaccination, surveillance, safe and dignified burials, and Ebola treatment centers

• The WASH strategy, as part of the Infection Prevention and Control (IPC), aims to stop the spread of the disease through the availability of (1) WASH in public and private health care facilities, as well as reinforcement of basic WASH services and awareness with traditional practitioners, which includes providing water and WASH kits, (2) hygiene promotion and the provision of WASH kits in schools, including handwashing stations and soap/temperature check points, (3) WASH in communities through mass outreach on hygiene promotion to vulnerable communities and the setup of handwashing stations/temperature control in strategic transit locations, and (4) joint supervision of health infrastructures to ensure quality and efficient sustainability of programs are developed

• The child protection and psychosocial support to EVD confirmed and suspect cases and their family members as well as contact families seek to (1) provide psychosocial support, (2) establish or re-establish social and community networks and support systems, (3) provide social kits to EVD affected families, and (4) identify and provide appropriate care to orphans and unaccompanied children due to the Ebola epidemic. The key elements of the strategy includes (i) psychosocial support for EVD confirmed and suspect cases, including children, in the ETCs, psychosocial activities for children and their families, (ii) material assistance to affected families to better support children, (iii) the facilitation of professional help to children and families with more severe psychological or social problems/needs, (iv) the coordination mental health and psychosocial support (MHPSS), and (vi) psychosocial assistance, appropriate care, and research of long-term solutions for orphans and unaccompanied children.

• The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases in the six health zones affected by Ebola or in situations of nutritional alert in North Kivu province. In addition, it will address infant

DRC EBOLA SITUATION REPORT 24 November 2018 and young child feeding practices that are impacted by the increasing number of women affected by the Ebola epidemic

• The education sector strategy involves key EVD prevention measures on the school premises, including: (1) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas, (2) training of educational actors (students, teachers, inspectors, school administration agents, head of educational provinces, parents’ association) on Ebola prevention in schools including WASH in school, psychosocial support in classrooms, and against discrimination, (3) provision of infrared thermometers and handwashing kits in schools including clean water, soap, and capacity reinforcement on hygiene behaviors, (4) provision of school cabins for school entry checking, (5) provision of specific documentation and protocol for prevention, guidance, and management of suspected cases in school, (6) provision of key messages on Ebola prevention to families, and (7) close monitoring of the effective use and implementation of the protocol of prevention of EVD in schools

Summary Analysis of Programme Response An overview of the key elements in the response, with a special emphasis on UNICEF’s response in the affected health zones, is detailed below.

Communication and social mobilization (C4D) As an increase in Malaria cases was registered in the region, the cases of malaria-related fever further aggravated the situation through the increased number of false Ebola alerts and visits to health centers. In response, the C4D team led the efforts through the development of a malaria prevention communication strategy. The plan was adapted to the present situation in Nord Kivu and includes ways to simultaneously address Ebola and malaria. The control of malaria is expected to also contribute to a drop in Ebola alerts and visits to hospitals and ETUs, while, if not controlled, the malaria epidemic could also have an adverse effect on the Ebola response. The Malaria communications strategy includes the pairing of IPC with the distribution of 275,000 mosquito nets, realized through an ambitious door-to-door campaign by 4,700 trained social mobilizers. In addition, locally adapted radio programs are being produced to inform the population and reduce confusion between the Ebola and Malaria teams. Workshops to reinforce the capacities of frontline workers have already began, and the campaign is expected to be launched before end of the month. Community Engagement With the telephone alert system active in Butembo, 1,533 phone calls were received this week from village chiefs, representing a 95% reporting rate from those who received a mobile phone or phone credit. These reports include alerts of suspected cases, deaths, or acts of serious resistance in communities. These calls to the surveillance and communication teams resulted in the investigation of 11 alerts, 5 deaths, and 7 resistance cases, all resolved by the surveillance and communication teams. With the spread of the disease to other health areas, the communication teams continue to focus on the engagement of youth and women. Over the reporting period alone, 173 youth leaders were trained in Butembo and the surrounding health zones of Lubero, Vuhovi, and Musienene. An estimated 13,000 additional youth benefited from direct sensitization from these leaders. In addition, dialogue sessions with 627 women were completed in the same zones. Promotion of preventive behaviors 3,875 households were visited through door-to-door sessions. These visits were organized and completed by the local communication teams in the health zones of Butembo, Katwa, Masereka, and Musienene. This was an important opportunity to distribute printed materials and personally respond to concerns of families.

DRC EBOLA SITUATION REPORT 24 November 2018 Responding to Resistance and Rumors In the new high-risk health zones of Kalunguta, Vuhovi and Kyondo, 11 additional local radio stations were engaged to join the fight against Ebola. They will each begin broadcasting pre-recorded programs and testimonies from survivors, and covering positive Ebola activities and community engagement events. Over 210 cases of resistance were reported in communities, with 59 requiring personal visits by the communication teams in both Beni and Butembo. These visits resolved strong and, at times, aggressive behavior towards vaccination, safe and dignified burials, or surveillance response teams. With continued concern that negative information can quickly influence others, follow-up with the concerned groups is scheduled and implemented on a routine basis. C4D Preparedness Mass awareness and engagement sessions were completed in over 170 churches in the surrounding provinces of Ituri, Tchopo, and Tanganyika. In addition, over 630 frontline workers were briefed in the Ituri province and 14 radio stations continue to support the response with innovative peer-to-peer approaches and programing. In Goma, two round-table radio sessions were produced with community leaders and Ebola experts to address a potential spread of Ebola to their city and ways to identify and prevent it. UNICEF C4D has committed to play a critical role in the design and implementation of a larger government initiative to prepare all neighboring provinces for a potential response. Water, Hygiene and Sanitation (WASH) During the reporting period, activities and interventions on the ground were limited due to the deterioration of the security situation in Beni. A performance-based financing system to improve service quality and eliminate infections in health centers has been validated by the general coordination body as well as the Beni coordination. Through bi-weekly follow-up visits, a team made up of representatives of the WASH, IPC, and Prevention Commissions evaluate the quality of service based on a pre-defined list of indicators. One or more staff members of UNICEF partners will be part of the team, with UNICEF staff supporting them as needed. Payments will be based on the scores of each IPC/WASH indicator, and will increase as performance improves. The follow-up visits in the health centers started during the reporting period. To ensure a clear and harmonized communications strategy on the programme, a presentation followed by an information session regarding the system was conducted with the Communications Commission.

As of 24 November, 12 additional health facilities in the affected health zones in North Kivu province benefitted from essential WASH activities. These include the provision of handwashing points, briefing of staff on hygiene promotion, disinfection, and the installation of chlorination points. Since the beginning of the response, a total of 374 out of the 400 (95% coverage) targeted health facilities have been reached. As the epidemic persists, the response also needs to consider how the support provided can be sustained over time. WASH materials in the targeted facilities are therefore being restocked every two months, and the performance-based financing system described above looks at both the continued availability of materials and their proper use.

As of 24 November, 913 community sites (ports, market places, local restaurants, churches) out of the targeted 900 were provided with handwashing facilities for Ebola infection control in Beni, Mandima, Mabalako, Butembo and Tchomia Health zones. These were provided in partnership with Oxfam and PPSSP and CEPROSSAN.

Since the beginning of the response, a total of 876,200 persons have gained access to safe water through the distribution and chlorination of water, the distribution of Aquatabs, or the rehabilitation of water points in the affected health zones. This represents 92% out of the 952,946 persons targeted by UNICEF.

In terms of preparedness activities, additional activities are starting in Bunia, Goma and Bukavu, thanks to USAID support. These activities are being implemented in coordination with DPS and WHO. Preparedness activities will follow the Ebola strategy by focusing on FOSA, schools, and public places, to reinforce prevention mechanisms and support the sustainability of infrastructure in selected areas. UNICEF will collaborate with a total of four partners to support the implementation of activities.

DRC EBOLA SITUATION REPORT 24 November 2018

Key activities in the last seven days:

• In Beni and Butembo, UNICEF continued the distribution of WASH packages in 12 new health centers. These centers benefited from the installation of the essential WASH package. • As of 24 November, 19,768 people benefited from drinking water treated through functional chlorination points, in Beni, Tchomia and Butembo. • In Beni, UNICEF completed the construction of 6 latrines in the General Hospital. Also, work on the construction of two water distribution points is ongoing with the REGIDESO. • In Butembo, UNICEF continued the follow-up and distribution of 7,500 liters of chlorinated water for 67 handwashing facilities in public areas.

Education Since the beginning of the response, UNICEF has reached 434 schools out of the 600 targeted, with seven schools supported during the reporting period. Activities over the reporting period reached 5,338 children, bringing the total number of children reached by the response to 89,227 (30% coverage). Four schools in Butembo and Lubero Health Zones (EP Kipese, Ep Mihake, EP Malio et Matanda) received handwashing kits for Ebola prevention and Ebola sensitization. UNICEF also briefed 328 teachers and head of schools from these schools on the usage of handwashing facilities, thermal flashes and Ebola prevention messages. A briefing on EVD prevention was also given by UNICEF to 310 new inspectors about to be transferred to the school administration, using their pre-service training as an opportunity to conduct this activity. The refresher briefing or sensitization was done jointly with C4D colleagues. An additional three schools in Butembo (EPA Annuarite, EP Bunyuka and Institut Bunyuka) also benefitted from sensitization activities. In Tchomia and Kasenyi health zones, inspectors of the Ituri Provincial Ministry of Education conducted follow-up visits targeting 20 schools which already received prevention kits to ensure that the prevention protocol is understood and implemented accordingly. The follow-up shows that in most schools that are close to water wells, there is no problem with hand-washing daily. However, this is a problem faced in some schools due to the dry season, when wells are dried up. Students are then forced to bring water, sometimes unclean, from home, or simply don’t wash their hands. Following this, inspectors recommended that school directors insist that parents provide clean water to children for handwashing. UNICEF’s Education and WASH sections are coordinating in order to provide the concerned schools with a more sustainable solution. During the reporting period, UNICEF also continued its efforts to advocate for the effective start of schools in a protective environment for children, meeting with the Beni sub-provincial education director, together with UNESCO and MONUSCO.

Psychosocial and Child Protection EVD-affected children and families Since the start of the response, 1340 persons affected by the EVD received psychosocial support in the Ebola Treatment Centers. During the reporting period, 62 children (4 confirmed, 58 suspect cases)3 in the ETC received specific individual psychological assistance, reaching a total of 421 children since the beginning of the epidemic4. Among these 62 children, 37 (two confirmed, 35 suspected cases) were in the ETC of Beni, 11 (two confirmed, nine suspected cases) were in the

3 This figure is issued from data collected by the psychosocial commission. 4 Idem 6

DRC EBOLA SITUATION REPORT 24 November 2018 ETC of Butembo, and 14 (all suspected cases) were in the ETC of Mangina. Nine recreational kits were also distributed in the ETCs. The psychologists play a key role in the ETC. Beyond psychological counselling, they explain the functioning of the ETC, prepare the patients for a change of status (to confirmed or to no case), welcome the families for visits, and pay special attention to children. Cured patients also play a crucial role as caregivers for children in the ETCs. Although training has been provided to them on psychosocial support for children, UNICEF is planning to further reinforce this with specific training on childcare. Moreover, there are not enough cured patients in the ETC of Butembo to take care of the children. Consequently, four EVD-cured persons of Mangina were transferred to Butembo to support teams inside the ETC. 141 families newly affected by EVD (confirmed and suspected cases) received psychosocial support and/or material assistance in all the affected health zones in North Kivu Province, reaching a total of 520 families throughout the response. Discharged and cured patients were provided with 160 hygiene kits and 179 food assistance. Nine families received funeral kits, 21 families received newborn kits, and 19 families received NFI kits. 208 previously identified EVD- affected families received continuous psychosocial support through regular visits of psychosocial agents in their communities. Orphans and separated children5 17 new orphans due to the Ebola epidemic were identified and received appropriate care, reaching a total of 406 orphans and separated children out of the targeted 600. Follow-up visits to 54 previously identified orphans and separated children were conducted by psychosocial agents. The majority of children are psychologically stable: they are well- integrated in the community and play with other children. Additional material assistance is provided when specific needs are identified. However, it should be noted that despite the advocacy of UNICEF and partners for the reopening of schools, the continuous closure of schools in Beni and some schools in Butembo (teachers' strike because of insecurity) can cause serious child protection issues. Children are often alone during the day, exposing them to more risks of EVD contamination or risks of exploitation. In addition, all children identified for school reintegration currently cannot benefit from assistance. This problem particularly affects orphaned children but also children who are cured from EVD. Contact persons A total of 297 contact families received a psychosocial support in Beni and Butembo, reaching a total of 3,929 out of the 4,187 targeted contact family members. In Tchomia, 22 contact persons received a follow up visits. In Butembo, the psychosocial commission continued to follow children and contact persons from the orphanage where confirmed cases of EVD were identified. As a prevention measure, an evaluation of the other orphanages in the city was also conducted. Hygiene and NFI kits are going to be distributed to prevent any contamination.

