DRC EBOLA SITUATION REPORT 12 May 2019

Democratic Republic of the Congo Ebola Situation Report and Ituri

PhotoPhoto Credit: Credit: UNICEF UNICEF DRC DRC Tremeau Thomas Nybo

12 May 2019 SITUATION IN NUMBERS

Highlights 1,705 total reported cases (MoH, 12 May 2019) SITUATION IN NUMBERS • Insecurity persists in Katwa and health zones, resulting in 1,617 confirmed cases temporary suspension of activities. On 3 May, a Safe and Dignified (MoH, 12 May 2019) Burial team was violently attacked by community members after the burial of a confirmed Ebola case. On 8 May, 50-armed militia entered 484 children <18 among confirmed

Butembo and opened fire in the city. This led to the temporary cases (MoH/ WHO, 12 May 2019) suspension of activities for five days 20 January 2019 deaths among confirmed cases 1,036 (MoH, 12 May 2019) • As of 7 May, women and children continue to be disproportionally affected by the virus, of the total cases with recorded sex and age, 12,320 contacts under surveillance 57% (907) were female and 30% (475) were children aged less than (MoH, 12 May 2019) 18 years. UNICEF Ebola Response Appeal

US$ 50.15 million Ebola Response Funding Status 2018 - 2019 UNICEF’s Response Funding Gap Indicator Target Result US$7.93M 16% # of at-risk people reached through community engagement and interpersonal communication approaches (door-to-door, church 19,500,000 15,339,003 meetings, small-group training sessions, school classes, briefings with leaders and journalists, other) Ebola NK and Ituri Phases # of listed eligible people for ring vaccination informed of the I, II & III benefits of the vaccine and convinced to receive the vaccine within 116,473 * 114,553 Funding requirements* : required protocols. $ 50,149,121 # of households of confirmed cases, contacts and neighbours of confirmed cases who received a hygiene and prevention kits with 15,000 2,476 Total funding adequate messaging available** US$42.21M # of teachers briefed on Ebola prevention information 32,296 21,650 84% # of affected families with confirmed, suspects, probable cases who 5000** 4,727 * Funding requirement includes budget for phase I ($ 8,798,899), received one or several kits of assistance to support their children phase II ($ 13,031,305), phase II.I ($ 3,933,000) and phase III ($ 24,385,917) * The target is dynamic as listing of eligible persons is defined **Funds available include Reprogrammed funds from Equateur **The target is estimated based on both the number of confirmed, probable and suspected case, and is adjusted according to the Response and funds received since August 2018 response

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DRC EBOLA SITUATION REPORT 12 May 2019 Guy

Epidemiological Overview1 Summary Table (12/05/19) Confirmed and Probable Cases Deaths Suspect Cases under Province Health Zone Deaths among Confirmed Probable Total Total Deaths investigation confirmed cases 279 9 288 151 160 49 Butembo 167 0 167 183 183 10 Kalanguta 85 15 100 40 55 18 Kyondo 19 2 21 13 15 16 Mabalako 142 16 158 97 113 7 Masereka 36 3 39 14 17 1 Musienene 38 1 39 19 20 11 Mutwanga 5 0 5 3 3 11 Nord-Kivu 41 0 41 20 20 13 Katwa 541 14 555 362 376 13 Vuhovi 79 12 91 28 40 3 Biena 7 1 8 8 9 30 0 0 0 0 0 4 Kayna 8 0 8 4 4 4 Mangurujipa 10 0 10 4 4 15 Lubero 8 2 10 2 4 16 Mambassa 0 0 0 0 0 5 Mandima 119 4 123 73 77 14 Komanda 28 9 37 10 19 3 Ituri Nyakunde 1 0 1 1 1 0 Tchomia 2 0 2 2 2 0 Bunia 2 0 2 2 2 8 Total 1617 88 1705 1036 1124 251 Previous Total 29 April 2019 1400 66 1466 891 957 239

1 Data source: Epidemiological table based on daily numbers by the National Coordination Committee (Comité National de Coordination, CNC)

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DRC EBOLA SITUATION REPORT 12 May 2019 Key Epidemiological Developments The Ebola outbreak in the Democratic Republic of the Congo (DRC) continues to take place in the provinces North Kivu and Ituri, both affected by conflict and armed violence. According to latest risk assessments by the World Health Organization (WHO), the national and regional risk levels remain very high, while global risk levels remain low. Since late February, recorded cases of Ebola have increased per weekly basis. A general deterioration of the security situation, and the persistence of community mistrust exacerbated by political tensions, have resulted in temporary suspension of activities and delays in case investigations. The high proportion of community deaths reported among confirmed cases, relatively low proportion of new cases who were known contacts under surveillance, existence of transmission chains linked to nosocomial infection, persistent delays in detection and isolation in ETCs, and challenges in the timely reporting and response to probable cases, are all factors increasing the likelihood of further chains of transmission in affected communities and increasing the risk of geographical spread both within the DRC. This past week saw a continued increase in the number of new Ebola virus disease (EVD) cases reported in the North Kivu and Ituri provinces of the Democratic Republic of the Congo, with a total of 106 new confirmed cases reported. The outbreak remains contained to a geographical area, with hotspot areas within Katwa, Mandima, Butembo, Mabalako and Musienene health zones. In the 21 days between 15 April – 5 May 2019, 76 health areas within 14 health zones reported new cases, representing 47% of the 163 health areas affected to date (Table 1 and Figure 2). During this period, a total of 298 confirmed cases were reported, the majority of which were from the health zones of Katwa (40%, n=120), Mandima (13%, n=40), Butembo (13%, n=38), Musienene (8%, n=25), Mabalako (8%, n=24), and Beni (6%, n=19).

