DRC Ebola Response Nord-Kivu and Ituri

19 November 2018 DRC EBOLA SITUATION REPORT 07 July 2019

Democratic Republic of the Congo

Ebola Situation Report North Kivu and Ituri

Photo Credit: UNICEF DRC Thomas Photo Credit: UNICEF DRC Mark Naftalin Photo credit:Credit: UNICEF UNICEF RDC DRC Nybo 0707 July July 2019 2019 SITUATION IN NUMBERS

Highlights 2,522 total reported cases (WHO, July 16th 2019)  On June 23th, in Butembo, UNICEF celebrated the International Widows' Day by raising awareness among 3,000 widows and orphans on 2,428 confirmed cases preventive measures against Ebola Virus Disease (EVD). (WHO, July 16th 2019)

th  On June 30 , a case who had travelled overland from Beni was confirmed 684 children <18 among confirmed in Ariwara, close to the borders with Uganda and South Sudan. This is cases (MoH, July 14th 2019) the first confirmed case in this health zone. UNICEF immediately

deployed a rapid response team. 1,604 deaths among confirmed cases th (WHO, July 16 2019)  On July 13th, the Ebola Strategic Response Plan 4 covering the period Guyfrom July to December 2019 was finalized in Goma and validated by the 18,676 contacts under surveillance (MoH, July 16th 2019) Minister of Health. UNICEF Ebola Response Appeal US$ 50.15 million

UNICEF’s Response Ebola Response

Indicator Target Result Funding Status 2018 - # of at-risk people reached through community engagement and 2019 interpersonal communication approaches (door-to-door, church 21,500,000 18,636,000 meetings, small-group training sessions, school classes, briefings with leaders and journalists, other) Funding Gap # of listed eligible people for ring vaccination informed of the 19% benefits of the vaccine and convinced to receive the vaccine within 156,530 * 155,027 required protocols. Ebola NK and Ituri Phases # of households of confirmed cases, contacts and neighbours of I, II & III confirmed cases who received a hygiene and prevention kits with 15,000 10,101 Funding requirements* : adequate messaging $ 50,149,121 32,296 31,577 # of teachers briefed on Ebola prevention information Total funding available* # of affected families with confirmed, suspects, probable cases who 7,000** 6,636 81% received one or several kits of assistance to support their 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 suspected case, and is adjusted according to the 8,798,899), phase II ($ 13,031,305), phase II.I ($ 3,933,000) response and phase III ($ 24,385,917) **Funds available include Reprogrammed funds from Equateur

DRC EBOLA SITUATION REPORT 07 July 2019

Epidemiological Overview1 Summary Table (July 16th, 2019) Confirmed and Probable Cases Deaths Province Health Zone Deaths among Total Confirmed Probable Total confirmed cases Deaths Beni 481 9 490 307 316 Butembo 255 0 255 293 293 Kalanguta 128 15 143 54 69 Kyondo 22 2 24 13 15 Mabalako 349 16 365 241 257 Masereka 47 6 53 15 21 Musienene 71 1 72 29 30 Mutwanga 11 0 11 6 6 Nord- Oicha 45 0 45 24 24 Kivu Katwa 621 16 637 428 444 Vuhovi 91 13 104 33 46 Biena 15 1 16 12 13 Kayna 9 0 9 5 5 Manguredjipa 20 0 20 12 12 Lubero 28 2 30 4 6 Alimbongo 4 0 4 2 2 Goma 1 0 1 1 1 Mambasa 1 0 1 1 1 Mandima 181 4 185 100 104 Komanda 32 9 41 13 22 Nyakunde 1 0 1 1 1 Ituri Tchomia 2 0 2 2 2 Bunia 4 0 4 4 4 Rwanpara 8 0 8 3 3 Ariwara 1 0 1 1 1 Total 2428 94 2522 1604 1698 Previous Total July 7th 2019 2324 94 2418 1536 1630

1 Data source: Epidemiological table is based on WHO data as of July 14nd, 2019. The “key epidemiological developments” paragraphed is based on WHO for data as of July 14nd and on daily numbers by the National Coordination Committee (Comité National de Coordination, CNC) for data as of June 07rd.

DRC EBOLA SITUATION REPORT 07 July 2019

Key Epidemiological Developments2 With more than 1,500 deaths among confirmed cases since the declaration of the outbreak in August 2018, the Ebola virus continues to spread within several health Zones of North Kivu and Ituri provinces, both affected by conflicts and humanitarian crisis. As of July 16th, a total of 2,522 EVD cases were reported, among which 2,428 confirmed and 94 probable cases. More the two third of EVD confirmed cases died: 1,698 deaths, among which 1,604 confirmed and 94 probable cases (global case fatality ratio 67 per cent). During the reporting period (June 24th to July 07th), 171 new confirmed cases were reported, thus representing a feeble decrease from the previous two weeks (171 vs 185)3. The proportion of new confirmed cases listed as contacts remained low and slightly decreased in comparison to the previous period (54,8 per cent on average in the last three weeks4 against 56 per cent during the previous three weeks). During the last three weeks, Beni passed to be the major hotspot for EVD transmission (36 per cent of new confirmed cases, in comparison to 15 per cent of the previous three weeks) followed by Mabalako (22 per cent in comparison to 35 per cent of the previous three weeks). Collectively, these two health zones account for the majority (58 per cent) of the 250 new cases reported in the last twenty-one days. On June 30th, a new confirmed case who had travelled overland from Beni was confirmed in a health area of Ariwara, a newly affected health zone in the Ituri province, more than 460 kilometres north of Beni, close to borders with Uganda (20 km) and South Sudan (70 km). In addition, on July 14th a confirmed case coming from Beni was reported in the city of Goma. Out of the 23 health zones affected by EVD5 since the beginning of the outbreak (August 2018), 17 health zones of North Kivu and Ituri reported at least one confirmed EVD case in the last three weeks, with 70 EVD affected health areas (among which 7 new health areas where affected during the last two weeks). Despite a slight decrease during the last two weeks in comparison to the previous two weeks (25.7 per cent vs 27.5 per cent), the proportion of EVD deaths at community level remains significant, with more than one confirmed case out of four dying in the community6. Disaggregated data by gender and age shows that, out of the 2,321 total cases recorded, 56.5 per cent (1,313) are female, among these, 59 per cent are childbearing age (15-49 years); and fifteen (15) per cent are children under 5 (346 children). Six (6) healthcare workers were affected by EVD during the last two weeks, reaching a total of 128 health personnel affected since the beginning of the epidemic outbreak (5 per cent of total cases).