Nutrition From the 12th to the 24th of November 2018, appropriate nutritional care was provided to 138 patients in the ETCs. At the same time, 456 pregnant and lactating women, who are contacts and caregivers of children in the ETCs, were reached by infant and young child feeding nutrition counselling. These counselling sessions were held in the centers and in the communities. During the same period, ten orphaned and or separated children under 6 months of age had access to adequate nutrition care according to the IYCF-E guidelines.

In addition, the UNICEF nutrition expert in the field conducted an assessment of nutritional and health status and hygiene conditions in three orphanages located in Butembo town (Malaika, Nain and Compassion for Children in Distress). The

5 Orphans and separated children are those who have either lost one or both parents/caregivers or are separated from their parents/caregivers due to the Ebola epidemic.

DRC EBOLA SITUATION REPORT 24 November 2018 number of children in these orphanages varied, from 20 (Malaika) to 58 (Compassion for Children in Distress). Unclean conditions were observed in all orphanages, and it was recommended that:

• Colleagues from WASH, Communication, and Child Protection be invited to assess and integrate awareness messages in orphanages on preventive measures against EVD, as well as reinforcement of hygiene measures with posters on Ebola and hand-washing kits including soaps; • Information be shared with the surveillance team to monitor the six sick children in the Compassion orphanage; • A focal point be designed for the collection of information on the use of milk substitutes for children <6 months and 6-12 months for the four orphanages; • Nutritionists in the health zone be empowered to raise awareness about IYCF in the three orphanages.

Supply & Logistics Since the beginning of the response, $3,231,145.88 worth of items composed of WASH, C4D, Child Protection, Health, Education and ICT supplies have been procured for the Ebola response in Ituri and North Kivu province. Out of the total value of items, $ 163,983.00 are ICT equipment for staffs.

Human Resources As of 24 November, 76 UNICEF staff members are deployed to the affected health zones in North Kivu and Ituri provinces. Through the network of implementing partners mobilized by UNICEF for the response, a total of 429 personnel are currently deployed in the affected areas supporting the response. External Communication During the reporting period the Ebola crisis and UNICEF’s response received media coverage in Deutsche Welle, Telegraph.co.uk, BBC News, CNN, Emol.com, El Mundo, Montevideo , Excélsior, and Actualite.cd. The UNICEF CO published 44 articles on its blog since the beginning of the crisis, as well as 42 Facebook posts, 28 pictures on Instagram, and almost 300 tweets.

DRC EBOLA SITUATION REPORT 24 November 2018

Funding Based on the Joint Response plan of the Ministry of Health and partners, the total funding required for the response is estimated at USD 105 million. As part of the joint response plan, UNICEF response strategy focused on Communication, WASH and Psychosocial care, nutrition and cross-cutting education sector response is estimated at US$21.8 Million. At present, the UNICEF response has a funding shortfall of USD 12.03 Million. Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018) Funds available Funding gap Requirements Appeal Sector Funds Received Current $ $ % Year Water, Hygiene and Sanitation - WASH / IPC 10,536,519 2,962,719 7,573,800 72% Communication for Development (C4D) - Community engagement and Communication 6,097,005 3,333,405 2,763,600 45% for Campaigns Child protection and Psychosocial Support 1,851,200 648,800 1,202,400 65% Medical Care: Management of Severe Acute 749,800 549,800 200,000 27% Malnutrition in Ebola Treatment Center Operations support, Security and Coordination costs and Information and Communications 2,273,680 1,304,175 969,505 43% Technology Preparedness Plan 322,000 0 322,000 100% Total 21,830,204 8,798,899 13,031,305 60%

Next Sitrep: 29 November 2018

RESPONSE COORDINATION # of affected localities with functioning partner coordination mechanism 5 5 0 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, 15,500‡ 10,454 411 community engagement and interpersonal communication activities. (CAC, religious /traditional leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on Ebola response and 10,200‡ 6,540 466 participatory community engagement approaches. # of at-risk population reached through community engagement, advocacy, 11,500,000‡ 6,375,987 361433 interpersonal communications, public animations, radio, door-to-door, church meetings, schools, adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious misperception about Ebola, refusals to secure burials or resistance to 900‡ 676 59 vaccination. 9

DRC EBOLA SITUATION REPORT 24 November 2018 # of listed eligible people for ring vaccination informed of the benefits of the 35,105† 34,839 5,848 vaccine and convinced to receive the vaccine within required protocols.

% of respondents who know at least 3 ways to prevent Ebola infection in the 80%† 91% 8% affected communities (from Rapid KAP studies) WATER, SANITATION & HYGIENE # of health facilities in affected health zones provided with essential WASH services. 400‡ 378 12

# of target schools in high risk areas provided with handwashing facilities 600‡ 438 8

# of community sites (port, market places, local restaurant, churches) with hand 900‡ 913 47 washing facilities in the affected areas # of people with access to safe water source in the affected areas 952,946‡ 876,200 19768 EDUCATION # of students reached with Ebola prevention information in schools 297,000 89,227 5338

# of teachers briefed on Ebola prevention information in schools 7,200 4,257 328

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of affected families with confirmed, suspects, probable cases who received one or 451* 451 68 several kits of assistance to support their children # of affected families, including children, with confirmed, suspects and probable 451* 451 68 cases who received continuous psycho-social support in their community # of contact family members, including children, who receive psycho-social support 4,187** 3,929 0 and/or material assistance # of unaccompanied children and orphans* identified who received appropriate 600‡ 326 17 care and psycho-social support NUTRITION # of < 23 months children caregivers who received appropriate counseling on IYCF 9,756 2,188 456 in emergency † The target is dynamic as listing of eligible persons is defined +The target changes with changes in the epidemiology ‡ The target changes with changes in the epidemiology and as geographical coverage expands *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures ** The target is dynamic and 100% of listed contacts is the identified target

DRC EBOLA SITUATION REPORT 30 November 2018

Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

Photo Credit: Anne Herrmann

30 November 2018 SITUATION IN NUMBERS

Highlights 434 total reported cases (MoH, 30 November 2018)  An operational review of the response strategy is currently being carried out, under the leadership of the Ministry of 386 confirmed cases Health of DRC. (MoH, 30 November 2018)

 Elections are expected to proceed as planned in Ebola- affected zones. UNICEF is working with the Ministry of 201 deaths recorded (MoH, 30 November 2018) Health to ensure that handwashing facilities are available in the voting centers as a measure of prevention. 4,895 contacts under surveillance  Initiatives and increasing momentum for a community-led (MoH, 30 November 2018)

surveillance and reporting system were observed during the reporting period, with an average of 411 daily alerts covering UNICEF Ebola Response suspected cases, deaths, and resistance reported by local Appeal chiefs, frontline workers, and women leaders. US$ 21.8M

UNICEF’s Response Target Result

# of at-risk people reached through community engagement and interpersonal communication approaches. (door-to-door, church meetings, small-group training sessions, school classes, briefings 11,500,000 6,753,131 with leaders and journalists, other) # of listed eligible people for ring vaccination informed of the benefits of the vaccine and convinced to receive the vaccine 38,952† 38,353 within required protocols. # of people with access to safe water in the affected health 952,946 889,440 zones # of teachers briefed on Ebola prevention information 32,296 4,310 # of affected families with confirmed, suspects, probable cases who received one or several kits of assistance to support their 517* 517 children † The target is dynamic as listing of eligible persons is defined *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response matures

DRC EBOLA SITUATION REPORT 30 November 2018

Epidemiological Overview1

Summary Table (30.11.18): Confirmed and Probable Cases Total Deaths Suspect Cases under Province Health Zone Confirmed Probable Total Recorded investigation Beni 186 9 195 102 56 Butembo 16 0 16 17 9 Kalanguta 32 12 44 11 1 Kyondo 3 2 5 1 0 Mabalako 67 16 83 36 2 Nord-Kivu Masereka 6 1 7 1 1 Musienene 3 1 4 3 0 Mutwanga 3 0 3 1 1 Oicha 4 0 4 1 0 Katwa 43 4 47 16 7 Vuhovi 4 0 4 1 1 Ituri Mandima 16 3 19 9 5 Komanda 1 0 1 0 0 Tchomia 2 0 2 2 0 TOTAL 386 48 434 201 83 Previous Total 23 November 2018 348 47 395 184 56

1 Data source: Epidemiological table based on daily CNC numbers

DRC EBOLA SITUATION REPORT 30 November 2018 Humanitarian leadership and coordination

The Crisis Management Team continued to meet daily under the leadership of the Ministry of Health with all concerned partners and with the chairs of the different working groups providing thematic updates. UNICEF continues to participate actively in the coordination meetings at the national level and in Beni (operational headquarters) and co-leads the commissions on communication, WASH and psychosocial care. UNICEF is also active in the working groups on logistics and vaccination. A UNICEF security specialist is also deployed in the field to support security assessment and safety of the operations. Beni and Butembo health zones are the most concerning areas for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused around five coordination hubs based in Beni, Butembo, Tchomia, and Mabalako health zones. One sub-coordination hub is operational in Bunia city. The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases and the geographical extension of the epidemic to newly affected health zones. UNICEF coordinates Musienene, Katwa, Masereka, Vuhovi, Kalanguta, and Kyondo’s response from the sub-coordination group based in Butembo health zone, and efforts are underway for a second coordination team to be based in Butembo. Efforts are also ongoing to put in place a coordination team in Komanda and Bunia. Response Strategy

In support of the joint response plan, the UNICEF response strategy will continue to focus on communication, WASH, and psychosocial care, nutrition, and a cross-cutting education sector response. As the epidemic enters its fifth month, an operational review of the response led by the Ministry of Health is currently being carried out.

 Risk communication, social mobilization and community engagement with the aim to (1) proactively engage with affected and at-risk communities, (2) provide timely and accurate health advice to encourage positive health seeking behaviors, and (3) address community concerns and rumors. The strategy is implemented through 5 pillars that include (i) community engagement; (ii) promotion of preventive behaviors; (iii) responding to resistance; (iv) advocacy and capacity building of actors and (v) communication in support of ring vaccination, surveillance, safe and dignified burials, and Ebola treatment centers

 The WASH strategy, as part of the Infection Prevention and Control (IPC), aims to stop the spread of the disease through the availability of (1) WASH in public and private health care facilities, as well as reinforcement of basic WASH services and awareness with traditional practitioners, which includes providing water and WASH kits, (2) hygiene promotion and the provision of WASH kits in schools, including handwashing stations and soap/temperature check points, (3) WASH in communities through mass outreach on hygiene promotion to vulnerable communities and the setup of handwashing stations/temperature control in strategic transit locations, and (4) joint supervision of health infrastructures to ensure quality and efficient sustainability of programs are developed

 The child protection and psychosocial support to EVD confirmed and suspect cases and their family members as well as contact families seek to (1) provide psychosocial support, (2) establish or re-establish social and community networks and support systems, (3) provide social kits to EVD affected families, and (4) identify and provide appropriate care to orphans and unaccompanied children due to the Ebola epidemic. The key elements of the strategy includes (i) psychosocial support for EVD confirmed and suspect cases, including children, in the ETCs, psychosocial activities for children and their families, (ii) material assistance to affected families to better support children, (iii) the facilitation of professional help to children and families with more severe psychological or social problems/needs, (iv) the coordination mental health and psychosocial support (MHPSS), and (vi) psychosocial assistance, appropriate care, and research of long-term solutions for orphans and unaccompanied children.

DRC EBOLA SITUATION REPORT 30 November 2018  The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF), therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases in the six health zones affected by Ebola or in situations of nutritional alert in North Kivu province. In addition, it will address infant and young child feeding practices that are impacted by the increasing number of women affected by the Ebola epidemic

 The education sector strategy involves key EVD prevention measures on the school premises, including: (1) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas, (2) training of educational actors (students, teachers, inspectors, school administration agents, head of educational provinces, parents’ association) on Ebola prevention in schools including WASH in school, psychosocial support in classrooms, and against discrimination, (3) provision of infrared thermometers and handwashing kits in schools including clean water, soap, and capacity reinforcement on hygiene behaviors, (4) provision of school cabins for school entry checking, (5) provision of specific documentation and protocol for prevention, guidance, and management of suspected cases in school, (6) provision of key messages on Ebola prevention to families, and (7) close monitoring of the effective use and implementation of the protocol of prevention of EVD in schools

Summary Analysis of Programme Response

An overview of the key elements in the response, with a special emphasis on UNICEF’s response in the affected health zones, is detailed below.