As of 12 May 20192, a total of 1705 EVD cases, including 1617 confirmed and 88 probable cases, were reported. A total of 1,124 deaths were reported (overall case fatality ratio 66%), including 1036 deaths among confirmed cases. Of the 1705 confirmed and probable cases with known age and sex, 56% (951) were female, and 29% (502) were children aged less than 18 years. The number of healthcare workers affected has risen to 101 (6% of total cases).

Humanitarian Leadership and Coordination

UNICEF continues to support coordination in all locations with functional strategic or operational commissions, and co-leads the commissions on communication and community engagement, WASH - IPC, and psychosocial care. UNICEF is also active in the working groups on logistics, vaccination and nutrition.

The strategic Ebola response coordination based in Goma maintains a strong support to active operational coordination (Butembo / Katwa, Mangina, Mandima , Vuhovi, Beni and all active 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. A multi-sectoral UNICEF Rapid response team is in place and deployed to new hotspots as required.

The past week showed a continued deterioration of the security situation in Butembo city. 3 May 2019, a safe and dignified burial (SDB) team in Katwa was also attacked after conducting a SDB of a confirmed case. Response activities were temporarily suspended in Butembo and neighbouring health zones from 4-5 May 2019 following a civil demonstration by members of a local moto-taxi drivers union. Response operations later resumed following negotiations with community leaders, threats of attacks persisted against some healthcare facilities and healthcare providers. On 8 May, Butembo centre was at the heart of a coordinated attack apparently targeting some local institutions. Despite no response actors were affected, activities were suspended for 48 hours. In Butembo, current

2 Source: World Health Organisation 12 May 2019

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DRC EBOLA SITUATION REPORT 12 May 2019 coordination efforts aim to enhance security measures collectively through the UN Security Management System. Coordination efforts included updating security risk management processes by addressing procedural, operational and physical security measures.

Response Strategy The Ebola response is based on the joint National Strategic Response Plan (SRP) III against the Ebola Virus Disease (EVD) in North Kivu and Ituri provinces, which covers a six-months period until 31 July 2019. SRP III aims at containing the transmission of EVD in the provinces of North Kivu and Ituri and to avoid the spread of the disease to new health zones as well as neighbouring provinces and countries. Through the broadening of the scope of the response to all 70 health zones in North Kivu and Ituri provinces to eradicate Ebola and due to the longer six-month time frame, in comparison with previous planning, SRP III allows for greater flexibility in adopting rapid, effective and needs-based response measures. The strategy further provides for a strong anchoring of the response in the local health system, the strengthening of the information management system, and a strong accountability framework. In support of SRP III, the UNICEF Ebola response strategy continues to focus on communication and community engagement, WASH, and psychosocial care, nutrition, and a cross-cutting education sector response.

Summary Analysis of Programme Response

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

Communication and Social Mobilization The risk communication, social mobilization and community engagement aims to (1) proactively engage with affected and at-risk communities, (2) provide timely and accurate health advice to encourage positive health seeking behaviours, and (3) address community concerns and rumors. The strategy is implemented through five 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 ETCs. Implementing Partners (IP): Oxfam GB, Action Contre la Faim (ACF), Search for Common Ground, Caritas Congo, Réseau des Medias pour le Développement (ReMed), MEDAM

Main activities during the reporting period

Risk Communication and Community Engagement (RCCE)

In Butembo health zone, the executive members of the Federation of Congolese Enterprises (FEC) collaborated with local authorities to prevent escalation of violence following the death of a motorcyclist during an Safe and Dignified Burial (SDB) through meetings with taxi and moto associations in the city.

On 5 May, as part of World Hand Hygiene Day, a carnival was organized to raise awareness on hand hygiene by women and men from various churches along the main roads in Goma city. This promoted the usage of installed handwashing stations to prevent the spread of Ebola.

UNICEF's partner, Search for Common Ground, organized a workshop on risk communication and the importance of positive information to all the editors and deputy editors of 36 local radio stations (16 of Katwa health zone, of Butembo health zone, two of Vuhovi health zone, eight of Masereka health zone) and eight correspondents of national radio and television stations in Butembo heath zone.

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DRC EBOLA SITUATION REPORT 12 May 2019 Responding to Refusals/Reticence and Rumours

A total of 204 refusals and reluctances related to vaccination, decontamination, transfers to ETC, SDB / SWAB were identified in the reporting period, of which 109 refusals and reluctances were resolved (53%).

During the reporting period, two major rumors (one about ETCs as a place where infected people systematically die and the second about the decontamination of households as a way of transmitting Ebola to families) were resolved in Butembo health zone. With the support of 22 Community Animation Cells (CACs), a series of guided visits to the ETCs were organized in Butembo and Katwa health zone, followed by sharing testimonies of cured persons on radio stations and press conferences. In Bunia, strong reticence to SDB persist despite community dialogues with the community. Out of 215 alerts on SDB received, only 31 alerts (14%) were resolved. Rumors that come up through community dialogues and educational talks include: • Ebola is perceived as a business. The disease was created by white people and through the help of Congolese doctors and nurses, the disease is spread to patients in health centers and hospitals. • Ebola is a disease of evil spirits; which explains the persistence of the disease • The Congolese government is collaborating with white people as the government does not want to organize a mass vaccination The RCCE commission recommends harmonizing messages to communities in order to avoid confusion with different messages. The commission is planning to reinforce interpersonal communication with community leaders to respond to these rumors. In addition, radio broadcasts were organized with Bunia’s 14 radio stations and Ebola response specialists, to help diffuse appropriate information to the population. Thanks to the RCCE commission’s advice, the Coordination in Bunia is organizing a press conference with the new Governor of Ituri, who will help diffuse messages on Ebola prevention to the population.