Humanitarian Leadership and Coordination

UNICEF continues to support coordination in all established Coordination (EOC; Emergency Operations Center) and Sub-Coordination with functional strategic or operational commissions. Based on the accountability framework, UNICEF is co-leading the commissions on Risk Communication and Community Engagement (RCCE), WASH – Infection

2 Except for paragraph on total number of cases and sentence on the case reported in Goma, all other paragraphs refer to the reporting period from June 24th to July 07th. 3 New confirmed cases: 91 in week 26 and 80 in week 26. 4 Week 25, 26, 27 for the period June 17th to July 07th. 5 Health zone having reported at least 1 confirmed or probable EVD case. 6 Proportion of death at notification: 27 per cent of confirmed cases during week 26 and 24 per cent during week 27. 3

DRC EBOLA SITUATION REPORT 07 July 2019 Prevention and Control (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 coordinations in Butembo/Katwa, Mangina, Bunia, Beni and all active health zones. In addition, multi-sectoral UNICEF rapid response teams are in place and deployed to new hotspots as required. As soon as the new case was confirmed in Ariwara7, UNICEF deployed a multisectoral team and immediately after this reported case died, the team was ready to support the entire family and provide psychosocial support, raise awareness among the community, as well as to implement IPC/WASH activities. In addition, following the deterioration of the security situation in Ituri Province with multiple attacks involving the Hema and Lendu groups, 20,000 displaced persons have reached Bunia. In the displacement camps, the threat of Ebola is combined with measles. Thus, on July 11th, UNICEF launched a measles campaign led by the Ministry of Health, in collaboration with MSF already present on the ground. The campaign targeted 4 displacement camps in 7 health areas of the city. In total, 40,629 persons were vaccinated, including 9,055 IDPs. Among them, 6,357 children between 6 and 59 months were vaccinated since July 11th. The boundary of one camp, located alongside Bunia’s General Hospital, is less than 100 metres away from an Ebola treatment center, thus the campaign incorporates additional measures to protect against Ebola transmission. In addition, UNICEF is also developing a multi-sector response to address the other IDPs humanitarian needs. Furthermore, on June 28th and 29th, the Minister of Health chaired a two-days experts’ meeting in Kinshasa that aimed at creating a consultative framework to transparently share the latest scientific and technical information on existing experimental Ebola vaccines to facilitate the Ministry of Health's decision-making on their use in the response. After this conference, it was decided that the only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine. On June 30th, when celebrating the Independence Day, Felix Tshisekedi, the President of the Democratic Republic of the Congo (DRC) travelled to Bunia on official visit in order to asses on the humanitarian situation. He also took this opportunity to visit an Ebola Treatment Center (ETC).

Response Strategy The Ebola response is based on the joint National Strategic Response Plan (SRP) against the EVD in North Kivu and Ituri provinces. The SRP 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. The national SRP was launched on August 1st 2018 and was revised four times8. In support of the SRP, the UNICEF response strategy focuses on a cross-cutting Community-based approach including WASH/Infection, Prevention and Control (IPC), Psycho-social care, Risk Communication and community engagement, Education, Child Protection, Nutrition interventions and pediatric clinical care in ETC. During the week between July 8th and 14th, the MoH, UNICEF and partners gathered in Goma and finalized the new SRP IV through an inclusive and participative approach. On July 14th, the new SRP IV was validated by the Ministry of Health. This document represents a « final push » for all the stakeholders for ending EVD epidemic.

7 See Key Epidemiological Developments, page 3. 8 The National Strategic Response Plan (SRP) was launched on August 1st and was revised three times. The initial Response Plan (SRP 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 October 19th 2019, the MoH released the revised Ebola Response Plan (SRP 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 December 20th 2018, the MoH updated the Ebola Response Plan II (SRP II-I, November 2018 – January 2019) to include assumptions and additional needs until January 31st 2019, estimated at US$ 23,506,000 million. Finally, on February 13th 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.

DRC EBOLA SITUATION REPORT 07 July 2019 In support of implementing the SRP, the United Nations also developed a scale-up strategy for ending the 10th Ebola outbreak in DRC. This United Nations scale-up strategy provides a framework for organizing the response by the United Nations system in support of the Government of the DRC’s public health response priorities as well as to enhance the overall enabling environment within which the response is situated. The scale-up strategy will be implemented across five main pillars9 identified as essential for an effective response to end the Ebola outbreak. As part of the pillar one “strengthened public health response in support of the Ministry of Health”, UNICEF will scale up its RCCE interventions to enhance dialogue and partnerships between Ebola response teams and individuals or communities in affected areas enabling community ownership in the response and real time exchange of information. UNICEF will also continue to be responsible of improving infection prevention and control interventions in communities in affected areas, including the provisions of supplies and household decontamination for confirmed and probable cases. The Psychosocial support interventions will also be sustained, and UNICEF will remain the lead agency to provide patients with EVD and their families psychosocial support through direct psycho/social care and provision of social support and food assistance to affected individuals and households.

Together with OCHA, UNICEF is also co-leading the pillar 3 aimed to strengthen community ownership and support programs in response to community needs to enable Ebola control activities (UNICEF) and strengthen multi-sectorial humanitarian coordination (OCHA). In particular, UNICEF and its partners will promote community ownership and implement social and humanitarian programs to respond to critical community needs, mitigate the adverse effects of the response, and strengthen community systems to enable sustained community engagement.

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. Risk Communication and Community Engagement The risk communication,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 (SFCG), Caritas Congo, Réseau des Medias pour le Développement (ReMed), Association Medias Auto Centré pour le Développement du Maniema (MEDAM)

Main activities during the reporting period Under UNICEF’s lead, RCCE partners developed new key messages on the EVD response according to the community feedback mechanism. During the reporting period, the government validated and disseminated these messages in the 7 sub-coordination’s of the two affected provinces. The messages were developed by thematic (surveillance, IPC, Ebola survivors, safe and dignified burials, vaccination, nutrition, medical care, entry points) and for the intend of specific group such as families, teachers, politico-administrative authorities, health workers, religious leaders, traditional healers, community members, contacts. The harmonization of these messages was crucial to move forward with the

9 The five main pillars of the scale-up strategy are: (i) Strengthened public health response led by WHO in support of the Ministry of Health; (ii) Strengthened political engagement, security and operations support led by EERC; (iii) Strengthened support to communities affected by Ebola led by the EERC and supported by OCHA and UNICEF; (iv) Strengthened financial planning, monitoring and reporting, led by the World Bank and (v) Strengthened preparedness for surrounding countries led by WHO and supported by OCHA and IASC partner. 5

DRC EBOLA SITUATION REPORT 07 July 2019 scale up strategy and its pillar III on strengthening communities affected by Ebola. They will be updated as needed based on regular feedback from community members.