Communication and social mobilization (C4D) Community Engagement Through the increased focus on the transfer of responsibilities to community leadership in both Beni and Butembo, new initiatives and increasing momentum for community-led surveillance and self-reporting were observed during the reporting period. On average, 411 daily alerts are being reported by local chiefs, frontline workers, and women leaders. In the reporting period alone, 38 were treated as serious alerts and visited by the surveillance teams. The continuing acceptance to self-report reflects a positive shift of accountabilities, and the need for the communication teams to continue their support for local leadership to end the epidemic. In Wayene, (Katwa Health Zone), positive outcomes from UNICEF’s work with community groups were also observed. These groups, believed to be highly influential in the area, were previously strong adversaries of the Ebola response. They were sensitized, trained, and engaged by UNICEF teams; and were thus able to show initiative and take the lead in diffusing a high-tension situation in the community, with community members blaming health center staff for the death of a family member. The groups called a meeting with concerned parties where each was allowed to express their concerns. Following this, the parties cooperated fully with the response teams, allowing the vaccination teams to conduct their prevention activities. In the districts of Maman Musayi, Salomon, Wayene, Mitoya, Vutetse, 693 frontline workers and mobilizers were trained; 3,788 households were reached through door-to-door visits; six women associations were able to engage 2,900 peers; and 243 leaders visited ETCs in Butembo, Katwa, and Beni. Responding to Resistance and Rumors In Butembo Health Zone, UNICEF’s anthropologist reported rising frustration in the population due to the perception that important Ebola statistics were being kept from them by response teams. As a result, the coordination committee reversed its policy prohibiting the reporting of statistics by anyone other than Ebola experts. Twenty-three local radio stations in Butembo and Katwa were thus permitted to share information and statistics, including daily confirmed cases, deaths, survivors, negative cases, and daily activities planned by the commissions. However, the commission and the

DRC EBOLA SITUATION REPORT 30 November 2018 radio stations agreed that the sharing of information needs to be closely monitored and controlled to ensure that negative information is being balanced by positive stories and testimonies of survivors. Promotion of Preventive Behaviors In North Kivu, 43 religious leaders reported that over 14,600 followers received reminders to cooperate with surveillance committees. They were also reminded about the importance of their involvement in community surveillance efforts, namely assuring that family members or neighbors do not hide, travel, or panic if they show signs of Ebola. In the markets of Musienene, 5,465 shoppers were reached with vital information on Ebola, and received brochures to distribute to others. The parallel Malaria prevention campaign in Beni described in the previous Situation Report2 was completed on 28 to 30 November. C4D interventions included the production of four radio spots, ten billboards, theatre sketches, and briefings of 250 village chiefs, 200 religious leaders, and active frontline workers. During these three days, 250,000 Treated Mosquito Nets were distributed by 3,500 mobilizers. These mobilizers are also trained on Ebola and were therefore be able to answer any Ebola-related questions from the community.

C4D Preparedness Preventive activities were also planned and implemented to inform and prepare neighboring provinces for a potential Ebola threat. Activities include the engagement and dissemination of messages by 187 religious leaders in Tshopo, Ituri, Bas-Uele, and Sud-Kivu. A new focus is being placed on Goma to assure that an emergency plan is in place and its urban population is informed with facts about Ebola, transmission and prevention, and what to expect during an Ebola response. Renewed interventions in Goma include more frequent meetings of the Ebola task-force team with assigned roles and responsibilities, recommendations to recruit seven new influential members to the task force, and a gap analysis of needed human and financial resources. A meeting is also planned to brief all media agencies including local radio stations that already have signed contracts to engage in the response.

Water, Hygiene and Sanitation (WASH) During the reporting period, activities and interventions on the ground have continued with a few limitations and constraints due to the security situation in Beni and Butembo.

The development of the performance-based financing system, as described in the previous Situation Reports3, continued last week in Beni. All UNICEF partners and other actors have been informed and agreed to support the implementation. A steering committee was set up during the reporting period with UNICEF as a member. This committee will validate follow-up evaluation reports (Infection Prevention and Control - WASH scores) on which the amount to be paid will be based, channel UNICEF WASH interventions (supplies, construction) to the selected Formations Sanitaires (FOSAs) according to the needs identified in the evaluations. and support and advise the committee on WASH aspects in improving the response and prevention strategies.

Sixteen additional health facilities in the affected health zones in North Kivu province benefitted from essential WASH activities, including the provision of handwashing points, briefing of staff on hygiene promotion and disinfection, and the installation of chlorination points. With this, UNICEF has reached a total of 394 health facilities out of the 400 targeted (99% coverage) since the beginning of the response.

A formative research study was launched to understand the population’s perceptions, beliefs, health-seeking behaviors and utilization of health services provided in public and private healthcare structures, looking at the demand side to improve the responsiveness of the healthcare system.

2 https://www.unicef.org/appeals/files/DRC_Ebola_Sitrep_Ebola_24_Nov_2018.pdf 3 Idem 5

DRC EBOLA SITUATION REPORT 30 November 2018 As of 25 November, 918 community sites such as ports, marketplaces, local restaurants, and churches were provided with handwashing facilities for Ebola infection control in Beni, Mandima, Mabalako, Butembo, and Tchomia Health Zones. These activities were implemented in partnership with Oxfam, Programme de Promotion de Soins de Santé Primaire (PPSSP), and Centre de Promotion Socio-Sanitaire (CEPROSSAN).

Since the beginning of the response, a total of 889,440 persons have gained access to safe water in the affected health zones, out of the targeted 952,946 (93% coverage), through the distribution and chlorination of water, the distribution of Aquatabs, or the rehabilitation of water points in the affected health zones.

Elections are expected to proceed as planned in Ebola-affected zones. UNICEF is working with the Ministry of Health to ensure that handwashing facilities are available in the voting centers as a measure of prevention.

Key activities in the reporting period:

 In Beni, UNICEF continued the distribution and installation of the essential WASH package in 16 new health centers.  As of 25 November, 13,240 people benefited from drinking water treated through functional chlorination points in Beni, Tchomia, and Butembo.  In Beni, UNICEF completed the construction of one water distribution point providing 10,000 liters of chlorinated water. Work on the construction of the second distribution point is ongoing with the Régie de Distribution d'Eau (REGIDESO)4.  In Butembo, UNICEF continued the follow up and distribution of 8,900 liters of chlorinated water for 98 handwashing facilities in public areas. Education During the reporting period, UNICEF reached 2,174 children through its education activities, reaching a total of 91,401 children since the start of the response. Activities to date have covered 444 schools out of 2,476 targeted schools. It is important to note that the number of targeted schools was drastically increased over the last weeks, from 600 to the current target of 2,476, due to the expansion of the geographical coverage of the response. Subsequently, the target number of students was also increased from 297,000 to more than one million; and the number of teachers from 7,200 to 32,296. UNICEF and its implementing partners are scaling up the response to reduce the gap between the new targets and the actual coverage.

Two schools in Musienene Health Zone, Kimbulu and Musimba primary schools, were provided with handwashing kits, thermometers, and Ebola prevention messages. Fifty-three teachers and head of schools were briefed on the usage of the materials provided.

Visits were also conducted to five schools in Butembo and Lubero Health Zones, specifically Mahuzurio, Matanda, Matengenezo, Migheri, and Lubero Cite primary schools, with a total of 4,292 students. The purpose of the visits was to follow-up the use of previously provided handwashing kits and thermometers. During these visits. it was observed that the handwashing kits were installed at the main entrances of schools. Children washed their hands before entering the schools and/or their classrooms, and the temperature of the children was taken as they washed their hands.

During International Children's Day on 20 November 2018, UNICEF supported the sensitization of 400 students from 15 primary schools and 17 secondary schools in Butembo health zone on prevention measures.

In Magina and Oicha Health Zones, the C4D and psychosocial commissions jointly held an awareness-raising session for 115 students and 15 teachers and supervisors. The session aimed to sensitize the participants on preventive measures

4 A public utility responsible for providing water to residential, commercial, and industrial users in DRC.

DRC EBOLA SITUATION REPORT 30 November 2018 against EVD in schools, and also included presentations on the importance of transporting suspected cases by ambulance to the ETCs, and safe and dignified burials.

Psychosocial and Child Protection EVD-affected children and families

During the reporting period, 60 children (4 confirmed, 56 suspected cases)5 went through ETCs and received individual psychological assistance, bringing the total number of children going through ETCs to 481 since the beginning of the epidemic6. Among them, 38 children (1 confirmed, 37 suspected cases) were in Beni, eight (three confirmed, five suspected cases) were in Butembo, and 10 (all suspected cases) were Mangina. All of them received specific psychosocial support.

Psychosocial support and/or material assistance was provided to 121 families newly affected by EVD (confirmed and suspected cases) in all the affected health zones in North Kivu Province. Discharged and cured patients were provided with 118 hygiene kits and 270 food assistance packages; six families received funeral kits, eight families received newborn kits, and 65 families received customized kits of non-food items (NFI)7. Continuous psychosocial support was provided to 85 previously identified EVD-affected families through regular visits of psychosocial agents in their communities.

Persons cured of EVD continue to be monitored by psychologists. Many of them feel stigmatized by their community and ask for deeper psychosocial support. In Beni, a cured woman had to take refuge in the hospital after she was threatened by her family and her community. Psychologists are working with her family towards acceptance and reintegration into the community, and are also providing specific psychotherapy. In Mangina, an eight-month old baby was cured and a joint UNICEF Child Protection and Nutrition intervention was designed to follow up the baby in his family through visits of psychosocial agents.

Orphans and separated children8

During the reporting period, twenty-eight orphans due to the Ebola epidemic were identified and received appropriate care, reaching a total of 354 out of the targeted 600 since the start of the response. Four separated children were placed in the nursery because their mothers were accepted in the ETC. Fifty-nine previously identified orphans and separated children received follow-up visits by psychosocial agents. An orphan, whose mother died at an ETC and is stigmatized by her classmates, was visited by psychosocial agents to provide psychological support. A psychoeducation is also planned at the school. Orphans reached during the reporting period received 44 NFI kits, 38 food assistance and 16 school support.

Contact persons

A total of 344 contacts families received a psycho-social support in Beni and Butembo, reaching a total of 4,895 out of the 5,190 targeted.

In addition to the above, the Psychosocial Commission provides support to the Surveillance Commission through reducing tensions at family and community levels, helping convince suspected cases to join the ETCs. Support is also provided in the listing of contacts through the Psychosocial Commission’s knowledge of the communities and its capacity to follow up contacts through the deployment of psychosocial agents. Several joint missions were organized between

5This figure is issued from data collected by the psychosocial commission. 6 Idem 7 Non-food items provided under the response’s psychosocial component are customized according to the specific needs of the target beneficiaries. Items can include mattresses, sheets, kitchen utensils, baby items, etc. 8 Orphans and separated children are those who have either lost one or both parents/caregivers or are separated from their parents/caregivers due to the Ebola epidemic. 7

DRC EBOLA SITUATION REPORT 30 November 2018 the Psychosocial and Vaccination Commissions to convince high-risk contacts to get vaccinated. Additionally, in Mangina, the interventions of the Psychosocial Commission resulted in the Safe and Dignified Burials for six deaths at the community levels.

Nutrition Over the reporting period, appropriate nutritional care was provided to 116 patients in the ETCs. Thirteen orphaned and separated children in ETCs and in communities, all under six months of age, received adequate feeding support according to national guidelines for infant and young child feeding in emergencies. In addition, 377 pregnant and lactating women in ETCs and the communities were sensitized on appropriate infant and young child feeding and hygiene practices.

UNICEF supported the government through training 32 NGOs and government nutrition staff in Goma on the procedures and approaches for infant and young child feeding interventions in emergency contexts. During the training, a specific session was dedicated to operational actions for infant and young child feeding (IYCF) in the on-going EVD outbreak in Eastern Part of DRC. One of the major actions resulting from this training was the development of key messages for the community on IYCF practices for orphans, separated children, children of EVD survivors, and breastfeeding children with high risk of contact.

With the increased number of infants and young children in the EVD-affected population, there is a need to minimize other risks and maximize the survival of infants. In this regard, the following challenges have been identified:

 Infants are more vulnerable in the context of the EVD epidemic, and specific monitoring on IYCF is needed;  Artificially-fed infants are particularly vulnerable and the use of infant formula or other milk products is dangerous and should be controlled and monitored;  Pregnant and lactating mothers with infants below two years of age need to be prioritized for additional holistic support at the ETC but also at the communities. To address these challenges, the following actions are being put in place:

 The development of a clear protocol focused on actions and key messages for the community to address the nutrition needs of orphans, separated children, children of survivors, and breastfeeding children with high risk of contact;  The reinforcement of the field presence of UNICEF’s technical nutrition personnel through deploying one nutritionist in Butembo, one in Goma, and one in Beni; and deploying two nutritionists in the ETC of Goma and one in Mangina to provide technical assistance to the National Nutrition Program (PRONANUT) and strengthen nutrition activities in the ETCs. Supply & Logistics Since the beginning of the response, $2,911,612.479 worth of items composed of WASH, C4D, Child Protection, Health, Education and ICT supplies were procured for the Ebola response in Ituri and North Kivu province. Offshore procurement represents a total value of $1,104,259.21 (38%) and local procurement represents a total value of $1,807,353.26 (62%). Orders for $200,000 worth of WASH items are currently underway.