Promotion of Preventive Behaviours

38 radio stations in Beni, Oicha, Mangina and Butembo health zones have produced and broadcast 15 spots on Ebola prevention. In addition, four testimonies of cured persons from Katwa ETC were also broadcast to show that patients do come out of ETCs alive and that Ebola can be cured. Three newspaper articles were produced and broadcast on the 38 radio stations in French, Swahili and Kinande on the risks of self-medication for patients with symptoms of Ebola. These are to encourage patients to seek treatment at health facilities or to be taken in charge by ETCs. In Butembo health zone, four “sisi wate tupijanish ebola”, which translates to all against Ebola, broadcasts were produced and broadcast on the contribution of children in the fight against community incidences. In Butembo health zone, young influencers participated in two activities in Kyangike and Vulamba health areas. These activities focused on the roles of young people in rumor management. The second activity is requested the young influencers to organize meetings on Ebola prevention in their neighborhoods and promote the involvement of women. The mayor of Beni city organized a meeting with the security council to promote the theme of "make the fight against Ebola Beni my fight". Preparedness

As part of the preparedness activities, the Goma Communication Subcommittee conducted a sensitization session on the risks associated with EVD to 30 children in the city’s children's parliament. All young parliamentarians have 5

DRC EBOLA SITUATION REPORT 12 May 2019 included issues related to the disease in the agenda for parliamentary sessions. Also in Goma, 620 people from the Bukumu group and 87 members of the Muslim Women's Association benefited from information on EVD and prevention measures in Goma’s four risk areas.

In Butembo, 103 motorcycle taxis in Wayene health area were trained on the risks of EVD and their roles in stopping the spread of the virus. In Musienene health zone, 326 women leaders and 50 men were trained on the preventive measures against EVD by focusing on the actions carried out around the confirmed cases, SDB, SWAB and transfer of patients to ETCs with the support of CARITAS.

In Bunia, 255 community relays and community leaders from 7 health areas were briefed on risk communication and community engagement during EVD outbreaks.

Upcoming Activity

The RCCE Commission in Goma plans to organize three major workshops:

• 16-19 May: workshop on the harmonization of prevention messages • 20-21 May: Community Animation Cells (CAC) Workshop • Harmonization workshop for training modules. A C4D Specialist from WCARO is in Goma working with partners to develop a common Training of Trainers approach that will use the harmonized training materials.

Key Results

Total Result Change since COMMUNICATION AND SOCIAL MOBILIZATION Target3 UNICEF last report # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities (CAC, women and women’s 39,595 39,595 8271 organisations, religious /traditional leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, adolescents and private sector). # of frontline workers (RECO) in affected zones mobilized on Ebola response and participatory 18,927 18,927 1303 community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, 19,500,000 15,673,599 334596 adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious 5,481 5,481 578 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 116,473* 114,553 6,988 convinced to receive the vaccine within required protocols. % of respondents who know at least 3 ways to prevent Ebola infection in the affected 90% 56% 0 communities (from Rapid KAP studies4) * The target is dynamic as listing of eligible persons is defined

Infection Prevention and Control (IPC) and Water, Hygiene and Sanitation (WASH) The Water, Sanitation, and Hygiene (WASH) strategy, as part of EVD Infection Prevention and Control (IPC), aims to stop the spread of the disease through (1) the provision of WASH in public and private health care facilities plus

3 Targets cover the period since the beginning of the outbreak in August 2018 and include the more recent targets based on the Strategic Response Plan III (1 February to 31 July 2019), covering all health zones in Ituri and North Kivu province. 4 KAP results will be shared in the next sitrep, 12 May 2019

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DRC EBOLA SITUATION REPORT 12 May 2019 reinforcement of basic WASH services, which includes the provision of water and WASH kits5 and awareness raising of traditional practitioners (2) hygiene promotion and provision of WASH kits in schools6, (3) WASH in communities through mass outreach on hygiene promotion and the setup of handwashing stations/ temperature check points in strategic transit locations, and (4) joint7 supervision of health infrastructures to ensure that efficient and sustainable programmes of high quality are developed.

Implementing Partner: Mercy Corps, Red Cross DRC, OXFAM GB, Action Contre la Faim (ACF), MEDAIR, Programme de Promotion des Soins de Santé Primaires (PPSSP), Mutuelle de Sante Canaan (MUSACA), and CEPROSSAN

Main activities during the reporting period

Infection Prevention and Control (IPC) and Water, Hygiene and Sanitation (WASH)

At the Ebola Coordination Center in Goma, as co-lead, UNICEF works with the IPC commission to strengthen and harmonize activities within the overall coordination. The commission with UNICEF and WHO is in the process of presenting an ongoing series of workshops focused on IPC Standard Operating Procedures and standardized data collection tools. In addition to Goma, this workshop has been held in Beni and will be recurrent with the IPC sub- committees in Mangina, Bunia and Komanda in the weeks to come.

All commissions, including IPC have finalized the operational action plans along with implementation monitoring tools for each sub-coordination for the remainder of SRP3 and is under review for final validation by the Ministry of Health.