Moreover, on June 28th, the opinion leader who belongs to the Rally for Congolese Democracy party, Antipas Mbusa Nyamwisi, visited Butembo for the first time after 7 years of exile. In his address, he called on the people of Butembo to collaborate and trust the teams fighting EVD. He sent a strong message to the reluctant population as he got vaccinated against Ebola. Responding to Refusals/Reticence and Rumors The RCCE Commission and community animators took the opportunity of the social reintegration of two Ebola survivors in the health areas of Kasebere to organize a raising awareness activity and convince the community of the importance of timing treatment of Ebola. During the event, where 200 people were present, the family, community and local authorities warmly welcomed and reintegrated them into their community.

In Butembo, UNICEF and the civil society organized a community dialogue that started with an animation and a short play on the EVD response and related rumors. After this opening, experts answered a total of 23 questions from the public. The aim was to encourage people to express themselves on the Ebola response. About 800 people attended, including 650 women.

Mangina remains a hotspot for EVD transmission and for community resistance too. UNICEF and partners are increasingly engaging with the community and with potential allies among local leaders including the religious ones. Upon their request, singers from Linzo Adventist Church visited the Mangina ETC. Then, they involved in awareness activities in the community during which they explained to the worshippers that the ETC are not a place where people die but a place where people can be saved through Ebola treatment.

Promotion of Preventive Behaviors On June 23th, in Butembo, UNICEF celebrated the International Widows' Day by raising awareness among 3,000 widows and orphans on preventive measures against EVD. Moreover, in Butembo and Katwa, 7,241 teachers, including 2,534 women, were briefed on the EVD prevention during a 2-day-training workshop in 8 sites. This activity took place at the end of the school year to encourage teachers, as well as students and their parents, to adopt prevention measures along the holidays. The purpose was also to make these teachers real ambassadors in the fight against EVD in the community during the school holidays, with the aim to get rid of EVD by the beginning of the school year. This awareness raising activity was made possible thanks to the collaboration of WHO, educational government bodies10, the MoH, Red Cross and the NGO SFCG, PPSSP and Food for the Hungry International (FHI) 360. UNICEF‘s support included provision of 8 trainers, 8 video projectors, 8,000 French EVD leaflets and 8 handwashing kits.

In the health area of Hoho, Rwampara HZ, UNICEF briefed 50 local leaders including 12 women on the importance of the community engagement during the response. During this session, the team in charge of safe and dignified burials presented their work.

In Komanda health zone, UNICEF raised awareness among 612 children on the EVD preventive measures including the promotion of correct hand washing in schools on the closing of the school year.

UNICEF organized two community dialogue sessions on the implementation of community engagement actions. The first one gathered 292 leaders of Mangina commune and the second one, all the health care providers of the Mabalako health zone (traditional healers, nurses and pharmacists).

10 Enseignement Primaire, Secondaire et Professionnel (EPSP) and the education provincial division (PROVED). 6

DRC EBOLA SITUATION REPORT 07 July 2019 Media activities With UNICEF and SFCG, two newspapers about testimonies of Ebola survivors French, Swahili and Kinyande were produced and broadcasted on 26 radio stations in Butembo. In addition, 2 spoken newspapers and a magazine on the testimony and discharge of three cured pastors were produced and broadcasted on 12 radio stations in Beni.

Key Results Change since Total Result RISK COMMUNICATION AND COMMUNITY ENGAGEMENT Target11 last report UNICEF ▲▼ # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities (CAC, religious /traditional leaders, 47,695 49,138 3,453 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 32,821 29,404 879 community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, 21,500,000 18,636,000 845,827 adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious 8,481 8,744 1,152 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 156,530* 155,027 13,394 convinced to receive the vaccine within required protocols. % of respondents who know at least 3 ways to prevent Ebola infection in the affected 80% 73% 0 communities (from Rapid KAP studies) * This figure indicates the number of listed eligible people for ring vaccination from August 8th, 2018 to July o6th, 2019

11 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 For 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 supplies 13 For IPC/ WASH kits for schools, items are provided in accordance with three areas of support: (1) Screening (thermoflash), (2) handwashing (with soap), (3) cleaning and decontamination supplies. 14 Multidisciplinary teams comprise health specialists from the MoH and/ or Medical NGOs as well as WHO. 7

DRC EBOLA SITUATION REPORT 07 July 2019 After the series of trainings conducted during the past weeks by UNICEF WASH information manager team for all the members of the IPC sub-committee, a first dashboard was created with display of results for each IPC/WASH key component at health centers, schools and communities level. During the reporting period, and despite accessibility constraints due to the security situation, prevention activities, implemented by UNICEF partners CEPROSSAN and Mercy Corps continued in all the Butembo sub-coordination health zones through the distribution of 343 hygiene kits to households, 519 handwashing stations in public places and IPC/WASH kits in 34 schools and 159 complete or supplementary kits to health facilities. In Kalunguta health zone, some areas where several suspected cases are reported, remain hardly accessible and the response limited. In Kayna and Alimbongo health zones as well access remains a challenge, despite the set-up of local teams for delivering the first response. In these areas, population mainly relies on traditional practitioners, who are barely informed and briefed on EVD symptoms and treatment protocols. Works were completed in the Butembo health zone for a decontamination area: WASH facilities such as drilling, provision of hydraulic items (reservoir, pipes and fittings), 4 latrines and 4 showers have been constructed by UNICEF and its partners. In addition, an integrated transit center is now operational in Vuhovi health zone, thus facilitating the reference and treatment of EVD-suspected cases. In the same health zone, WASH/IPC teams noted a slight decrease in community resistance through a series of community dialogues aimed at stimulating the community engagement in the Ebola response. During the reporting period, the Beni health zone reported 76 new EVD confirmed cases (including 19 cases in the Mandradele health area), more than the double of the previous reporting period. This is mainly due to the resistance of the population to the response and resulting difficulties in acceding these areas. After the attack of June 24th to the EVD response teams, activities were temporary interrupted with a consequent negative impact on the timely identification, treatment and follow up of cases. Despite the security and accessibility conditions, UNICEF implementing partner PPSSP distributed hygiene kits to 364 households (2,184 beneficiaries) and 7 schools. In these latter, prevention activities continued with hygiene promotion sessions, attended by 1,202 students and 109 teachers. 19 public places and 6 schools were supplied with handwashing devices and 182 handwashing devices in other public places were daily supplied with treated water and their functionality regularly monitored. About 1,021,580 liters of water treated with chlorine and other 400 kg of chlorine were donated to the WHO for water treatment in the ETC of Beni. In the Mabolio health area, UNICEF partner SNRH started the construction of a drilling in order to alleviate water shortage in the neighborhood. Hygiene promotion sessions were attended by 1,253 persons. At the same time 300 community sensitization workers coming from local organizations were briefed on EVD prevention measures as well as on the use and management of hygiene kits. In addition, UNICEF teams involved 1,040 women in a series of dialogues around EVD protection and prevention measures. In Oicha health zone, 208 handwashing devices were installed in public places together with treated water provision, and their utilization monitored. Security access in Oicha remained volatile and only possible with armed escort, thus limiting the response rapidity and flexibility. To enhance capacities of local actors and IPC/WASH commission as a whole, 90 focal points issued from the different health areas of Mandima and Mabalako health zones (Mangina sub-coordination) started a training on IPC/WASH prevention measures. For routine activities, WASH kits were distributed to 34 health facilities, 6 schools and 27 public places. At the same time 1,024 households received hygiene kits (54 households with EVD cases and 970 around EVD cases). Kits distribution in households, schools and public places was accompanied by sensitization activities touching 2,121 persons. The number of inaccessible health areas more than doubled in comparison to the previous report: 7 health areas, as well as a part of Mabalako town, were inaccessible during the reporting period because of the insecurity caused by armed groups and the resistance of some communities. In these areas many cases are being reported.