9 This amount is less what was reported in the previous Situation Report. The amount previously reported included all the emergency stock of UNICEF DRC for November, instead of only the stock for the Ebola response.

DRC EBOLA SITUATION REPORT 30 November 2018 Human Resources

As of 29 November, 60 UNICEF staff members are deployed to the affected health zones in North Kivu and Ituri provinces. Through the network of implementing partners mobilized by UNICEF for the response, a total of 429 personnel are currently deployed in the affected areas supporting the response.

External Communication During the reporting period the Ebola crisis and UNICEF’s response received media coverage in The Economist, Europa Press, Actualite.cd, La libre Afrique, Digital Congo.net, Reuters and Africa News. The CO organized a press mission to Beni and Butembo for VoA and the NYT, covering the various dimensions of the Ebola Response, including community communication and psychosocial assistance to affected people. The UNICEF CO published 17 articles on its blog since the beginning of the crisis, as well as 46 Facebook posts, 29 pictures on Instagram and almost 310 tweets. In order to respond to external communication requests the CO updated a set of Key Messages as well as a set of Questions and Answers. These documents are internal documents.

Funding Based on the Joint Response plan of the Ministry of Health and partners, the total funding required for the response is estimated at USD 105 million. As part of the joint response plan, UNICEF response strategy focused on Communication, WASH and Psychosocial care, nutrition and cross-cutting education sector response is estimated at US$21.8 Million. At present, the UNICEF response has a funding shortfall of USD 13.03 Million. Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018) Funds available Funding gap Requirements Appeal Sector Funds Received Current $ $ % Year Water, Hygiene and Sanitation - WASH / IPC 10,536,519 2,962,719 7,573,800 72% Communication for Development (C4D) - Community engagement and Communication 6,097,005 3,333,405 2,763,600 45% for Campaigns Child protection and Psychosocial Support 1,851,200 648,800 1,202,400 65% Medical Care: Management of Severe Acute 749,800 549,800 200,000 27% Malnutrition in Ebola Treatment Center Operations support, Security and Coordination costs and Information and Communications 2,273,680 1,304,175 969,505 43% Technology Preparedness Plan 322,000 0 322,000 100% Total 21,830,204 8,798,899 13,031,305 60%

Next Sitrep: 09 December 2018

DRC EBOLA SITUATION REPORT 30 November 2018

Nord Kivu Province 2018 Change Ebola Response Tracking Indicators (26 Nov 2018) New Total since last Target results report ▲▼ RESPONSE COORDINATION # of affected localities with functioning partner coordination mechanism 5 5 0 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, religious /traditional 15,500 11,198 744 leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents.

#of frontline workers (RECO) in affected zones mobilized on Ebola response and 10,200 7,233 693 participatory community engagement approaches.

# of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, 11,500,000 6,753,131 377,144 schools, adolescent groups, administrative employees, armed forces.

# of households for which personalized house visits was undertaken to address serious 900 763 87 misperception about Ebola, refusals to secure burials or resistance to vaccination.

# of listed eligible people for ring vaccination informed of the benefits of the vaccine and 38,952† 38,353 3,332 convinced to receive the vaccine within required protocols. % of respondents who know at least 3 ways to prevent Ebola infection in the affected 80%† 91% 0 communities (from Rapid KAP studies)** WATER, SANITATION & HYGIENE # of health facilities in affected health zones provided with essential WASH services. 400 394 16

# of target schools in high risk areas provided with handwashing facilities 2,476+ 444 6 # of community sites (port, market places, local restaurant, churches) with hand washing 918 918 5 facilities in the affected areas # of people with access to safe water source in the affected areas 952,946 889,440 13,240 EDUCATION # of students reached with Ebola prevention information in schools 1,090,006+ 91,401 2,174

# of teachers briefed on Ebola prevention information in schools 32,296+ 4,310 53 CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of affected families with confirmed, suspects, probable cases who received one or 517* 517 66 several kits of assistance to support their children

# of affected families, including children, with confirmed, suspects and probable cases 517* 517 66 who received continuous psycho-social support in their community

# of contact family members, including children, who receive psycho-social support 5,190** 4,895*** 966 and/or material assistance # of separated children and orphans identified who received appropriate care and 600 358 32 psycho-social support NUTRITION

# of < 23 months children caregivers who received appropriate counseling on IYCF in 9,756 2,565 377 emergency

† The target is dynamic as listing of eligible persons is defined +The target changes with changes in the epidemiology **Results are based on a KAP study completed in November 2018. *** Number of contact is on the decline as response proceeds

UNICEF DR CONGO EBOLA SITUATION REPORT 10 December 2018

Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri

Photo Credit: Guy Hubbard

10 December 2018 SITUATION IN NUMBERS

Highlights 500 total reported cases • On 08 December, UNICEF’s Regional Director for West and Central (MoH, 10 December 2018)

Africa was in Beni where she visited an Ebola Treatment Center and met with UNICEF staff and response teams, youth groups actively 452 confirmed cases (MoH, 10 December 2018) involved in the response, and EVD-affected families. The Regional Director also participated in the strategic Ebola response coordination deaths recorded meeting. 240 (MoH, 10 December 2018) • After being hit by Ebola cases in August and in September, Ituri province has again reported confirmed cases in early December. 6,321 contacts under surveillance Komanda health zone, with one previously recorded case from (MoH, 10 December 2018)

October, signaled seven new cases in four different villages in three health areas. UNICEF is rapidly deploying multi-sectoral teams and UNICEF Ebola Response assets to the area. Appeal • The World Bank Group approved additional funding of almost USD 13 million for UNICEF, covering the previously reported funding gap. US$ 21.8M However, as the epidemic enters its fifth month and the Joint Response Plan is being reviewed, the necessity for additional funds is being

anticipated. Ebola Response Funding UNICEF’s Response Status 2018 Target Result

# of at-risk people reached through community engagement and Funding Gap interpersonal communication approaches. (door-to-door, church 0% meetings, small-group training sessions, school classes, briefings 11,500,000 7,552,577 with leaders and journalists, other) # of listed eligible people for ring vaccination informed of the Ebola NK and Ituri Phases I & 45,247† 44,447 benefits of the vaccine and convinced to receive the vaccine II within required protocols. Funding requirements* : # of people with access to safe water in the affected health 1,107,812 1,107,812 Total zones funding # of teachers briefed on Ebola prevention information 32,296 4,877 available * # of affected families with confirmed, suspects, probable cases 100% who received one or several kits of assistance to support their 580* 580 children † The target is dynamic as listing of eligible persons is defined *The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response * Funding requirement includes budget for phase I matures ($8,798,899) and budget for phase II ($ 13,031,305) **Funds available include Reprogrammed funds from Equateur Response 1

UNICEF DR CONGO EBOLA SITUATION REPORT 10 December 2018

Epidemiological Overview1

Summary Table (10.12.18):

Confirmed and Probable Cases Total Deaths Suspect Cases under Province Health Zone Confirmed Probable Total Recorded investigation Beni 204 9 213 104 40 Butembo 30 0 30 17 15 Kalanguta 31 12 43 16 0 Kyondo 4 2 6 1 0 Mabalako 72 16 88 42 8 Nord-Kivu Masereka 7 1 8 2 0 Musienene 2 1 3 2 2 Mutwanga 3 0 3 2 0 Oicha 7 0 7 2 0 Katwa 56 4 60 33 15 Vuhovi 8 0 8 3 2 Lubero 0 0 0 0 2 Ituri Mandima 18 3 21 10 2 Komanda 8 0 8 4 0 Tchomia 2 0 2 2 0 Mambasa 0 0 0 0 1 TOTAL 452 48 500 240 87 Previous Total 30 November 2018 386 48 434 201 83

1 Data source: Epidemiological table based on daily CNC numbers

UNICEF DR CONGO EBOLA SITUATION REPORT 10 December 2018 Humanitarian leadership and coordination The Crisis Management Team continued to meet daily under the leadership of the Ministry of Health with all concerned partners and with the chairs of the different working groups providing thematic updates. UNICEF continues to participate actively in the coordination meetings at the national level and in Beni (operational headquarters) and co-leads the commissions on communication, WASH and psychosocial care. UNICEF is also active in the working groups on logistics and vaccination. A UNICEF security specialist is also deployed in the field to support security assessment and safety of the operations. Beni, Butembo, and Katwa health zones are the most concerning areas for the response due to the high number of reported confirmed and probable cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused around five coordination hubs based in Beni, Butembo, Tchomia, and Mabalako health zones. One sub-coordination hub is operational in Bunia city. The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases and the geographical extension of the epidemic to newly affected health zones. UNICEF coordinates Musienene, Katwa, Masereka, Vuhovi, Kalanguta, and Kyondo’s response from the sub-coordination group based in Butembo health zone, and efforts are underway for a second coordination team to be based in Butembo. Efforts are also ongoing to put in place a coordination team to respond to new cases in Komanda.

Response Strategy In support of the joint response plan, the UNICEF response strategy will continue to focus on communication, WASH, and psychosocial care, nutrition, and a cross-cutting education sector response. As the epidemic enters its fifth month, an operational review of the response led by the Ministry of Health is currently being carried out. The Ebola strategic response plan is being reviewed jointly by the MoH, WHO, UNICEF, and partners. The main goals of this revision include broadening the geographic scope of the response by deploying three teams in geographic rings ahead of the virus, as follow: full response teams in health zones with active cases; active response (mobile teams) in regions with contacts or within population movement routes leading to or out of zones with active cases; and stand-by teams in peripheral regions within eastern DRC for preparedness activities. Beyond January 2019, a longer-term perspective of a six-month response up to June 2019 is also being discussed.

UNICEF DR CONGO EBOLA SITUATION REPORT 10 December 2018 care to orphans and unaccompanied children due to the Ebola epidemic. The key elements of the strategy includes (i) psychosocial support for EVD confirmed and suspect cases, including children, in the ETCs, psychosocial activities for children and their families, (ii) material assistance to affected families to better support children, (iii) the facilitation of professional help to children and families with more severe psychological or social problems/needs, (iv) the coordination mental health and psychosocial support (MHPSS), and (vi) psychosocial assistance, appropriate care, and research of long-term solutions for orphans and unaccompanied children.

• The nutrition component will provide the appropriate nutritional care for EVD patients including children. The nutrition component will also promote and protect infant and young child feeding practices in the EVD context, in both the ETCs and in communities, with a special focus on orphans, separated, and other vulnerable infants and young children such as children with lactating mothers with a high risk of contact, or lactating mothers identified as frontline health workers, among others. The early detection of acute malnutrition cases and the adequate management of severe acute malnutrition in the affected health zones will also be supported. UNICEF will support the government in strengthening the coordination of the nutrition response through the cluster coordination mechanisms.

Summary Analysis of Programme Response An overview of the key elements in the response, with a special emphasis on UNICEF’s response in the affected health zones, is detailed below.