To strengthen community engagement, UNICEF WASH teams are identifying and partnering with local organizations with long-established links with affected communities. By partnering with such organizations UNICEF aims to strengthen community engagement and have improved access to insecure intervention areas. In addition, new agreements with partners have been finalized to ensure that ongoing activities remain consistent until the end of July. Preparedness activities continue in non-affected areas and additional activities are being developed to strengthen preventative measures.

Working with the UNICEF supply team, WASH is putting mechanisms in place (tracking tools) that will allow for close monitoring of critical supply orders. Further to this, a workshop for the Operation team (admin, supply, human resources) was held in Goma on May 6-8 in which WASH staff participated – this workshop aimed to address bottlenecks in the WASH supply chain. While this is positive progress in reinforcing the supply mechanisms, careful monitoring and support is required to guarantee consistent stock is available for project implement.

Ongoing insecurity and resistance in communities in the Butembo health zone continues to impact the response negatively. Due to attacks and threats against response teams, many activities have had to be put on hold. Security escorts have been met with mixed responses of acceptance and reluctance. Given the limited movement of the response teams, the IPC commission is finding ways to adapt to difficult circumstances; one example of this is empowering/training hygienists in the health care facilities to conduct decontamination activities themselves. At the household level, family members are being implicated in the decontamination of their own households, under the supervision of trained IPC specialists.

Despite this persistent challenge, limited activities were performed with World Health Organisation and the Ministry of Health partners in response to 80 of 126 cases, with the decontamination of 75 health care facilities, 4 Schools (1000, students) and 102 households (612 family members) and 639 households (3,834 beneficiaries) receiving prevention kits in nine health zones. Additionally, IPC/WASH kits have been distributed within the rings to 21 schools (5,250 students) and 12 health care facilities.

In Oicha health zone, drilling was successful by the SNHR (National Society of Rural Hydraulics) at the General Reference Hospital, resulting in a 65m deep well with a potential of 5,000 litres/hour. Work continues with the installation of the

5 IPC/ WASH kits for health centres, items are provided in accordance with four areas of support: (1) Triage and case identification, (2) handwashing, (3) individual protection equipment, (4) waste management, (5) cleaning and decontamination. 6 IPC/ WASH kits for health centres, items are provided in accordance with four areas of support: (1) Triage and case identification, (2) handwashing, (3) individual protection equipment, (4) waste management, (5) cleaning and decontamination. 7 Multidisciplinary teams comprise health specialists from the MoH and/ or Medical NGOs as well as WHO. 7

DRC EBOLA SITUATION REPORT 12 May 2019 pump and water network to the hospital storage tank. Construction of 13 showers and latrines (520 beneficiaries) were completed by partner Medair at the Oicha Transit Center, however, improved WASH infrastructure is still needed in both health facilities. With the support of UNICEF, the Oicha Development Organization (ODO) continues to manage and monitor the water supply to public handwashing facilities within the health zone.

55 confirmed cases were reported in the Mandima and Mabalako health zones (within the Mangina sub-coordination). In response to these cases, hygiene kits were distributed to 123 households (738 beneficiaries) as well as WASH kits to one health facility, five churches and five public places. Regarding decontamination, 15 health centres, 28 households (168 beneficiaries) and 3 places of worship were decontaminated in the 24 hours after confirmation of a case. It is important to note that in the face of insecurity and resistance, teams were unable to gain access to respond to reported cases in Visiki, Aloya, Katanga, Vusayiro and Bingo health areas.

In response to suspect EVD cases coming to Komanda from Butembo and Katwa, a renewed emphasis has been made on the reinforcement of EVD prevention activities in Ndalya, Bwanasura, Idohu, Lula and Samboko health areas. In an effort to strengthen local capacities, particularly when response teams are unable to respond due to insecurity, briefings were held with six IPC Supervisors from health facilities, schools and public places from Idohu, Bwanasura, Ndalya and Nyankunde health areas. These briefings aimed to support the IPC Supervisors on conducting WASH assessments and the provision of WASH kits as well as working with them to improve acceptance in communities. Further to this, WASH kits were provided to 31 schools (7,750 students) and 2 health care facilities in Idohu, Ofay, Mangiva and Bamande Health Areas.

Results of a post distribution survey for hygiene kits that was conducted in Komanda (38 households) highlighted some areas of improvement in response to a low use of water treatment products, limited water storage capacity and lack of soap. This interaction also gave the community an opportunity to pose questions and for the response team to respond and provide information.

In Mambasa health zone, the strengthening of EVD prevention activities and additional materials were needed to respond to new hotspots (Byondo mining site, Pede Health Area). Due to the lack of viable sources there is a shortage of water and an insufficient water supply for handwashing devices in public places. Drilling activities were delayed at the Mambasa General Reference Hospital, however, should move ahead this week, as should the installation of 2 additional entry points at the Isiro and Kisangani axes.

In Bunia HZ, efforts are being made to ensure consistent supply of kits for distribution particularly with ongoing challenges of purchasing materials locally. A WASH kit was distributed to 1 school (250 beneficiaries). 97,760 litres of chlorinated water were distributed in health facilities, schools and public places of Bunia and Rwampara. A programmatic visit was conducted with a partner to access the progress and quality assurance of their preparedness activities. Due to stock ruptures and supply delays, just 49/120 health care facilities had received WASH kits. Ensuring a consistent supply is a programme priority. Evaluations continue to identify and formalize partnerships with local organizations to support community-based approaches. Progress is being made on the extension of the water supply from the Bunia General Reference Hospital to the latrines of the coordination response.