DRC EBOLA SITUATION REPORT 07 July 2019 In Komanda health zone a new confirmed case was reported on July 1st. Around this case, IPC/WASH kits were distributed in 4 health facilities (one each) and 18 health workers were briefed on IPC/WASH kit use. In addition, hygiene kits were distributed to 16 households around this confirmed case and 254 people (92 male, 135 female and 22 children) received instruction on the use of the kit and sensitized on good handwashing practices. During the reporting period, EVD prevention activities continued to be strengthened. About 382,660 liters of drinking water were provided to 9 chlorination points (with a daily average of 2,500 beneficiaries) and 70,946 liters of water for handwashing supplied in 68 public places. Complete WASH kits were distributed in 5 schools (one kit per school) and supplementary items (including soap and replacement of thermoflash) donated to 10 schools (including 2 National End of primary Studies Test (TENAFEP) centers). In Komanda and Nyankunde centers, the organization of the TENAFEP was also the occasion to sensitize 855 students and 69 adults (of which 33 supervisors, 30 directors and 6 exam organizers) on hand washing practices and Ebola prevention in schools. In addition, 766 students, 33 teachers and 200 parents were sensitized on handwashing and EVD prevention measures in 7 schools of Komanda center and other 4,266 students and parents sensitized during the presentation of the end of the year results. In health facilities, 40 health workers were briefed on IPC/WASH kit use and one health facility was supplied with a IPC/WASH kit. The IPC/WASH teams monitored the use of kits and the functioning of handwashing devices in 32 health facilities and 15 public places. The soap was distributed in 36 public places. The International Organization for Migration (OIM), in charge of the health screening and prevention activities at entry points, received 2 sprayers by UNICEF to be installed at Bunia key-entry points. Reinforcement of EVD preparedness activities continues in Mambasa health zone, specifically with the supply of chlorinated water to 24 public places (8,800 liters) including 2 centers for the high school final test (EXETAT) and to 2 entry points (6,350 liters) and to the Mambasa General Hospital (16,800 liters). In addition, UNICEF partners installed 5 chlorination points and distributed Aquatabs tablets to 12 health facilities. The health workers distribute these tablets during the anti-natal and pre-school consultations and the community health workers monitor their adequate utilization through regular household’s home visits. A WASH kit was donated to one health facility. Based on the monitoring results on the use and functionality of WASH kits in 29 health facilities and 2 centers hosting the high school final test, these latter and 15 health facilities were supplied with complementary WASH items. Hand washing points were installed in 2 public places and 2 churches and monitoring on their functionality was conducted in 24 public places. UNICEF supported IOM activities with the distribution of chore to 2 entry points. To strengthen local capacities and promote community engagement, 4 members of the local association « MAOSHO » charged of burials of muslim-faith death cases participated in a training on EDS in Bunia, led by the IPC/WAS Commission, and are now operational on the ground. A new EVD confirmed case was reported in a new health zone, Ariwara, under the Bunia sub-coordination. Access to Ariwara is possible by flight only, because of the insecurity in the Djugu area. The health zone was supplied with WASH/IPC and health workers briefed on IPS/WASH prevention measures. In Rwampara and Bunia health zones, 52 IPC/WASH kits were distributed in 31 schools and 21 health facilities. In addition, 45 households around the confirmed cases received hygiene kits. About 234,099 liters of chlorinated water were supplied to 5 health facilities and 143 public places in Bunia and 2 health facilities and 11 public places in Rwampara. 7 handwashing devices were distributed in Bunia public places (2 for the Governorate, 4 for child-friendly spaces and 1 for the parking of the Reference General Hospital) and 2 distributed to a local church in the Hoho health area, together with 10 boxes of soap. In order to receive the beneficiary feedback on the assistance they had received, the IPC/WASH commission conducted a post distribution monitoring surveys with 58 households15. In Goma, new agreements with UNICEF implementing partners are ongoing to extend and expand preparedness activities. A series of local associations were also identified in order for them to start a collaboration with UNICEF

15 Data analysis is ongoing. 9

DRC EBOLA SITUATION REPORT 07 July 2019 under the SRP IV. A working session with all partners working in Goma health zone, the IPC\WASH sub-commission supervisors and the Health Zone was held to discuss about updated need assessment, mapping of actors and remaining gaps to be covered. UNICEF implementing partner installed 20 handwashing devices in several public places such as markets, parkings and travel agencies. Provision of handwashing devices was accompanied by the sensitization on WASH prevention measures: 251,939 people (99,131 women, 65,987 men, 41,912 boys and 44,909 girls) were sensitized. About 6,371 people (2,373 women, 1,531 men, 732 boys and 1,735 girls) showed their refusal for handwashing. About 154,800 liters of water were provided in the different health zones: 12,000 liters in Kirotshe, 60,000 liters in Goma, 79,920 liters in Karisimbi et 2,880 liters in Nyragongo. On July 02nd, the WASH/IPC commission organized a workshop in Goma on existing sectorial operational procedures and standards connected to each IPC/WASH response components. A total of 65 people participated, such as implementing partners, president, vice-presidents and supervisors of the PCI/WASH sub-commission and health zone teams. Key Results Change since Total Result WATER, SANITATION & HYGIENEF Target16 last report UNICEF ▲▼ # of health facilities in affected health zones provided with essential WASH services. 1,887 2,678 1,206