Communication and social mobilization (C4D) Community Engagement As communication teams in Beni, Mangina, and Butembo health zones remained focused on ongoing community engagement and community-led surveillance efforts, a new team was created and sent to Komanda, the new epicentre in Ituri province. Over the past two weeks, seven new confirmed cases were reported in this new intervention zone, defined by active terrestrial movements from both infected individuals and their contacts. As a result, other infections and confirmed cases can be expected over the next week. A communication commission was created in Komanda health zone and presently includes six external communication experts and nine local influencers. Despite initial accomplishments, the team reported that difficulties accessing affected areas due to road conditions and isolation presented a significant challenge. For example, it takes over two hours to reach Kazaroho, an affected health area that is only 65 km away from Komanda, with the last 20 km only passable by motorcycle. Telephone coverage is both weak and irregular in the affected areas, local radio stations do not reach all affected health areas, and there is insufficient lodging for staff, forcing team members to travel to and from Bunia almost every day, a two-hour trip each way. Present activities include finalizing detailed mapping, which takes into account the area’s influential leaders, including women and adolescent leaders, existing social networks, the capacity of radio stations, and key information

UNICEF DR CONGO EBOLA SITUATION REPORT 10 December 2018 opportunities, and identifying effective communication channels between the teams and the leaders of affected communities. UNICEF partners remain engaged and are on their way to the affected zones. So far, 230 community leaders have been trained in five health areas, and briefings were completed with 916 students, 30 frontline workers, 37 religious leaders, 10 journalists, 30 health workers, and six local community-security committees. The two existing local radio stations have been engaged, and 400 posters and 3,500 flyers have been distributed. Responding to Resistance and Rumors The initial assessments of this early phase in Komanda also report that the population is in shock, with high levels of fear, mistrust, and incertitude. Six communication teams accelerated critical and timely briefings with leaders from all communities to prevent an escalation to violence, which would be more difficult to negotiate. There is little understanding from the population around the general response protocols, that include administrative policies, burial procedures, information on the Ebola treatment units, vaccination, and basic understanding of surveillance objectives and the concept of contact tracing. As the communication teams play the crucial role of preparing the communities for work of the surveillance and vaccination teams, efforts are being made to further strengthen coordination between teams. Promotion of Preventive Behaviors In Butembo, a new effort to mobilize and acknowledge the efforts of women was sponsored by the communications commission. As women are the main caregivers of the sick, they are also considered the most vulnerable in the Ebola response. Women’s organizations were invited to a meeting organized by women leaders, with the goal of encouraging women to take immediate action in collective surveillance responsibilities and to accompany all persons with symptoms to the nearest Ebola Treatment Unit (ETU) for analysis. “We ask all women to keep an eye on their communities, and to make sure friends and family members understand what is at stake. If a person goes to the ETU early, they have an 80% chance to survive, ETUs are the only place where Ebola can be treated’”, said Ms. Furaha, advisor and member of the group. The meeting was concluded by a large march in the town of Butembo by both older and young women to bring attention to gender equality and the rights of women. C4D Preparedness To prepare surrounding provinces for the possible intrusion of EVD, reinforced efforts to prepare leaders in vulnerable zones are being planned by all response components. In communications, through UNICEF’s partners, the Archbishop of Kisangani organized a workshop with all provincial pastors and launched “Operation Ceinture”, to inform religious leaders from all health zones on what to do and expect in case cases are identified and confirmed in the province. In Kasai, in collaboration with the provincial mayors, C4D staff participated in the training of 400 community leaders, 10 journalists, and 450 religious leaders. Agreements with three local radio stations were made in Mbuji-Mayi, and they were trained on risk-communication and their critical role in prevention as well as in response, if cases of Ebola are confirmed in the province. A national initiative has been put in place with the participation of partners (MoH, WHO, UNICEF, DFID, USAID, OIM, CDC, World Bank, JICA, KOICA) to address preparedness at a large scale. The initiative is being rolled out in three phases. The first phase was completed in November 2018 and covered six provinces. The second phase will last three months and will cover nine provinces, and the last phase will be implemented over one year and cover 26 provinces. Although this is planned within the context of EVD, the efforts will address preparedness for all health epidemics. The overall strategy is being developed, and will be followed by the development of provincial communication plans. At present, seven C4D experts from UNICEF have contributed to the national EVD preparedness initiative. This past week, an internal C4D meeting was organized by both field and support managers to share lessons learned, and how to better adapt and plan for this growing epidemic. Action points include the development of a stronger strategy

UNICEF DR CONGO EBOLA SITUATION REPORT 10 December 2018 to mobilize local populations as part of the managerial and operational core teams, and the acceleration of community- led surveillance and alert systems.

Water, Hygiene and Sanitation (WASH) During the reporting period, the health zone of Komanda in nearby Ituri province, an hour and a half from Beni, reported seven new confirmed cases. This makes the zone a priority hotspot together with Butembo, which is now reporting more daily cases than Beni. The WASH section deployed two staff in Komanda to support the immediate response. On 10 December 2018, an inter-agency mission including one WASH Adviser from UNICEF was on site to plan the next steps of the response. Two additional WASH officers are also expected to join the team in Butembo in the coming week. In terms of strategy, the WASH section is supporting the prevention commission in developing and implementing a strategy for the provision of hygiene and infection prevention kits for contact households and neighbors in all zones covered by the response. As of 10 December, 36 additional health facilities in the affected health zones in North Kivu province benefitted from essential WASH activities. These include the provision of handwashing points, briefing of staff on hygiene promotion and disinfection, and the installation of chlorination points, reaching a total of 457 health facilities since the beginning of the response. The roll-out of the performance-based financing system continued last week in Beni. The basic evaluation was conducted in 80 health facilities in Beni, and the analysis of results is currently being completed by WHO. WASH-Infection Prevention and Control (IPC) kits will be delivered next week to health centres as part of the performance-based financing project. In Butembo, 120 WASH-IPC kits for health centres arrived from Goma, covering 45% of the 267 health centers targeted. As of 10 December, 948 community sites (ports, market places, local restaurants, churches) have been provided with handwashing facilities and a total of 1,107,812 persons have gained access to emergency safe water in the affected health zones since the beginning of the response. The formative research study, “Perceptions and Use of Health Services in Ebola”, mentioned in the last Situation Report was concluded. Key findings indicated:

• An increase in the use of public health facilities of up to 700% in many health facilities as a result of free healthcare; • Perceptions of decreased quality of healthcare due to the free service, fuelled by rumors that health workers are not being paid or are overworked as a result of increased patients; • Perception that women are not included in interventions, highlighting the need for actions led by women and women’s groups. Recommendations from the community emerging from the research include the implementation of a performance- based financing system to increase the quality of service; the provision of specific support and health information for women, mothers and their children, including pregnant and breastfeeding who are not vaccinated against EVD; the identification of opportunities for sustainable investments in public and private health facilities; and the provision of support to private facilities, similar to what is provided to public facilities. The research will inform WASH-IPC and C4D interventions and will be shared with commissions in the coming week. It will be followed by additional work this coming week with healthcare workers, to understand how they are able to cope with the number of increased patients, their perceptions of their capacity to identify Ebola, and how they feel the Ebola response could better support them. Key activities in the reporting period:

• In Komanda, emergency water supply was provided to Bwanasura health centre where most of the suspected cases are received.

UNICEF DR CONGO EBOLA SITUATION REPORT 10 December 2018 • In Butembo, water supply was facilitated for the main hospital by supporting and negotiating with the local water users’ association. Twenty cubic meters of water will be supplied to the ETC from next week. • Fourteen public places in Butembo and Mangina health zones were provided with hand-washing stations. Thirty- eight active bucket chlorination points were also provided in Mangina. • Twenty-three schools were provided with assistance including WASH kits, hand-washing stations and thermoflashes (non-contact thermometers) in Komanda, Butembo, Beni and Mangina health zones. • Eighteen health centers in Komanda and Beni health zones were provided with WASH kits, while ten health centers in Butembo were provided with emergency toilets and showers.

Education Due to the increase in confirmed cases of EVD in Butembo and Lubero health zones, the number of targeted schools in the ongoing response was increased from 600 to 2,476. Since the beginning of the response, a total of 105,605 children in 477 schools have been reached, 10% of the response’s target number of children. Following efforts by UNICEF and its partners to scale up the response during the reporting period, 14,204 children were reached by education activities, a result almost seven times higher than the last reporting period. Despite all these efforts, the coverage rate remains low at 10%, due to an increase of almost four times in the target number of children, from 297,000 to 1,090,006 children. In the reporting period, 11 schools in Mandima health zone received Ebola sensitization and handwashing kits from UNICEF’s WASH section. In Butembo health zone, UNICEF’s WASH section provided handwashing kits and thermoflashes to 15 schools. 567 teachers and heads of schools from the aforementioned schools in Mandima and Butembo health zones were briefed on the usage of handwashing facilities and received Ebola prevention messages. In Beni health zone, handwashing facilities and thermoflashes were provided by UNICEF to 17 universities. UNICEF conducted joint visits with the Provincial Ministry of Education to four schools in Butembo health zone and five schools in Beni health zone. The purpose of the visits was to follow up the implementation of EVD-preventive measures in schools that received training and sensitization on Ebola prevention and to ensure that the prevention protocol is accordingly implemented. It was observed that the four schools visited in Butembo, with 4,188 students, set up handwashing stations either with the support of UNICEF’s NGO partners or by their own initiative, after sensitization on EVD-prevention. More guidance on prevention was provided during the visits where some misuse of the stations was noted. In Beni health zone, the five schools visited had previously received handwashing kits and thermoflashes from UNICEF’s NGO partners, Mercy Corps, Oxfam, and CBEKA. During the visits, it was noted that some schools were not effectively using the materials provided. According to the school’s directors, they are waiting for more children to reattend school before using them. Given this, UNICEF’s Education and WASH sections, together with the Provincial Ministry of Education, are planning to conduct refresher sessions on EVD prevention and additional follow-up visits to ensure the implementation of prevention protocol in the two health zones. In the period covered by the report, two EVD cases were reported in schools; one in the Komanda health zone, Ituri province and another in Beni health zone in North Kivu province. Actions were taken to strengthen EVD prevention measures in these schools, including decontamination of the classrooms of the two children. Parents of children from both schools were sensitized and briefed on the importance of vaccinating their children; after which they were vaccinated together with their children. In the school in Beni, El Salem Primary School, 20 classmates of the child with EVD and their parents were vaccinated. Nineteen teachers, including the school director, were refreshed on EVD prevention and were provided with psychosocial support. In the school in Komanda, Adventiste Primary School, handwashing kits were also provided. UNICEF continued its efforts to advocate for the reopening of schools in a protective environment for children, after they were closed in mid-September due to insecurity in Beni and Oicha health zones. UNICEF met with the Provincial

UNICEF DR CONGO EBOLA SITUATION REPORT 10 December 2018 Education Director of North Kivu 22, who reassured a gradual reopening of schools in the two health zones by the first half of December 2018. It was noted in the first week of December that only 10% to 20% of schools had been reopened, mostly in the urban area of Beni, out of 300 schools in Beni health zone.

Psychosocial and Child Protection3 Key results:

• During the reporting period, 42 children (11 confirmed and 31 suspected cases)4 went through existing ETCs and received individual psychological assistance. A total of 523 children have been reached in ETCs since the beginning of the response. Ten recreational kits were distributed, and more specific recreational materials such as toys, play mats, radios, and electronic tablets will be provided, following consultations with the NGOs managing the ETCs, Alima and Médecins sans Frontières. The additional materials will be procured by • UNICEF. • UNICEF and its partners provide psychosocial support and/or material assistance to EVD-affected families to ensure that they can continue to provide care for their children. In the reporting period, 242 families newly affected by EVD, including both confirmed and suspected cases, received psychosocial support and/or material assistance in all the affected health zones of North Kivu and Ituri Provinces. 165 hygiene kits and 133 food assistance were distributed to discharged and cured patients; 18 families received funeral kits; 47 families received newborn kits; and 59 families received non-food item (NFI) kits. • Twenty-nine orphans and 22 separated children due to the Ebola epidemic were identified, reaching a total of 409 out of the targeted 600. Over the last month, an increase in the rate with which orphans and separated children are being identified can be observed, with an increase of more than 50% from one month ago and an increase of 14% since the last reporting period alone. This can be attributed to the growing number of patients passing through the transit centers and the ETCs. The identified orphans and separated children all received appropriate care, including NFI kits and food assistance. • Four-hundred fifty contact persons received psychosocial support in the EVD-affected health zones of North Kivu, reaching a total of 5,335 persons. Other activities and needs/gaps identified:

• EVD cured persons continue to be followed by psychologists. In Mangina, a sanctuary has been set up by WHO and UNICEF for the medical and psychological follow-up of the cured persons. Specific psychotherapy and/or additional assistance are proposed, especially for children. For example, a one-month-old child, recently cured, received specific assistance for birth registration. His family will also receive assistance for the rehabilitation of their house.

2 The Provincial Education Director of North Kivu 2 covers the Grand Nord, which includes Beni and Oicha health zones. The Petit Nord is covered by the Director of North Kivu 1. 3 The UNICEF Child Protection team in DRC co-leads the psycho-\social pillar of the Ebola response with the Ministry of Health. The implementing partners are Danish Refugee Council (DRC) for North Kivu and Caritas for Ituri. All results, unless otherwise stated, are UNICEF results with implementing partners. 4This figure is issued from data collected by the psychosocial commission. 8

UNICEF DR CONGO EBOLA SITUATION REPORT 10 December 2018 • In Butembo, 100 new psychosocial agents were trained to meet the emerging additional psychosocial assistance needs linked to the increase in Ebola cases. • In Butembo, a growing number of incidents of community reluctance to the EVD response has been observed, mainly in the health zones of Vuhovi and Katwa. The Psychosocial Commission is actively providing psychosocial support at the community-level to facilitate the work and investigations conducted by the surveillance commission. • In Komanda, following newly identified positive EVD cases, 24 caregivers and 83 pregnant women received a psychosocial assistance in the Bwanasura health zone. 93 contacts received psychosocial support and food assistance. In addition, a joint activity of psychoeducation was organized for 97 persons by the psychosocial and communication commissions. The psychosocial commission also closely worked with the prevention commission to support the decontamination of homes and health centers. More psychosocial agents are needed to cover the Bwanasura, Katabey, Idohu, and Kazaroho health zones, and efforts are ongoing to train and identify agents.