Preparedness activities continue in Goma and surrounding area with 233 children who attended Ebola prevention sessions and the distribution of WASH kits to 23 health facilities and 34 traditional practitioners. As well, agreements with partners are being finalized to extend and expand preparedness activities. Activities of the IPC sub-commission have been interrupted for the last week due to an ongoing strike by the Ministry of Health staff over non-payment of salaries. Efforts are being made to continue with essential activities while discussions are ongoing to find a resolution.

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DRC EBOLA SITUATION REPORT 12 May 2019 Key Results Change since Total Result WATER, SANITATION & HYGIENE Target8 last report UNICEF ▲▼ # of health facilities in affected health zones provided with essential WASH services. 1887 1135 36

# of target schools in high risk areas provided with handwashing facilities 2,400 1,137 65 # of community sites (port, market places, local restaurant, churches) with hand washing 8,000 3,234 1008 facilities in the affected areas % of schools and public places near confirmed cases locations where handwashing 100% 89% 33% stations are installed and utilized Number of households of confirmed cases, contacts and neighbours of confirmed cases 15,000 2,476 1384 who received a hygiene and prevention kits with adequate messaging

Education The education strategy involves key EVD prevention measures on schools, including (1) the mapping of schools to identify their proximity to a confirmed case and 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 behaviours, (4) provision of school cabins for school entry checking, (5) provision of specific documentation and protocol for prevention, guidance, and management of EVD suspect 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.

Implementing Partner: Enseignement Primaire, Secondaire et Professionnel (EPSP)

Main activities during the reporting period As a result of recurrent security incidents, response activities were temporarily suspended, particularly in Mabalako, Butembo, Katwa and neighboring health zones.

During the reporting period, seven students were confirmed with EVD, including six girls, in Katwa, Butembo, Musienene and Kalunguta health zones. The actions of the response were taken immediately at the level of the schools concerned, including the decontamination of schools, the supply of vaccination kits (Kyuhu primary schools, Agora and secondary schools of Mahano, Kalemba, Vulema, Lyambo).

In collaboration with the WASH sector, the education team distributed handwashing devices, thermometers and advocated for the usage of these devices to promote EVD prevention in 25 schools benefiting, 8,844 students, 550 teachers and school principals in Katwa health zone and 52 schools in Mambassa health zone, benefiting 14,017 students, 632 teachers and schools principals.

In North Kivu province, UNICEF continues to assist the Ministry of Education in disseminating the Ebola Prevention Guidance Note. The note is to be used by teachers to provide daily lessons on Ebola prevention. 6,848 copies of the Ebola Guidance Note were distributed in 951 nurseries, primary and secondary schools in Beni, Kalunguta, Mabalako,

8Targets cover the period since the beginning of the outbreak in August 2018 and include the more recent targets based on the Strategic Response Plan III (1 February to 31 July 2019), covering all health zones in Ituri and North Kivu province.

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DRC EBOLA SITUATION REPORT 12 May 2019 Oicha, Butembo, Katwa, Masereka, Musienene, Vuhovi and Mutwanga health zones. 276,339 students (140,197 girls) and 802 teachers from the same schools received training prior to receiving the Ebola guidance notes.

During this reporting period, 299,200 students, 1,984 teachers and 77 schools have been reached with Ebola responses’ activities. An achievement that brings a total of 711,477 students out of the target of 1,090,006 (65%) and 21,650 teachers (67%) reached out of the target of 32,296. These results have been achieved in 2,285 schools out of 2,476 targeted.

UNICEF and the Ministry of Education conducted visits in three primary schools (Kanzulinzuli, Mapendano and Maadibisho) to ensure trainings on EVD prevention protocol are implemented and guidance notes are distributed. According to feedbacks received from principals, teachers and school inspectors, these observations were made:

- Schools remain an influential channel for communicating EVD and prevention messages to the community. It is important to strengthen awareness-raising activities and briefings on preventive measures in schools for teachers, students, members of parent committees and systematically to set up “Brigades Scolaires” in schools. - The three schools visited do not systematically use thermometers for screening students every morning at the entrance of the school or classroom. Thermometers are used in isolation rooms just when a student appears to be sick. The directors of the schools explained they only received two or one thermometers, which makes it difficult to screen 300 students. In the three schools visited, the place of isolation is either in the school principal’s office, or another free office. For other schools, there are no isolation costs due to the resources required to build it. - It has also been noted that the World Food Programme is involved with the school canteen project in 25 schools in the Beni health zone, which have been equipped by UNICEF with handwashing disposals and thermometers. Among the three schools visited, two primary schools Kanzulinzuli and Mapendano benefitted from the WFP school canteen.

In Ituri Province, particularly in Nyakunde and Komanda health zones, 53 out of 107 pre-schools, primary and secondary schools were trained on the guidance note for the prevention and fight against EVD in schools and parents’ general meetings. 5,035 parents of pupils, including 3,975 women in these schools, were informed about the strategies contained in the guidance note for the prevention and fight against EVD in schools.

Key Results

Change since Total Result EDUCATION Target9 last report UNICEF ▲▼ # of students reached with Ebola prevention information in schools 1,090,006 711,477 299,200 # of teachers briefed on Ebola prevention information in schools 32,296 21,650 1,984

Psychosocial Support and Child Protection10 The Child Protection and Psycho-Social Support (CPPSS) strategy seeks to respond to the specific needs of EVD confirmed and suspect cases and their family members as well as contact persons. The key elements of the CPPSS

9 Targets cover the period since the beginning of the outbreak in August 2018 and include the more recent targets based on the Strategic Response Plan III (1 February to 31 July 2019), covering all health zones in Ituri and North Kivu province. 10 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.