# of target schools in high risk areas provided with handwashing facilities 2,400 2,124 809 # of community sites (port, market places, local restaurant, churches) with hand 8,000 5,155 1,109 washing facilities in the affected areas % of schools and public places near confirmed cases locations where handwashing 100% 89% 13% stations are installed and utilized Number of households of confirmed cases, contacts and neighbours of confirmed 15,000 10,101 5,261 cases 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 behaviors, (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 Partners : Enseignement Primaire, Secondaire et Professionnel (EPSP), Associazione Volontari per lo Sviluppo Internazionale (AVSI)

Main activities during the reporting period During the report period, the Ebola Operations Center (EOC) reported 7 students and 3 teachers among the confirmed cases. Among the 7 students (3 girls), 4 are dead cases. Moreover, among the 3 teachers, one was a woman dead case. All the cases reported were respectively from primary and secondary schools from Butembo, Vuhovi, Beni, Biena and Rwampara.

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 (February 1st to July 31st, 2019), covering all health zones in Ituri and North Kivu province. 10

DRC EBOLA SITUATION REPORT 07 July 2019 In Beni health zones, the WASH/IPC teams have decontaminated all the 6 schools. The other cases (both alive and dead ones) in the three health zones of Butembo, Vuhovi and Biena were community contamination. All the cases did not attended school during their symptomatic period. In the health zone of Rwampara, the student from the Leopoldville Primary school dead at the ETC did not attend school during his symptomatic period either as the school was already closed. However, prevention measures have been taken around his school including the ring vaccination of around 100 students and neighbors. Awareness raising activities on EVD prevention measures: To ensure that the fight against the EVD doesn’t slow down during the holidays, the RCCE Commission team in collaboration with the Education Department (EPSP) have distributed 376,800 pamphlets on EVD prevention measures messages in French, Swahili and Nande during the end-of-school-year activities and exams in 1,060 schools in the Butembo, Katwa, Musienene, Kyondo, Vuhovi, Kalunguta health’s zone. These same pamphlets were distributed to 1,219 students (700 girls) and 30 teachers (20 females) in Butembo Health zone. In this health zone, additional raising awareness activities were also organized in 16 primary and secondary schools reaching 3,947 students (1,732 girls). 40 WASH kits and 38 Thermoflashes have also been distributed in 19 schools. In addition, 16 exams centres for the Tests National de Fin d’Etudes Primaire (TENAFEP) received additional IPC/WASH kits and Thermoflash. In the health zones of Nyankunde, Komanda and Mambasa, school authorities jointly with the Ebola team took advantage of the end-of-school-year graduation ceremony to raise awareness among more than 10,000 people (students, teachers and parents) on EVD prevention measures in 19 schools. Several students performed poems as part of the community awareness on preventive measures against EVD. Psychosocial support activities in classroom Prior to the end of the school year, UNICEF partner AVSI jointly with the provincial education governmental partners have organized recreational, expressive and psychosocial activities for 26,489 students (13,506 girls and 12,983 boys) from 80 school structures in Lubero, Musienene and Masereka health zones and raised awareness on the protection, hygiene, water, diseases and other related dirty hand diseases. In addition, 4,132 parents (2,512 males and 1,620 females) benefited from awareness raising activities on the importance of education, child protection and the prevention of EVD. During the same period, AVSI distributed 80 recreational and expressive kits in the 80 targeted schools. However, in Lubero, Masereka, and Musienene, AVSI has suspended recreational, expressive and psychosocial activities in schools that are now on holidays. AVSI will resume with those activities in September at the opening of the school year 2019-2020.

322 teachers and the heads of non-formal 66 education structures in Beni, Oicha and Mabalako health zones benefited from psycho-social support in classroom trainings. Thus, a total of 1,021 teachers school principals and heads of non- formal education centers have been trained (419 females). During this reporting period, an additional 41,199 students (15,948 girls) and 7,733 teachers (3,113 females) have been reached with Ebola prevention information in schools.

Key Results Change since Total Result EDUCATION Target17 last report UNICEF ▲▼ # of students reached with Ebola prevention information in schools 1,090,006 872,898 41,199 # of teachers briefed on Ebola prevention information in schools 32,296 31,577 7,733

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.

DRC EBOLA SITUATION REPORT 07 July 2019 Psychosocial Support and Child Protection18 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 strategy include the provision of (1) psychosocial support19 for EVD confirm and suspect cases, including children, in the ETCs; (2) material20 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 care21 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 Centers and nurseries Since the beginning of the epidemic a total of 5,164 children were admitted to the different ETCs or Transit Centers (TCs) and received individual psychological support. During the reporting period, 610 children 22 , including 15 confirmed (10 girls, 5 boys) and 595 suspect cases (207 girls, 388 boys)16 were assisted. The high number of suspect cases is due to an increase of referrals to TCs or ETCs of sick children presenting EVD-like symptoms, particularly from Beni, Oicha, Mangina and Bunia. In the ETC of Mangina, psychologists have faced difficult some cases affecting children. Two siblings who tested EVD positive (a boy and girl, of 12 and 17 respectively) were severely affected by the loss of 9 members of their family. Their distress and anxiety combined with the rumors they had heard about food poisoning in the ETCs resulted in their refusing to take medicines and food. After discussions and dedicated psychological support, the children began to let go of their fears and started to accept food and treatments, finally believing in the possibility of recovery. A total of 13 new children (8 girls) received full time care from UNICEF nutritional and psychosocial team in the temporary residential nurseries of Beni, Butembo and Katwa.

 In communities: As a way to support affected families so that they continue to have the emotional and material capacity to care for their children, 427 affected families received psychosocial support and material assistance in all Ebola-impacted health zones of North Kivu and Ituri Provinces. A total of 902 kits of material assistance (hygiene, funeral, NFI, new-born kits and food assistance) were distributed to discharged and recovered patients and affected families. A total of 1,378 persons who had contact with EVD-infected individuals received psycho-social support. Contact tracking for the purpose of providing psychosocial support remained a challenge, partly due to coordination difficulties experienced with Surveillance Commission about the quality and timing of the release of the contact lists (delay and unclear addresses). It should be noted that when contact persons need longer psychological support, psychosocial agents continue to provide such for a period that extends beyond the 21 days of EVD incubation period.