Nutrition Key results in ETCs For the period covered by the report, the number of children who have had access to adequate nutritional care is steadily increasing through the actions of UNICEF and its implementing partners. From 24 November to 08 December, 12 children including four under six months of age and eight aged six to 23 months, received appropriate nutritional care. At the same time, 93 patients suffering from EVD received an adequate diet, improving overall medical and nutritional care. In addition, 95 pregnant and lactating women have improved knowledge on best practices for infant and young child feeding in emergencies (IYCF-E). Key results in communities In the communities and at the household level, UNICEF and its partners provided adequate feeding care to six infants under six months of age, and sensitized 922 pregnant and lactating women on IYCF-E practices. Specific actions carried out by the UNICEF during the reported period include:

• The role of nutritionists in the ETCs has been expanded to include the community component of IYCF-E; • The nutritionist of Mangina held a meeting with International Medical Corps (IMC), Danish Refugee Council (DRC), psychosocial agents and UNICEF staff at Makeke ETC to clarify the adequate nutritional care to be provided to separated children in the ETCs and in the communities. Despite these achievements, the operationalization of the community component of IYCF-E in EVD context remains a challenge due to the lack of an operational strategy. UNICEF therefore continues to support the National Nutrition Program (PRONANUT) in finalizing a strategy, including specific actions and key messages for separated children, orphans, and other vulnerable children in orphanages and in households. This community strategy will be implemented as a joint approach of the nutrition and child protection components of the response. Supply & Logistics There was no change in supply and procurement since the last Situation Report, with USD 2,911,612.47 worth of WASH, C4D, Child Protection, Health, Education, and Information and Communication Technology (ICT) items procured for Ituri and North Kivu province since the beginning of Ebola the response.

Human Resources As of 10 December, 62 UNICEF staff members are deployed to the affected health zones in North Kivu and Ituri provinces. Through the network of implementing partners mobilized by UNICEF for the response, a total of 429 personnel are currently deployed in the affected areas supporting the response. In preparation for a scenario where the epidemic persists and/or intensifies, efforts are underway to increase UNICEF’s surge capacity.

UNICEF DR CONGO EBOLA SITUATION REPORT 10 December 2018 External Communication The CO organized a press mission to Beni and Butembo for VoA and the NYT, covering the various dimensions of the Ebola Response, including community communication and psychosocial assistance to affected people. During the reporting period the Ebola crisis and UNICEF’s response received media coverage in The Economist, Europa Press, La libre Afrique and Digital Congo.net, Actualite.cd, TV5 Monde, and Voanews. A videographer of UNICEF arrived in the affected region early December to cover the impact of the Ebola crisis on children and the response put in place by the teams of UNICEF on the ground. New photo and video material produced by the videographer are posted on WeShare and are accessible to all. From 05 to 11 December 2018, UNICEF’s Regional Director for West and Central Africa visited the DRC country office, including a visit to Ebola response activities in Beni on 08 December. The visit included a meeting with UNICEF staff and response teams and youth groups actively involved in the response. She also participated in the strategic response coordination meeting. The Regional Director also visited an ETC and met with families affected by EVD. The visit to Beni was also covered by the videographer. The Regional Director also used the photos and videos of her visit on her twitter account. The UNICEF CO published 48 articles on its blog since the beginning of the crisis, as well as 48 Facebook posts, 30 pictures on Instagram and more than 310 tweets.

Funding Based on the Joint Response Plan developed by the Ministry of Health and Partners, the total funding required for the response is estimated at USD 105 million. As part of this joint response plan, UNICEF’s response strategy, focused on communication, WASH, psychosocial care, nutrition, and a cross-cutting education sector response, is estimated at USD21.8 million. The World Bank Group, through the Contingent Emergency Response Component (CERC) of its DRC Health System Project investment, recently approved an additional funding of USD 12,947,688.00, covering the funding gap reported in the last Situation Report. However, as the epidemic enters its fifth month, the Ministry of Health is currently revising the Joint Response Plan to include assumptions and additional needs until 31 January 2019 (Strategic Response Plan 2.1). the necessity for additional funds is therefore being anticipated.

UNICEF DR CONGO EBOLA SITUATION REPORT 10 December 2018

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018)

Funds available Funding gap Requirements* Appeal Sector $ Funds Received $ % Current Year**

Water, Hygiene and Sanitation - WASH / IPC 10,536,519 10,136,819 399,700 4%

Communication for Development (C4D) - Community engagement and 6,097,005 5,963,389 133,616 2% Communication for Campaigns

Child protection and Psychosocial Support 1,851,200 1,854,000 -2,800 0%

Medical Care : Management of Severe Acute 749,800 750,800 -1,000 0% Malnutrition in Ebola Treatment Center

Operations support, Security and Coordination costs and Information and 2,273,680 2,856,585 -582,906 -26% Communications Technology

Prepardness Plan 322,000 300,000 22,000 7%

Total 21,830,204 21,861,593 -31,390 0%

* Funding requirement includes budget for phase I ($ 8,798,899) and budget for phase II ($ 13,031,305) **Funds available include reprogrammed funds from Equateur Response

Next Sitrep: 23 December 2018

UNICEF DR CONGO EBOLA SITUATION REPORT 10 December 2018

Nord Kivu Province 2018

Ebola Response Tracking Indicators (10 Dec 2018) Change since New Target Total results last report ▲▼ RESPONSE COORDINATION # of affected localities with functioning partner coordination mechanism 6 6 1 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, 15,500 12,809 1,611 religious /traditional leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents.

#of frontline workers (RECO) in affected zones mobilized on Ebola response 10,200 7,932 699 and participatory community engagement approaches.

# of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church 11,500,000 7,552,577 799,446 meetings, schools, adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious misperception about Ebola, refusals to secure burials or resistance to 900 834 71 vaccination. # of listed eligible people for ring vaccination informed of the benefits of the 45,247† 44,447 8,489 vaccine and convinced to receive the vaccine within required protocols. % of respondents who know at least 3 ways to prevent Ebola infection in the 80% 91% 0 affected communities (from Rapid KAP studies)** WATER, SANITATION & HYGIENE # of health facilities in affected health zones provided with essential WASH 457 457 63 services. # of target schools in high risk areas provided with handwashing facilities 2,476 477 33 # of community sites (port, market places, local restaurant, churches) with hand 948 948 30 washing facilities in the affected areas # of people with access to safe water source in the affected areas 1,107,812 1,107,812 218,372 EDUCATION # of students reached with Ebola prevention information in schools 1,090,006+ 105,605 14,204

# of teachers briefed on Ebola prevention information in schools 32,296+ 4,877 567 CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of affected families with confirmed, suspects, probable cases who received 580* 580 63 one or several kits of assistance to support their children

# of affected families, including children, with confirmed, suspects and probable 580* 580 63 cases who received continuous psycho-social support in their community

# of contact family members, including children, who receive psycho-social 6,842** 6,321 1,426 support and/or material assistance # of separated children and orphans identified who received appropriate care 600 405 51 and psycho-social support NUTRITION

# of < 23 months children caregivers who received appropriate counseling on 9,756 3,557 992 IYCF in emergency

† The target is dynamic as the listing of eligible persons evolves +The target changes with changes in the epidemiology * This target is estimated based on the number of confirmed, probably, and suspected cases and is adjusted as the response progresses. ** The target is dynamic and 100% of listed contacts is the identified target

DRC EBOLA SITUATION REPORT 25 December 2018

Democratic Republic

of the Congo Ebola Situation Report North Kivu and Ituri

Photo Credit: Guy Hubbard 25 December 2018 SITUATION IN NUMBERS Highlights 585 total reported cases • The Strategic Response Plan (SRP) was reviewed by the Ministry of (MoH, 25 December 2018) Health, leading to SRP 2.1 which covers the period up to 31 January 2019. Following this, the total budget required for the overall Ebola 537 confirmed cases response in North Kivu and Ituri provinces for August 2018 to January (MoH, 25December 2018)

2019 is now estimated at USD 128.6 million, up from SRP 2’s USD 105 million. 308 deaths recorded among confirmed cases • As part of the joint SRP 2.1, UNICEF’s budget requirement is now (MoH, 25 December 2018) estimated at USD 25.7 million, an increase from USD 21.8 million in SRP 2. At present, UNICEF’s response has a funding shortfall of USD 3.9 7,428 contacts under surveillance million. (MoH, 25 December 2018)

• The elections were postponed from 23 December to 30 December, with the National Election Commission further declaring that there will be no UNICEF Ebola Response elections in Beni and Butembo in December due to the epidemic and Appeal instability. This has brought about pockets of civil unrest in affected areas, and the negative impact on the response is already being felt. US$ 25.763M

Ebola Response UNICEF’s Response Funding Status 2018 Target Result Funding

# of at-risk people reached through community engagement Gap and interpersonal communication approaches. (door-to- 15% 11,500,000 8,205,269 door, church meetings, small-group training sessions, school

classes, briefings with leaders and journalists, other) Ebola NK and Ituri Phases I & II # of listed eligible people for ring vaccination informed of the benefits of the vaccine and convinced to receive the 54,028† 53,031 Funding vaccine within required protocols. requirements* : Total # of people with access to safe water in the affected health $ 25,763,204 funding 2,060,758 1,202,812 zones available* 85% 6,555 # of teachers briefed on Ebola prevention information 32,296

# of affected families with confirmed, suspects, probable * Funding requirement includes budget for cases who received one or several kits of assistance to 659* 659 phase I ($ 8,798,899), phase II ($ 13,031,305) and phase II.I ($ 3,933,000) support their children **Funds available include Reprogrammed † The target is dynamic as listing of eligible persons is defined *The target is estimated based on both the number of confirmed, probable and suspected case, and is adjusted according to the funds from Equateur Response response

DRC EBOLA SITUATION REPORT 25 December 2018

Epidemiological Overview1Summary Table (25.12.18): Confirmed and Probable Cases Total deaths Suspect Cases under Province Health Zone Confirmed Probable Total recorded among investigation confirmed cases Beni 211 9 220 123 36 Butembo 39 0 39 27 11 Kalanguta 37 12 49 17 5 Kyondo 6 2 8 3 2 Mabalako 85 16 101 50 6 Masereka 7 1 8 2 0 Nord-Kivu Musienene 4 1 5 2 2 Mutwanga 3 0 3 2 0 Oicha 13 0 13 4 0 Katwa 77 4 81 47 10 Vuhovi 8 0 8 3 0 Biena 1 0 1 0 0 Ituri Mandima 17 3 20 10 2 Komanda 27 0 27 16 0 Tchomia 2 0 2 2 0 TOTAL 537 48 585 308 74 Previous Total 10 December 2018 452 48 500 240 87

1 Data source: Epidemiological table based on daily CNC numbers

DRC EBOLA SITUATION REPORT 25 December 2018 Key epidemiological developments Key points in the evolution of the epidemic during the reporting period include a notable increase in confirmed cases reported in Oicha, Komanda, and Mabalako health zones, following a period with very minimal or no confirmed cases. In Komanda health zone, ramping up the response here has become a top priority. In Mangina, in Mabalako health zone, UNICEF is working with partners for the implementation of two mobile teams made up of WASH and communications staff to be rapidly deployed in locations with confirmed cases, working with communities and local actors to quickly scale-up control and prevention activities in the affected areas.

Beni, Butembo, Katwa, and Kalanguta health zones are also areas of concern for the epidemic due to the high number of reported confirmed and probable cases. This situation presents a high risk of the epidemic’s further spread to Goma due to high daily mobility from Butembo, particularly through the axe Butembo – Lubero – Goma. Although the epidemic seems to have stabilized in Beni, the risks still exist as surrounding geographical areas remain affected.

Humanitarian leadership and coordination The Crisis Management Team continued to meet daily under the leadership of the Ministry of Health with all concerned partners and with the chairs of the different working groups providing thematic updates. UNICEF continues to support coordination in all locations with functional strategic or operational commissions, and co-leads the commissions on communication, WASH, and psychosocial care. UNICEF is also active in the working groups on logistics and vaccination. A UNICEF security specialist is also deployed in the field to support security assessment and safety of the operations. A recent development that is expected to have an important impact on the coordination and implementation of the response is the postponement of the elections, scheduled for 23 December 2018, to 30 December 2018. The National Election Commission further declared that there will be no elections in Beni and Butembo until March 2019, due to the epidemic and instability. This has brought about pockets of civil unrest in affected areas, and the negative impact of this development on the response is already being felt. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused around five coordination hubs based in Beni, Butembo, Tchomia, and Mabalako health zones. One sub-coordination hub is operational in Bunia city. The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases and the geographical extension of the epidemic to newly affected health zones. UNICEF coordinates Musienene, Katwa, Masereka, Vuhovi, Kalanguta, and Kyondo’s response from the sub-coordination group based in Butembo health zone, and efforts are underway for a second coordination team to be based in Butembo. A UNICEF multi sectorial team was deployed on December 5th to respond to the extension of the outbreak in Komanda.