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DRC EBOLA SITUATION REPORT 12 May 2019 strategy include the provision of (1) psychosocial support11 for EVD confirm and suspect cases, including children, in the ETCs; (2) material12 and psychosocial assistance to affected families to better support children; (3) psychological support of contacts to support the Surveillance Commission in the follow up to contacts; (4) psycho-social assistance, socio-culturally appropriate care13 and research for long-term solution to orphans and unaccompanied children; and (5) support to specialized staff for assisting children and families with more severe psychological or social needs, especially regarding Ebola survivors; and (6) integrating mental health and psychosocial support in the different components of the response (vaccination, decontamination procedures and organization of Safe and Dignified Burials etc).

Implementing Partners: Danish Refugee Council (DRC) in North Kivu province and DIVAS (Division Provinciale des Affaires Sociales) in Bunia in Ituri province.

Main results during the reporting period:

• In/around the Ebola Treatment / Transit Centres

- During the reporting period, 223 children14, of whom 21 confirmed (9 girls, 12 boys) and 202 suspect cases (101 girls, 101 boys)16 were admitted to the different ETCs or Transit Centres (TCs) and received individual psychological assistance, reaching a total of 3,793 children since the beginning of the epidemic. - A total of 20 children (15 girls) received nutritional and psychosocial care in the nursery of Beni and Butembo. - The Psychosocial Commission often conducts family mediation to find solutions in the best interest of children affected by the EVD. 1. In Beni and following the discharge of a cured infant (who also lost her mother from Ebola) the child's maternal and paternal families have been fighting for custody of the child. The child was placed in the nursery the time to find a solution. Following family mediation, the child has been reunified with the maternal family with a written agreement from the father. 2. In Mangina and following family mediation, a solution was finally found for a MVE cured infant, whose mother died of Ebola and the family refused to take back15. His maternal family accepted to keep the child, who benefited from regular follow-up by psychosocial agents and material and nutritional assistance. 3. In Butembo, UNICEF and its partners jointly worked to proceed to family tracing for an orphan, temporary placed in the nursery after his mother died from EVD. After mediation, his aunt accepted to take back the child. Due to socio-economic vulnerabilities of the family, hygiene and NFI kits will be distributed as well as food assistance (for few months). In addition, psychoeducation will be conducted with the extended family and neighbourhood to avoid stigmatization and facilitate the reinsertion of the child.

• In the communities:

- In order to ensure improved support to children, 451 affected families received psychosocial support and material assistance in all Ebola-impacted affected health zones of North Kivu and Ituri Provinces. A total of 1,735 kits of material assistance (hygiene, funeral, NFI, new-born kits and food assistance) were distributed to discharged and cured patients as well as to affected families. - A total of 1,735 persons who had contact with EVD-infected individuals received psycho-social support in all EVD affected health zones. Contact tracking remains problematic, due to difficulties to list the contacts (access issues as well reluctance of the population).

11 Psychosocial support is comprised of daily individualized household visits to break stigmatization and identify any social problems which may result following the case of Ebola. 12 Material assistance is assessed on a case by case basis, according to the specific needs of children and their families. 13 According to the local context and socio-cultural norms 14 This figure is issued from data collected by the psychosocial commission. 15 Please refer to SITREP#29 11

DRC EBOLA SITUATION REPORT 12 May 2019 - A total of 51 orphans (35 girls and 16 boys) and 103 children newly separated due to the Ebola epidemic (54 girls and 49 boys) were newly identified, reaching a total of 904 orphans and 1.394 separated children since the beginning of the response. All of them received appropriate care, including NFI kits and food assistance. - Psychosocial teams deployed in the ETCs as well as in the communities continue to play a key role in convincing suspect cases to join ETCs and accept treatments. For example, in Beni, the Psychosocial Commission was in contact with a father and his son, who lost several members of their family from EVD and fled Butembo because of stigmatization. The eight-year-old son began to develop symptoms and psychologists provided critical emotional and psychological support to the father, so that he finally gave his authorization for the transfer of his son in the ETC), as well as to the child, who was very anxious and distressed, having already lost his mother from Ebola. The child was cured, and the father testified in the local media about the positive support he and his son received from the Psychosocial Commission. - Upon opening of 10 vaccination rings in Mangina, the Psychosocial Commission provided psychosocial support to 67 contacts and breastfeeding women and facilitated the weaning of their children so that they could be vaccinated. 56 women accepted the vaccination, and their children were assisted by the Psychosocial Commission.

Coordination/ needs and gaps identified

- Due to security incidents, activities are still slowed down in Butembo and Katwa and few information and figures on MHPSS activities were consequently shared. However, and as new confirmed cases emerged, activities were intensified in Lubero and Kayna, particularly in terms of psychosocial support for separated children and orphans. - In Mangina, UNICEF’s child protection team advocated with the local Social Affairs division and health structures in favour of free care of a pregnant and HIV-positive woman, who had been discharged as non-case from the ETC. Following the birth of the child, health and nutritional care were provided free of charge for mother and new-born. Psychosocial agents will continue to follow-up the child through regular visits. It is important to note that the lack of systematic free care – particularly for patients referred as MVE non-case to the health structures - is problematic and contributes to some community reticence for the acceptance of the MVE response.