18 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. 19 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. 20 Material assistance is assessed on a case by case basis, according to the specific needs of children and their families. 21 According to the local context and socio-cultural norms. 22 This figure is issued from data collected by the psychosocial commission. 12

DRC EBOLA SITUATION REPORT 07 July 2019 During the month of June, 385 pregnant and 253 breastfeeding women – all contact persons - received specific psychosocial support. A total of 82 newly orphaned children (43 girls and 39 boys) and 147 children (53 girls and 94 boys) newly separated due to the Ebola epidemic were identified and assisted, bringing a total of 1,185 and 1,890 the number of orphans and separated children identified and assisted since the beginning of the response. All of them received appropriate care, in addition to NFI kits and food assistance. The high number of orphans and separated children for this period is due both to the addition of figures from the last reporting period and an increase in community EVD deaths. For surviving Ebola children, life continues! All identified EVD orphans and separated children form UNICEF’s child protection teams, in close collaboration with Bunia and Komanda who received school support (11 psychosocial agents, regularly conduct follow-up visits of children and adolescents who are Ebola survivors. orphans and 8 separated children) passed their end-of- the- year exams with success. In Butembo and Katwa, In Beni, E., 12 years old, lives with his mother and 3 brothers. a rapid assessment by UNICEF child protection staff of Due to the fragile socio-economic situation of his family and the 36 randomly selected orphans (among the 114 who social impact of the EVD, he continues to receive psychosocial support as well material assistance, particularly to cover his have received educational assistance, such as payment school fees and those from his brothers. of schools feels and/or uniforms/school supplies, and psychosocial support), revealed that 32 of them (89%) In Butembo, R., 18 years old, was tested EVD positive and had excellent school results. Four are still seriously treated at the time he was supposed to pass state exams to finish affected and continue to be regularly followed up and his school cycle. Since the exam session in Butembo was already over once he was discharged by the ETC, UNICEF’s child supported by psychologists and psychosocial agents. protection and education teams jointly carried out successful UNICEF gives particular attention to the regular follow- advocacy with the local education authority, to authorize R to up of vulnerable orphans. For example, in Butembo, an take his exams in Beni where the exam session was still open. In 8-year-old child who lost his father from EVD, was addition, R received specific psychosocial support to facilitate his placed in the nursery and referred to the hospital for reintegration into his family and to help him to pass his exam. intensive nutritional care (the child was suffering from In Mangina, M. was declared EVD survivor at 3-month-old. acute malnutrition). Once his health stabilized, he was Unfortunately, his mother died from EVD and his father refused reintegrated into his family and is receiving regular to take him back. UNICEF and psychosocial agents conducted a 23 joint visits by UNICEF child protection and nutrition family mediation to reunify him with his extended family . teams. The relationship of trust built by the Today, M is 6 months old and his extended family is taking good care of him, thanks to the psychological and material support psychosocial agent with his mother greatly provided by UNICEF and its partners. Psychosocial agents contributed to a better nutritional and emotional care continue to regular visit him to decrease stigmatization by the of the child. surrounding neighborhood. Coordination/ needs and gaps identified In Goma, no Ebola survivor is present and available for working as a care giver. As a result, EVD-suspected children at the ETC often stay alone, without being in close contact with their families. Discussions between the ETC health team and psychosocial agents are ongoing to rapidly find a solution in order for children to have the appropriate psychosocial and emotional support. Human resources and capacity building In Beni, a training was conducted for Ebola Survivors who were going to be recruited as care givers of infants, children and adults in ETCs. 11 persons have been recruited. The training, conducted by UNICEF, its implementing partner and the international NGO Alima, was focused on their own experience when they were themselves in the ETCs, how to give emotional support to children, specific needs of sick infants, children and adolescents separated from their families as well as medical care and pathways for confirmed cases.

23 The first part of the case of M. was reported in Ebola SitRep 29 (April 28th, 2019), page 11. UNICEF and psychosocial agents are continuing to follow up the case. 13

DRC EBOLA SITUATION REPORT 07 July 2019 On June 24th, PSS and nutrition teams organized a workshop to make a point on ongoing activities of nutritional assistance and psychosocial support in the nurseries, follow up of children in the community and nutritional care to children with severe acute malnutrition as well as on data collection tools. In Goma, 9 psychologists and psychosocial agents received training by WHO to be part of rapid intervention teams. Additional psychologists have been deployed in Bunia (3) and Mangina (2) to cover increasing needs in those areas. New psychosocial agents (5) have also been recruited. Key Results Change since Total Result CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT Target24 last report UNICEF ▲▼ # of children as confirmed or suspect case receiving psychosocial support inside the 6,000* 5,180 448 transit centres and ETCs # of affected families with confirmed, suspects, probable cases who received 7,000* 6,636 539 psychosocial assistance and/or material assistance # of contact persons, including children, who receive psycho-social support 18, 998 ** 17,050 2,425 # of separated children identified who received appropriate care and psycho-social 2,000 1,939 164*** support as well as material assistance # of orphans identified who received appropriate care and psycho-social support as well 1,400 1,185 82*** as material assistance # of psychologists and psychosocial agents trained and deployed to respond to the needs 1,300 845 21 of affected children and families * This figure has been adjusted in regard to the high number of persons being admitted daily to the transit centers and ETCs as suspect cases. It includes support provided to families with suspect, probable or confirmed EVD members. ** The target number has been changed in relation to the evolution of the epidemic. *** For this reporting period, the figures for separated and orphan children included the preceding period.