Response Strategy In support of the joint response plan, the UNICEF response strategy will continue to focus on communication, WASH, and psychosocial care, nutrition, and a cross-cutting education sector response. As the epidemic continues into its fifth month, an operational review of the response led by the Ministry of Health is currently being carried out. The Ebola strategic response plan (SRP)was reviewed jointly by the MoH, WHO, UNICEF, and partners, leading to the development of SRP 2.1. The main goals of this revision include broadening the geographic scope of the response by deploying teams in geographic rings ahead of the virus, as follows: full response teams in health zones with confirmed cases at present; active response (mobile teams) in regions with contacts or within population movement routes leading to or out of zones with active cases; and stand-by teams in peripheral regions within eastern DRC for preparedness activities. Beyond January 2019, a longer-term perspective of a six-month response up to June 2019 is also being discussed.

DRC EBOLA SITUATION REPORT 25 December 2018 behaviors, and (3) address community concerns and rumors. The strategy is implemented through 5 pillars that include (i) community engagement; (ii) promotion of preventive behaviors; (iii) responding to resistance; (iv) advocacy and capacity building of actors and (v) communication in support of ring vaccination, surveillance, safe and dignified burials, and Ebola treatment centers

• The child protection and psychosocial support to EVD confirmed and suspect cases and their family members as well as contact families seek to (1) provide psychosocial support, (2) establish or re-establish social and community networks and support systems, (3) provide social kits to EVD-affected families, and (4) identify and provide appropriate care to orphans and unaccompanied children due to the Ebola epidemic. The key elements of the strategy include (i) psychosocial support for EVD confirmed and suspect cases, including children; in the Ebola treatment centers (ETC), psychosocial activities for children and their families, (ii) material assistance to affected families to better support children, (iii) the facilitation of professional help for children and families with more severe psychological or social problems/needs, (iv) the coordination of mental health and psychosocial support (MHPSS), and (vi) psychosocial assistance, appropriate care, and research of long-term solutions for orphans and unaccompanied children.

DRC EBOLA SITUATION REPORT 25 December 2018 Summary Analysis of Programme Response An overview of the key elements in the response, with a special emphasis on UNICEF’s response in the affected health zones, is detailed below.

Communication and social mobilization (C4D) Community Engagement C4D teams in Beni, Mangina, Butembo, Bunia, and Komanda health zones have continued their efforts to strengthen community engagement and community-based surveillance of the epidemic. The teams are now supported by ten additional UNICEF C4D Officers in Komanda and in newly affected health zones around Butembo, namely Katwa, Masereka, Lubero, Kyondo, Vuhovi and Kalunguta. A C4D Manager, based in Butembo, leads the coordination of C4D interventions.

In Komanda, with the support of UNICEF and its partner, Caritas, 167 community leaders were actively involved in mobilizing their communities’ efforts to curb the epidemic. Community dialogue sessions are conducted in villages in and around the epidemic’s epicenter. For example, the chief of Wales Vonkutu, a chiefdom located near Komanda, mobilized all 18 village and community leaders who were then briefed by UNICEF’s C4D Officer on the risks of Ebola disease and preventive measures. Community actors engaged in community mobilization activities are identified using a participatory “village” approach, where community influencers and social mobilizers are chosen by members of the village, with the participation of the village chief. The Caritas Bunia team regularly ensures monitoring missions to the health areas.

To further strengthen community engagement, community platforms that have already been implemented in the neighborhoods of Beni health zone were reorganized according to the health areas, conforming to the DRC’s health system. Various youth groups are now engaged in Butembo health zone to participate actively in the Ebola response. With the support of Caritas, at least 110 representatives and leaders of the youth groups of Butembo evaluated progress in the levels of awareness and engagement of young people. These groups also put in place measures to improve the impact of their interventions.

Responding to Resistance and Rumors

A study on knowledge, attitudes, and practices (KAP), using both quantitative and qualitative methodologies, was conducted in the Komanda health zone on 20 to 24 December 2018, with UNICEF support. The study aims to determine the level of knowledge, attitudes, and practices of the population following four weeks of the Ebola response in the zone, and analyze community perceptions. The information collected will enable the fine-tuning of the C4D strategy to meet the specific needs of the response in the zone. A total of 19 villages were randomly selected in eight health areas, including four EVD-affected health areas and four unaffected health areas. Four-hundred household heads were interviewed.

The survey results show that due to the outbreak, the community no longer perceives the hospital as an environment that can give them hope of recovery. Given this, some care structures are reporting only five patients per day seeking services, compared with more than 50 patients a day before the epidemic. The community members interviewed say they are afraid to go to the health center because they might be identified as a suspected Ebola case. Others believe that health workers "report suspected cases that are then brought to Beni to die". The indigenous peoples of Komanda health zone, who represent about 30% of the zone’s population, consider EVD as a "Bantu people disease", or a disease of the people who are not indigenous to the area.

To avoid the frustration of patients, prevent resistance, and address the community’s fears, the investigation team recommends that the Ebola treatment center (ETC) and laboratory be made functional in Komanda as soon as possible.

DRC EBOLA SITUATION REPORT 25 December 2018 The recommendations also state that the response team must strengthen their relationship with the leaders of the indigenous populations of Komanda, involving them as mediators and in community engagement efforts.

The KAP survey also highlighted low awareness in the health zone on the importance of safe and dignified burials (SDB). Only 21% of respondents in the affected areas know that SDB are organized to prevent the spread of the epidemic, not significantly higher than in the non-affected health areas at 19%. Regarding the Ebola vaccine, 76% of those interviewed in the affected health areas are aware of its existence, compared to only 42% in the unaffected health areas.

Resistance in Komanda health zone was found to be mainly related to rumors about the vaccine and safe SDB. A vaccination team was attacked two weeks ago in a village of Komanda by the indigenous people.

To better manage this situation, UNICEF and its partners have supported the organization of a traditional ceremony in Idowu health area, with the participation of all the elders of the village, indigenous peoples, and other groups. Commitments were made by indigenous peoples, village leaders, and other influential community members to accept response teams and engage in the fight against EVD. In other health areas, communication teams doubled up efforts to coordinate with authorities of the villages where incidents of resistance have been reported. Teams also supported the organization of community dialogue sessions. The C4D UNICEF team made two visits to the villages on the Bwanasura – Kazaroho axis, where strong reluctance was noted. Awareness-raising sessions and dialogues are continuing in these villages to facilitate immunization and decontamination activities.

Despite extensive efforts carried out by C4D teams, incidents of rumors, reluctance, and resistance were noted during the reporting period in the other health zones. For example, in Mangina health zone, the primary reason for resistance is the community’s belief that “the Ebola epidemic is already over", negatively affecting the level of community engagement in the response.

In Beni health zone, neighborhood leaders accompany the teams of the different commissions to manage resistance, and a positive impact in most neighborhoods has been observed. In Rwangoma health area, the youth gathered to address resistance, with more than 15 community leaders visiting the ETC to familiarize themselves with procedures in this structure so that they can educate members of their communities. Reinforced efforts continue to be made in more challenging neighborhoods that express stronger resistance towards the response.

Promotion of Preventive Behaviors

To strengthen community awareness of preventive behaviors, over 3,800 factsheets with information on Ebola in Swahili and in French, were disseminated in the affected areas of North Kivu and Ituri provinces. This tool was developed by the National Communication Commission with the support of UNICEF, and includes the contributions and feedback of field teams.

In Komanda health zone, after the capacity-building of various actors, sensitization on preventive behaviors continued through door-to-door visits, religious leaders in churches and mosques, community leaders, and mass media. According to the KAP study, these activities reached at least 85% of the population in all health areas included in the survey, with this percentage reaching 93% in affected health areas compared to 76% in the non-affected health areas. The survey also found that community-based workers and churches were the main sources of information for the population in the affected health areas, with 63% and 44% of the respondents identifying them as their main information source, respectively.

Despite the high percentage of the population receiving information, the KAP study shows that knowledge levels on preventive practices remain low. Only 54% of respondents in the affected health areas know at least three methods of EVD prevention. This number is much lower in non-affected health areas, with only 33%. This highlights the need to further strengthen communication interventions on preventive behaviors. For example, through mobilizing more

DRC EBOLA SITUATION REPORT 25 December 2018 influencers including village and neighborhoods chiefs, youth and women leaders, and local social networks such as churches, women's and youth associations. Interactive programs in local radios will also be multiplied.

C4D Preparedness

To prepare surrounding provinces for the possible spread of EVD to their areas, reinforced efforts were made to prepare local leaders and communities in vulnerable zones for a potential response. In Kisangani, opinion leaders and pastoral workers were trained by Caritas in communication approaches and essential messages for Ebola prevention. Trained youth groups are also taking action to raise awareness for several target audiences. In addition, at least four local radio stations are engaged in Kisangani and Isangi to educate people about the risks of Ebola disease and prevention measures.

Water, Hygiene and Sanitation (WASH) During the reporting period, the health zone of Komanda in nearby Ituri province continued to report EVD cases. The health zone has now reported a total of 27 confirmed cases. To quickly address the emerging needs, UNICEF WASH specialists have been deployed and directly support the Ministry of Health (MOH) to provide 20 health facilities in affected areas with handwashing stations and infection prevention and control (IPC) materials. During distributions, training is provided by WHO and medical NGOs on IPC, triage, case detection, and referrals. Forty schools and 103 public places in locations close to confirmed cases were also provided with handwashing stations. In addition, UNICEF providing all the WASH facilities to contribute to the set-up of a local Emergency Operations Center (EOC). UNICEF WASH has signed a small-scale funding agreement with the local NGO MUSAKA to scale-up activities in affected communities around Komanda. Discussions are ongoing with other potential partners to work along the road between Komanda and Bunia, and accelerate the IPC work in health facilities in the area. As a consequence of the increase in cases in Komanda health zone, the road between Bunia and Beni has become a hotspot with several locations affected: Nyakunde between Komanda and Bunia, and Otomaber and Oicha between Komanda and Beni. UNICEF WASH, together with the education teams, are planning to work with local partners to increase prevention activities in schools surrounding the location of confirmed cases. Churches and public places will also be targeted. However, some of the locations are challenging to reach; for example, Oicha is difficult to access due to insecurity. As new cases continue to be identified in Butembo and Katwa health zones every day, UNICEF WASH supported the prevention commission in adjusting the response strategy by improving the monitoring of activities done for each case, particularly in the surroundings of the homes of the confirmed cases, considering the short-cycle transmission mode of the disease and the worrying low proportion of known contacts among the last confirmed cases (20%, according MOH/World Health Organization). Key activities to be done around the location of each confirmed case include decontamination, the distribution of household prevention kits, distribution in schools of handwashing and cleaning/disinfecting kits with briefing sessions for the teachers and students, and the distribution of handwashing kits to public areas such as churches, markets, and moto taxi parking lots with public awareness sessions. The performance-based payment system in Beni health zone is ongoing for 72 health facilities. The number of facilities decreased from the previous Situation Report after eight facilities were dropped out of the performance-based financing program following evaluations showing ineligibility. After the distribution of IPC kits to the facilities during the reporting period, a first post-distribution evaluation will be conducted this week to measure the progress made by each facility. UNICEF WASH and the Research Unit is planning to conduct a formative research study in mid-January with the staff of a sample of targeted health facilities to better understand their perception of the project, its acceptance and level of implementation, and the Ebola response as a whole. This study will be conducted together with WHO.

DRC EBOLA SITUATION REPORT 25 December 2018 Key activities in the reporting period

• In Komanda, 20 health facilities in the four most affected health areas were provided with handwashing stations in clinical areas and near toilets; 236 health staff were trained in IPC; and 40 schools benefitted from a WASH intervention. In addition, UNICEF is directly supervising the building of eight toilets and four showers for the local EOC. UNICEF is also overseeing the installation of a ten-cubic meter water storage unit and is looking for prospective areas for a borehole to be drilled soon. • In Butembo, 14 health facilities were equipped with toilets and showers; 107 handwashing stations were distributed; 20 health facilities received a complete IPC kit; 68 handwashing stations were distributed to 13 schools; and one orphanage was supported with the construction of two toilets and two showers. In addition, the WASH team is contributing to building toilets at the coordination center in Butembo and is supporting the construction of the nursery at the ETC. • In Beni, two public water taps with water storage are 90% completed and are already delivering drinking water to the population nearby the hospital and Ebola transit center. Ten of the biggest churches in the city were equipped with handwashing stations prior to the Christmas gathering, and four orphanages are being supported to improve sanitary conditions.

Education Over the past two weeks, 13 new EVD cases, including 11 confirmed, were reported in 11 primary and secondary schools in Butembo, Mabalako, and Komanda health zones, impacting school attendance negatively. The number of schools with confirmed cases represents an increase of more than five times from the last Situation Report, with only two schools.