Key Results

Change Total Result since last CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT Target16 UNICEF report ▲▼ # of children as confirmed or suspect case receiving psychosocial support inside the 5,000 3,593 223 transit centres and ETCs # of affected families with confirmed, suspects, probable cases who received 5000* 4,727 451 psychosocial assistance and/or material assistance

# of contact persons, including children, who receive psycho-social support 12406** 12,320 2252

# of separated children identified who received appropriate care and psycho-social 1700 1,394 103 support as well as material assistance # of orphans identified who received appropriate care and psycho-social support as well 1400 904 51 as material assistance # of psychologists and psychosocial agents trained and deployed to respond to the needs 1300 794 0 of affected children and families * The figure has been adjusted in regard to the high number of persons joining every day the transit centres and ETCs as suspect cases. The figure includes the support provided to family having MVE probable, suspect and/or confirmed cases. ** The target changes with changes in the epidemiology

16 Targets cover the period since the beginning of the outbreak in August 2018 and include the more recent targets based on the Strategic Response Plan III (1 February to 31 July 2019), covering all health zones in Ituri and North Kivu province. 12

DRC EBOLA SITUATION REPORT 12 May 2019

Nutrition The nutrition strategy seeks to provide appropriate nutritional care for EVD patients, including children. UNICEF contributes to the promotion and protection of infant and young child feeding practices in Ebola contexts, including ETCs and communities. UNICEF strategy addresses orphans, separated, and other vulnerable infants and young children such as children with lactating mothers who are at high risk of contact with EVD infected individuals, e.g. lactating mothers engaged as frontline health workers. Early detection of acute malnutrition cases and the adequate management of severe acute malnutrition in the affected health zones is a strong focus of UNICEF’s work. UNICEF supports the Government in strengthening the coordination of the nutrition response through the cluster coordination mechanisms. Main activities during the reporting period During the reporting period, 316 new cases (suspects and confirmed patients) admitted in Ebola treatment centers (ETC) received adequate nutritional care, including 43 children under six months, 53 children aged from 6 to 59 months, 4 pregnant women and 12 lactating women.

In the communities and at household level, nutritionists and psychosocial agents supported by UNICEF provided support for 43 infants less than six months old who are non-breastfed (12 in Mabalako, 14 in Beni, 12 in Butembo 2 in Katwa, 3 in Komanda);

81 separated children and orphans aged from 6-23 months in the communities of Beni, Mabalako, Butembo, Katwa, Bunia, Komanda health zones were monitored for growth and health monitoring by the nutritionists.

Around 3,680 women caregivers were sensitized on adequate infant and young child feeding practices (IYCF) in the Ebola context (232 in Beni, 326 in Mabalako, 155 in Butembo, 2,804 in Katwa, 151 in Komanda and 12 in Goma). 303 children under five old are suffering of SAM and admitted for treatment in affected by EVD health zones

UNICEF nutrition staff conducted technical supervision of nutritional activities in ETC of Beni, Mabalako, Komanda, Katwa, Goma and Butembo and participated in different strategic meetings and to the clinical care partners meeting for EVD best practices and finalization of optimal supportive care protocol and IYCF strategies.

Change since Total Result NUTRITION Target17 last report UNICEF ▲▼ # of < 23 months children caregivers who received appropriate counselling on IYCF in 24,756 21,559 3,680 emergency # Ebola patients who received nutrition support during treatment according to guidance 3,036 3,036 316 note # of less than 6 months children who cannot be breastfed and who receive ready-to-use 223 223 43 infant formula in ETCs, nursery’s, orphanages and in the communities

Social Science Research

17 Targets cover the period since the beginning of the outbreak in August 2018 and include the more recent targets based on the Strategic Response Plan III (1 February to 31 July 2019), covering all health zones in Ituri and North Kivu province. 13

DRC EBOLA SITUATION REPORT 12 May 2019 The formative research section aims at increasing the accountability of those involved in the response to communities and to enhance community acceptance as well as their full and conscious participation in the Ebola response. Existing epidemiological and anthropological data is used to facilitate and adapt programme design and planning. UNICEF research involves the exploration of behavioural determinants and uses multiple methods to collect data. Formative research supports UNICEF programme teams to better understand the population and the factors that influence behaviour. Through providing a better understanding of community context, needs and behaviours, the research section guides UNICEF’s integrated communication, WASH, Psychosocial and Nutrition interventions toward a more effective response

Main results during the reporting period The teams continue to work in Butembo, Katwa, Vuhovi, Lubero and Kyondo health zones in partnership and via the Ministry of Health Epi Cell and together with World Health Organisation and Africa Centre for Disease Control and Prevention. Research themes are identified from meta-synthesis of data and based on analysis of context, the epidemiological situation and programme interventions or from requests from commissions. Data are collected using various questionnaires, structured and guided interviews, focus groups, informal discussions and observation. Data are triangulated with community feedback and commission reports. The following recommendations are identified from UNICEF’s briefing note on communication and language use in the response: • The word “alert” is perceived as something used police or crimes, for example you alert the police but never the doctor and reinforces perceptions that the response is policed and political. One suggestion is to use terms such as referral, or a call, as you would for further testing and treatment for any other illness • The word “ETC” refers only to a treatment centre, but there is no place for testing for Ebola. As a result, communities do not believe that you can go and get tested at the ETC and not be admitted after getting a negative test result. Suggestion: Ensure that the laboratory at the ETC has visible signs and can be seen from outside the centre and include the word “testing” (Ebola Testing and Treatment Centre ETTC) • The new set up of isolation and testing units are being referred to as “TC” or transit centres; however, the word “TC” and “ETC” sound the same and the distinction is not always heard. Furthermore, TC implies that you will be transited to the ETC, not that you’re simply getting a test. Suggestion: isolation centres should have the name of the health centre which they are attached to, making no distinction between the two. • The word "FEVER" on leaflets and awareness materials: "fever" means "homa" in Swahili, which means "cold" instead of fever. The posters therefore convey the message that every time you have a cold, you have to go to the ETC. Suggestion: "Moto ku panda" (elevation of temperature) is the correct translation for fever in Swahili

Supply and Logistics The total value of items composed of WASH, C4D, Child Protection, Health, Education and ICT supplies that were distributed for the Ebola response in Ituri and North Kivu provinces during the reporting period was US$ 127,868.24.