24 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 (February 1st to July 31st, 2019), covering all health zones in Ituri and North Kivu province. 14

DRC EBOLA SITUATION REPORT 07 July 2019 patients per day. In Butembo ETC, for example, nutritional care got to touch 120 patients in one single day, July 4th 2019. At communities and household level, the nutritionists and psychosocial agents of the ETCs, supported by UNICEF, provided nutritional support (Ready-to-Use Infant Formula - RUIF) to 58 infants less than six months old non-breastfed (9 in Mabalako, 11 in Beni, 17 in Butembo 17 in Katwa, 2 in Komanda and 2 in Bunia). In the communities of Beni, Mabalako, Butembo, Katwa, Bunia and Komanda health zones, the nutritionists of the Health Zone and the psychosocial agents of the psychosocial commission of Ebola Sub-coordination monitored 126 separated children and orphans aged 6 to 23 months for their growth and health development, thus resulting in a significant increase from the previous report (78). Sensitization activities on adequate infant and young child feeding practices (IYCF) in the Ebola context at ETCs and contacts household level also increased, passing from 2,846 women caregivers sensitized by the communication agents, health promotion workers and nutritionists during the previous reporting period to 3,101 (101 in Beni, 1083 in Mabalako, 871 in Butembo, 730 in Katwa, 104 in Komanda, 195 in Bunia and 17 in Goma). 11425 children under five suffering of Severe Acute Malnutrition were admitted for treatment in the OTPs (outpatients therapeutic programme) under the supervision of Health Zone nutritionists. In addition, UNICEF nutrition staff conducted technical supervision of nutritional activities in ETCs of Beni, Mabalako, Komanda, Katwa, Goma and Butembo. During the reporting period, the nutrition team organized a meeting with PSS teams at the presence of the health zone teams for the planning of future activities and data collection tools26. This meeting was a good opportunity for nutrition teams for better understand PSS norms and standards and link them with nutritional assistance. In addition, on June 29th, the WFP organized a meeting for the review of SOPs on nutritional and food assistance for EVD discharged cases and contacts. On June 29th, a Department for international Development (DFID) delegation visited the ETC and the nursery in Katwa and appreciated the holistic, including nutritional, care provided by UNICEF and its partners.

Key Results Change since Total Result NUTRITION Target27 last report UNICEF ▲▼ # of < 23 months children caregivers who received appropriate counselling on IYCF in 51,865 38,363 3,101 emergency # Ebola patients who received nutrition support during treatment according to guidance 5,000 5,591 870 note # of less than 6 months children who cannot be breastfed and who receive ready-to-use 600 450 58 infant formula in ETCs, nursery’s, orphanages and in the communities

25 Data for Komanda and Katwa health zones only. All other health zones did not report data because of administrative issues. These missing data will be reported in the next SitRep. 26 See the Psychosocial Support and Child Protection paragraph, pag. 12-14. 27 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 (February 1st to July 31st, 2019), covering all health zones in Ituri and North Kivu province. 15

DRC EBOLA SITUATION REPORT 07 July 2019 Social Science Research 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. Researches are conducted by the Social Science Research Group (SSRG) which includes anthropologists and researchers. Research themes are identified from metasynthesis of data and based on analysis of context, the epidemiological situation and programme interventions or from requests from the different 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. Research results including recent perceptions and use of health services (triangulated with CAP data) are presented every week on Wednesday during the Ebola operations center (EOC) coordination meeting.

Main results during the reporting period During the reporting period, key activities conducted by the research team, as part of the SSRG under the Ministry of Health and together with WHO and partners, include:

 On June 24th, the Social Sciences Research Group organized a one-day workshop in Goma. The 56 attendees which included the commission presidents, NGOs and key focal points from the CDC, NGOs, UN and donors, worked together to plan agreed actions aiming at strengthening the dissemination of study results and the development, monitoring and evaluation of resulting recommendations. Workshop report and action plan were developed and shared widely.  In Beni, the team continues the recruitment of 10 local social science researchers (together with WHO). The team should be in place by July 15th.  In Butembo, Thursday capacity building and information sharing days for the local research teams continue. This day is an opportunity to share and exchange results and identify recurrent themes as well as to support learning on research tools and analysis. Research – studies & results 1. Socio-cultural in-depth analysis has been completed, analyzed and presented in Mangina. The objective of this study was to understand barriers and enablers in engaging the community with the response. It also allowed to know how and with who the response interventions should be working to ensure appropriate and accountable approaches. 2. Key results reinforce the critical role of effective community engagement as greater reported reticence was found in areas where communities reported lower perceived inclusion and participation in the response. As an example, in Vusayiro (Mabalako health zone), the level of engagement of the community was self-reported as high and respondents felt sufficiently engaged in the response. This area also self-reported less resistance towards the response teams and even expressed gratitude towards them. Comparatively, in Aloya (Mabalako health zone), respondents reported feeling insufficiently engaged in the Ebola response and also explained various ways in which their communities were resistant and untrusting towards the response workers. This study also showed that rumors related to safe and dignified burials (SDB) remains, as it includes actions which are contrary to many ritualistic funeral practices in the area. 3. The Knowledge, Attitude, Perceptions and Practice survey with community and health workers in Katwa and Butembo has been analyzed and presented as part of the weekly Epi presentations at the EOC coordination meeting (on June 19th and July 3rd). The main results show the persistence of misunderstanding of some

DRC EBOLA SITUATION REPORT 07 July 2019 symptoms of the EVD (including highly reported symptoms such as joint and muscle pain, asthenia, anorexia) and persistent lack of knowledge of transmission risks (especially risks linked to contact with deceased persons) among community and health workers. There is a crucial need to revise and renew training curricula for health workers and deliver communication messages related to EVD symptoms at both the community and health center levels. 4. The Briefing Note on “Misunderstanding Ebola Symptoms: Causes and Impacts” (developed under the SSRG together with the CDC, IFRC and Medair) was approved by the MoH and shared widely. The objective of this meta-synthesis was to show the causes of misunderstandings and misbeliefs regarding Ebola symptoms and highlight potential and reported impacts these may cause. The note also provides some key recommendations and a case study from Medair. 5. The study about the impact of the Ebola Response on maternal and child health and practices in Butembo and Katwa has been completed and analyzed. The main results indicate some potential or perceived (self-reported) disruption in maternal and child health practices mainly explained by a fear of EVD and lack of trust between health workers and the community. 6. The qualitative study looking at proximity to health centres in Butembo and Katwa has also been completed and analyzed. The main results show the importance of including the community at all stages in the process of setting up access to new health services within the Ebola response and the need to integrate other healthcare services (treatment of all the other common diseases) within future new centers (including ETCs). Involving local health staff (those currently employed by the regular communities’ health facilities) in health care services delivery is also a crucial point to maintain the confidence in health services throughout the Ebola response. Supply and Logistics UNICEF regularly monitors the supply chain and discusses with the different involved actors in order to ever improve efficiency of the supply and services facilitation for the Ebola response in Ituri and North Kivu provinces. During the reporting UNICEF distributed WASH, C4D, Child Protection, Health, Education and ICT items and supplies for a total value of US$ 3,459.6128. The total value of procurement orders during the reporting period was US$ 991,881.32. Offshore procurement orders amounted to a value of US$ 215,810.03 (22 per cent), while local procurement orders amounted to a value of US$ 776,071.29 (78 per cent). Human Resources UNICEF DRC presence on the ground continues to be strengthened to better respond to the expanding outbreak in North Kivu and Ituri provinces. Goma remains the coordination hub to support the ongoing emergency response, with antennas established as sub-coordination hubs. The number of staff dedicated to the Ebola response slightly increased up to 176 persons already working in the affected areas, with an additional 72 persons under recruitment. In addition, excluding Ebola staff, UNICEF has a capacity of 23 staffs in Goma sub-office (North Kivu) and 35 in Bunia sub-office (Ituri) to support the overall UNICEF operations in the region. External Communication During the reporting period media coverage on the Ebola-response included Irin News, El Pais, Radio Okapi, Maghreb Online, Africa News and Fox News. Since the beginning of the outbreak, the CO published 84 content pieces on its website http://www.unicef.org/drcongo and the Ebola landing page is updated weekly, linking to key figures, press releases, situation reports and stories. To show the impact of the epidemic on children and UNICEF's response, the CO posted