Specific interventions are being implemented focusing on schools with confirmed cases. Seven of the 11 schools with confirmed cases are located in Butembo health zone. Of these seven schools, five benefitted from sensitization activities to ensure that the EVD prevention protocol is well implemented. Four schools were decontaminated, with all students also receiving vaccinations. Sensitization activities were also conducted in the three affected schools in Mabalako health zone and in the one affected school in Komanda health zone. The process of decontamination and vaccination is ongoing for these schools, as well as for the remaining three schools in Butembo health zone. Six additional schools in Beni health zone also benefitted from sensitization activities. It was observed that students as well as teachers and school directors are becoming more conscious and aware of the danger of EVD. They are therefore accordingly applying the prevention protocol.

To address this worrying development, UNICEF and its partners scaled up activities and were able to reach 20,089 children and 151 members of Parents’ Committees in Beni, Butembo, Komanda, and Bunia health zones with information on EVD prevention and on prevention measures taken specifically in the schools. The number of children reached represents a 19% increase from the results of the last reporting period. As reported in the WASH section of the Situation Report, UNICEF WASH teams and their partners also provided handwashing facilities and thermoflashes2 to several schools in the affected health zones.

Since the beginning of the response, a total of 125,694 children in 645 schools have been reached out of the over one million children targeted by the response, 12% of the target. Ebola prevention information for schools using the Guidance Note for EVD Prevention in Schools, and posters and banners with Ebola prevention messages were provided to 1,678 teachers and heads of schools, including 24 heads of non-formal education institutions who were reached in collaboration with UNESCO.

To enable the scaling up of the implementation of the EVD protocol in schools, in line with the new targets of the response, 25 master trainers made up of inspectors and school directors were trained on the Guidance Note for EVD

2 Non-contact thermometers 8

DRC EBOLA SITUATION REPORT 25 December 2018 Prevention in Schools. In addition, the two provincial ministries of education were actively involved in all school activities. They recommended all school directors to give daily briefings on EVD prevention to all students and teachers before the beginning of classes to achieve "Zero Ebola in Schools". They also required the inspectors to monitor the use of the handwashing kits and thermoflashes during their school visits.

Psychosocial and Child Protection3 Key results

• During the reporting period, 112 children admitted to ETCs and received individual psychological assistance. Of this number, 48 were confirmed EVD cases while 64 were suspected cases. This number is more than two times the number of children admitted to ETCs in the last Situation report. This can be attributed to the increase in areas affected by EVD and in more cases being alerted in the areas. With these results, UNICEF has reached a total of 635 children in the ETCs and the nurseries children since the beginning of the response4. • On Christmas Day, UNICEF supported holiday celebrations for 44 children and their care workers in the EVD treatment centers and the nurseries. • One-hundred fifty-six families newly affected by EVD, including both confirmed and suspected cases, received psychosocial support and/or material assistance in all the affected health zones of North Kivu and Ituri Provinces. The assistance provided includes 125 hygiene kits and 385 food assistance packs distributed to discharged and cured patients. Eighteen families also received funeral kits, while 59 families received NFI kits5. • 92 children, including 44 orphans and 48 separated children, were identified. These children have been orphaned or separated due to the Ebola epidemic. A total of 497 orphans or separated children have been identified since the start of the response. They were all provided with appropriate care, including NFI kits and food assistance. The number of orphans and separated children identified during this reporting period represents an increase of 22% from the last Situation Report. As with the number of children passing through ETCs, this increase is attributed to the increase areas affected by EVD as well as the increase in cases. • 1,365 contact persons received a psycho-social support in the EVD-affected health zones of North Kivu and Ituri provinces reaching a total of 7,428 persons. Other activities and needs/gaps identified

• Two contact families who were identified as high risk were located en route to Goma from Beni after having been in Kisangani. They are being supported in their return to Beni. • Forty-eight psychosocial assistants and nine psychologists were trained in case management and how to deal with community resistance, specifically relating to challenging contexts in Katwa following increased community reticence in recent weeks. In all affected areas, teams of psychosocial assistants and psychologists continue to work face-to- face daily with community members to deal with resistance and reticence. • In Bwanasura/Komanda in Ituri province, 75 new psychosocial agents were trained to meet the additional needs for psychosocial assistance linked to the increase of Ebola cases. • Following the situation in Komanda health zone, with the increasing number of confirmed cases, 687 contacts in Komanda and 181 contacts in Nyankunde received psychosocial support and food assistance. In addition, a joint psychoeducation activity was organized by the psychosocial and communication commissions for 13 traditional healers and 349 persons.

3 The UNICEF Child Protection team in DRC co-leads the psycho-\social pillar of the Ebola response with the Ministry of Health. The implementing partners are Danish Refugee Council (DRC) for North Kivu and Caritas for Ituri. All results, unless otherwise stated, are UNICEF results with implementing partners. 4This figure is issued from data collected by the psychosocial commission. 5 Non-food items provided under the response’s psychosocial component are customized according to the specific needs of the target beneficiaries. Items can include mattresses, sheets, kitchen utensils, baby items, etc. 9

DRC EBOLA SITUATION REPORT 25 December 2018 Nutrition For the reporting period, 277 patients in ETCs received adequate nutritional care. Of this number, 29 were infants less than six months old, including 18 newborns. In the communities and at the household level, the nutritionists and psychosocial agents supported by UNICEF provided adequate feeding care to 29 infants less than six months old. They also sensitized 1,229 women caregivers on adequate infant and young child feeding practices (IYCF) in the Ebola context. Following efforts to monitor the use of breastmilk substitutes (BMS), the 29 infants at the community-level, including 18 newborns, were identified as being unable to breastfeed. These infants, from Ebola-affected zones, are in orphanages or separated from their mothers, while some are being treated in the ETCs together with their mothers who are too weak to nurse. Others are infants of frontline health workers, at high risk of contact and needing vaccination. The infants are reported to have received BMS, highlighting the crucial need to promote and protect IYCF practices. A new strategy for supporting IYCF in the community needs to be put in place, in coordination with the psychosocial commission. PRONANUT, the national nutrition program, has requested UNICEF to procure RUIF (ready to use infant formula), to be used as a last resort for infants unable to breastfeed. The first quantities will arrive by 10 January 2019 in the country. As needs are expected to be high, new orders need to be placed. In addition to the above, the following activities were carried out by the UNICEF nutrition staff during the reporting period:

• New UNICEF nutrition staff were deployed in Beni. • An informative sheet on IYCF in the Ebola context and the use of BMS was developed by staff and the nutrition cluster, targeting other response actors and donors. • A meeting with implementing partners, Alima, Médecins Sans Frontières, and the Danish Refugee Council, was held to advocate for the strict application of the guidelines on limiting the use of BMS and the code of marketing of breastmilk substitutes. • Specific information sheets on cup-feeding was developed, targeted to health workers in ETCs. Cup-feeding is an alternative to using bottles and teats, that is in compliance with IYCF guidelines. • The supervision of nutritional activities in the ETCs and the supply of 2,600 cartons of ready-to-use therapeutic food (RUTF) and essential medicines for the treatment of severe acute malnutrition cases in the affected health zone are ongoing. Supply & Logistics Since the beginning of the response, USD 3,355,266.97 worth of items composed of WASH, C4D, child protection, health, education, and ICT supplies have been procured for the Ebola response in Ituri and North Kivu provinces. Offshore procurement represents a total value of USD 1,310,256.71 or 39 %, and local procurement represents a total value of USD 2,044,993.26 or 63%. Human Resources As of 23 December, 81 UNICEF staff members are deployed to the affected health zones in North Kivu and Ituri provinces. In preparation for a scenario where the epidemic persists and/or intensifies, efforts are underway to increase UNICEF’s surge capacity.

External Communication The CO issued a new press release focused on the number of Ebola-cases among children, linked to the visit of UNICEF’s Regional Director for West and Central Africa to the affected zone. The press release was picked-up widely by international media, including by Mail Online UK, CGTN News, ABC.es, All Africa.com, Europa Press, Deutsche welle, Channelafrica.co.za, ENCA, New York Times, Itv.com, Prensa Latina and Mail Online UK. The CO also facilitated a press

DRC EBOLA SITUATION REPORT 25 December 2018 mission to the affected region for ITV, NRC Handelsblad/NOS, De Volkskrant, and Frankfurter Randschau. A videographer for UNICEF travelled during the reporting period to Beni and Butembo, gathering photo and video material that are being posted on WeShare and are accessible to all. The UNICEF CO published 53 articles on its blog since the beginning of the crisis, as well as 52 Facebook posts, 33 pictures on Instagram, and almost 350 tweets. Recent stories posted on digital platforms include Ebola: inform to better vaccinate and Getting back to normal after Ebola strikes.

Funding On 20 December 2018, following the strategic and operational review of the response conducted in Beni and Butembo from 8-10 December, the MOH updated the Ebola Response Plan (Strategic Response Plan 2.1, November 2018 – January 2019) to include assumptions and additional needs until 31 January 2019. The needs therein are estimated at USD 23,506,000.00. With this, the grand total of the budget for the Ebola response in North Kivu and Ituri provinces from August 2018 to January 2019, including the initial budget and the additional budget needed, is now estimated at USD 128,617,545. As part of the joint response plan, UNICEF’s response strategy focusing on communication, WASH, psychosocial care, nutrition, and a cross-cutting education sector response is estimated at USD 25.7 million. At present, UNICEF’s response has a funding shortfall of USD 3.9 million.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018)

Funds available Funding gap Requirements* Appeal Sector $ Funds Received $ % Current Year**

Water, Hygiene and Sanitation - WASH / IPC 12,320,519 10,136,819 2,183,700 18%

Communication for Development (C4D) - Community engagement and 6,841,005 5,963,389 877,616 13% Communication for Campaigns

Child protection and Psychosocial Support 2,251,200 1,854,000 397,200 18%

Medical Care : Management of Severe Acute 749,800 750,800 0 0% Malnutrition in Ebola Treatment Center

Operations support, Security and Coordination costs and Information and 3,278,680 2,856,585 422,094 13% Communications Technology

Prepardness Plan 322,000 300,000 22,000 7%

Total 25,763,204 21,861,593 3,902,610 15% * Funding requirement includes budget for phase I ($ 8,798,899), phase II ($ 13,031,305) and phase II.I ($ 3,933,000) ** Funds available include reprogrammed funds from Equateur Response Next Sitrep: 06 January 2019

Who to contact Gianfranco Rotigliano Tajudeen Oyewale Pierre Bry for further Representative a.i. Deputy Representative Chief Field Operations UNICEF DRC information: UNICEF DRC UNICEF DRC Tel: + (243) 996 050 399 Tel : +(243) 996 050 200 Tel: + (243) 817 045 473 E-mail: [email protected] E-mail : [email protected] E-mail: [email protected]

DRC EBOLA SITUATION REPORT 25 December 2018 Nord Kivu Province 2018 Change since Ebola Response Tracking Indicators (10 Dec 2018) New Total last report Target results ▲▼ RESPONSE COORDINATION # of affected localities with functioning partner coordination mechanism 6 6 0 COMMUNICATION FOR DEVELOPMENT # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, religious /traditional 15,500 14,360 1,551 leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents. #of frontline workers (RECO) in affected zones mobilized on Ebola response and 10,200 8,644 712 participatory community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, 11,500,000 8,205,269 652,692 adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious 900 889 55 misperception about Ebola, refusals to secure burials or resistance to vaccination. # of listed eligible people for ring vaccination informed of the benefits of the vaccine and 54,028† 53,031 8,584 convinced to receive the vaccine within required protocols. % of respondents who know at least 3 ways to prevent Ebola infection in the affected 80% 91% 0 communities (from Rapid KAP studies)** WATER, SANITATION & HYGIENE # of health facilities in affected health zones provided with essential WASH services. 857+ 506 49

# of target schools in high risk areas provided with handwashing facilities 2,476+ 565 88 # of community sites (port, market places, local restaurant, churches) with hand washing 1,848+ 1052 104 facilities in the affected areas # of people with access to safe water source in the affected areas 2,060,758+ 1,202,812 95,000 EDUCATION # of students reached with Ebola prevention information in schools 1,090,006 125,694 20,089

# of teachers briefed on Ebola prevention information in schools 32,296 6,555 1,678 CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT # of affected families with confirmed, suspects, probable cases who received one or several 659* 659 79 kits of assistance to support their children # of affected families, including children, with confirmed, suspects and probable cases who 659* 659 79 received continuous psycho-social support in their community # of contact family members, including children, who receive psycho-social support and/or 8128** 7428 1107 material assistance # of separated children and orphans identified who received appropriate care and psycho- 600 501 92 social support NUTRITION # of < 23 months children caregivers who received appropriate counseling on IYCF in 9,756 4,786 1,229 emergency † The target is dynamic as the listing of eligible persons evolves +The target changes with shifts in the epidemiology * This target is estimated based on the number of confirmed, probable, and suspected cases, and is adjusted as the response progresses. ** The target is dynamic and 100% of listed contacts is the identified target