The total value of procurement orders during the reporting period was US$ 650,817.24. Offshore procurement orders amounted to a value of US$ 69,020.04 (10.61 per cent), while local procurement orders amounted to a value of US$ 581,797.20 (89.39 per cent).

Human Resources UNICEF DRC continues to reinforce its staff presence on the ground to respond to the expanding outbreak in North Kivu and Ituri provinces. There are 159 UNICEF staff currently working in the affected areas, with an additional 55 persons under recruitment. External Communication 14

DRC EBOLA SITUATION REPORT 12 May 2019 The CO continued its digital communication activities to highlight the impact of Ebola on children and UNICEF’s response. Since the beginning of the outbreak, 77 content pieces have been published on http://www.unicef.org/drcongo and the Ebola landing page on the website is updated weekly, giving an overview of key figures, press releases, situation reports and stories. The CO published more than 610 posts on its social media channels (Facebook, Twitter and Instagram) since the beginning of the outbreak, including messages of sensitization to good practices.

During the reporting period, the CO facilitated the coverage of the Ebola-epidemic and the response of UNICEF and its partners in Beni for the Swedish national radio and the New York Times. Press coverage during the reporting period included AFP, La Vanguardia, VOA, EFE, TV5 Monde, Slate Afrique, Prensa Latina, Listin Diario, La Respublica, Europe 1, Actu Orange, RTBF and Le Parisien.

Funding As part of the joint Strategic Response Plan for Ebola, UNICEF’s response strategy focuses on community engagement, IPC/ WASH, psychosocial care, nutrition and a cross-cutting education sector response. Since the beginning of the Ebola outbreak in North Kivu and Ituri provinces in August 2018, the UNICEF Strategic Response Plan (SRP) was revised three times. The initial Response Plan (Strategic Response Plan I, August - October 2018) was estimated at US$ 43,837,000 and focused on 4 out of 6 health zones with a special focus on two health zones (Beni and Mabalako) where the epicentre of the outbreak was identified.

• On 19 October 2019, the MoH released the revised Ebola Response Plan (Strategic Response Plan II, November 2018 – January 2019) to scale-up the response and respond to the current epidemiology. The revised response plan was estimated at US$ 61,274,545. • On 20 December 2018, the MoH updated the Ebola Response Plan II (Strategic Response Plan II-I, November 2018 – January 2019) to include assumptions and additional needs until 31 January 2019, estimated at US$ 23,506,000 million. • On 13 February 2019, the MoH launched the Ebola Response Plan III (Strategic Response Plan III, February – July 2019) for a total amount of US$ 147,875,000. As part of the SRP III, UNICEF initial requirements are estimated at US$ 24,385,917. The DRC grand total budget for the Ebola response in North Kivu and Ituri provinces from August 2018 to July 2019 is estimated at US$ 276,188,187. As part of this joint response plan, the UNICEF response is estimated at US$ 50,149,121. To date, UNICEF was able to mobilize US$ 42,210,757 from different Donors and has a current funding shortfall of US$ 7,938,364 (16 per cent of the budget). Lack of funding will affect UNICEF’s response in the field and the implementation of its key activities. UNICEF expresses its sincere gratitude to all current donors for their substantial contributions to UNICEF's actions in favour of the Ebola response: World Bank, European Commission – European Civil Protection and Humanitarian Aid Operations (ECHO), Gavi - the Vaccine Alliance, United States Agency for International Development (USAID), Central Emergency Response Fund (CERF), Government of Japan, the German Committee for UNICEF, DFID, and most recently, The World Bank Group’s Pandemic Emergency Financing Facility (PEF).

Funding Requirements as defined in the UNICEF component of the Joint Ebola Response Plan 2018 - 2019 Requirements* Funds available ** Funding gap Appeal Sector US$ US$ US$ % Water, Hygiene and Sanitation - WASH / 23,543,036 18,603,089 4,939,947 21% IPC

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DRC EBOLA SITUATION REPORT 12 May 2019 Communication for Development (C4D) - Community engagement and 13,172,505 10,808,256 2,364,249 18% Communication for Campaigns Child protection and Psychosocial 3,474,300 4,953,900 0 0% Support Medical Care: Management of Severe Acute Malnutrition in Ebola Treatment 949,800 1,196,240 0 0% Centre Operations support, Security and Coordination costs and Information and 7,167,480 5,929,271 1,238,208 17% Communications Technology Surveillance 1,520,000 720,000 800,000 53% Preparedness Plan 322,000 0 322,000 100% Total 50,149,121 42,210,757 7,938,364 16% * Funding requirement includes budget for phase I (US$ 8,798,899), phase II (US$ 13,031,305), phase II.I (US$ 3,933,000) and Phase III (US$ 24,385,917) ** Funds available include reprogrammed funds from Equateur Response and Funds received since the beginning of the North Kivu and Ituri outbreak (August 2018)

Next Situation Report: 26 May 2019

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) 817 045 473 Tel : +(243) 996 050 200 E-mail: [email protected] E-mail: [email protected] E-mail : [email protected]

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