28 The relative low amount in comparison to previous reports is due to the fact that, during the reporting period, UNICEF proceeded to its warehouses physical inventory and items distribution was concentrated in the period before and after the inventory period. 17

DRC EBOLA SITUATION REPORT 07 July 2019 more than 700 messages on Facebook, Instagram and Twitter. During the reporting period, several tweets were amplified by UNICEF’s global Twitter account and by Executive Director Henriette H. Fore.

Funding Since the beginning of the Ebola outbreak in North Kivu and Ituri provinces in August 1, 2018, the national Strategic Response Plan (SRP) was revised three times. 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. UNICEF was able to mobilize US$ 49,265,494 (98 per cent of the total requirement) from different Donors. However, some sectors remained underfunded such as WASH / IPC (21 per cent gap) and Surveillance (53 per cent GAP) Eleven months following the declaration of the Ebola epidemic, experts are increasingly concerned with the persistent EVD transmission in both Nord Kivu and Ituri provinces, with new areas recently affected and ongoing conflicts causing security challenges and humanitarian crisis. At the same time, the expansion of epidemic to other provinces and States remains unpredictable.

The SRP4 provisional funding requirement for the public health response is US$287 million for activities until end December 2019. Responding to the Ebola outbreak in the DRC requires a focus beyond specific Ebola prevention, care and treatment interventions to address the vulnerabilities of the affected populations and improve access to quality services in the affected areas. Approaches that strengthen the community resilience and the restoration of health system are critical to sustain the gains beyond the current Ebola Outbreak. Indeed, these approaches will reinforce those of the Ebola outbreak response and bring a medium to long term perspective to reduce population vulnerability, increase resilience and strengthen primary health care. In addition, these approaches will also strengthen the humanitarian-development continuum linking the outbreak response to the long term sustainable development. Rough estimate for beyond Ebola activities (pillar 3 as per the UN scale-up strategy) at this point is US$120 million. UNICEF expresses its sincere gratitude to all current donors for their substantial contributions to UNICEF's actions in favour of the Ebola response: The World Bank, The 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, The World Bank Group’s Pandemic Emergency Financing Facility (PEF), The United Kingdom and the Paul G. Allen Family Foundation.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response Plan 2018 - 2019)

Funds Reprogrammed Funding gap Received Funds funds from Requirements* for North available Appeal Sector Equateur $ Kivu ** Response $ % Phase I & II $ $ $ Water, Hygiene and Sanitation - 23,543,036 723,295 17,879,794 18,603,089 4,939,947 21% WASH / IPC Communication for Development (C4D) - Community engagement 13,172,505 371,558 13,356,698 13,728,256 0 0% and Communication for Campaigns Child protection and Psychosocial 3,474,300 100,000 7,053,900 7,153,900 0 0% Support ***

DRC EBOLA SITUATION REPORT 07 July 2019 Nutritional Care and Counseilling in Ebola Treatment Center / 949,800 0 1,686,118 1,686,118 0 0% Community **** Operations support, Security and Coordination costs and 7,167,480 132,761 6,919,369 7,052,130 115,349 2% Information and Communications Technology

Surveillance 1,520,000 720,000 720,000 800,000 53%

Prepardness Plan 322,000 0 322,000 322,000 0 0%

Total 50,149,121 1,327,614 47,937,880 49,265,494 5,855,296 12%

* Funding requirement includes budget for phase I ($ 8,798,899), phase II ($ 13,031,305), phase II.I ($ 3,933,000) and Phase III ($ 24,385,917) ** Funds available include reprogrammed funds from Equateur Response and Funds received since the beginning of the North Kivu & Ituri outbreak (August 2018) *** The Appeal Sector is overfunded since the requirement was based on an estimated 4,980 individuals in households affected by EVD. To date, the target increased with changes in the epidemiology - See HPM. **** The Appeal Sector is overfunded since the requirement was based on an estimated 2,500 individuals both in CTE and in the community. To date, the target increased with changes in the epidemiology - See HPM

Next Situation Report: 21 July 2019

Who to contact for further Edouard Beigbeder Frederic Sizaret Xavier Crespin information: Representative Deputy Representative ai Chief Health UNICEF DRC UNICEF DRC UNICEF DRC Tel: + (243) 996 050 399 Tel: + (243) 996 050 399 Tel: + (243) 816 058 830 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected]

UNICEF EOC1 - DRC Ebola Response Nord-Kivu and Ituri. What has been done since 1 year (August 2018 - July 2019) Population Nord-Kivu and Ituri2 Ebola3 14,4 M 7,4 M 8,4 M 2,7 M 2 749 1 813 inhabitants female children children<5 ans Conﬁrmed cases Deaths

Psychosocial 13 WASH/IPC 30 UNICEF EOC STAFF UNICEF provided lead support to the Government in the Psychosocial The Water, Sanita�on, and Hygiene (WASH) strategy, as part of EVD Infec�on Commission based in Goma with sub-commissions in other areas in North Kivu Preven�on and Control (IPC), aims to stop the spread of the disease through 4 and Ituri affected by the epidemic. The mobiliza�on of psychosocial assistants the provision of WASH in public and private health care facili�es plus 171 (APS) and psychologists to provide direct and individualized support to Ebola reinforcement of basic WASH services, which includes the provision of water Deployed affected children and families has been the key strategy of MHPSS response. and WASH kits and awareness raising of tradi�onal prac��oners hygiene staff BUNIA The APS, as the backbone of the psychosocial response, represents an promo�on and provision of WASH kits in schools10 , WASH in communi�es 8 important contribu�on from the child protec�on sector in a public health through mass outreach on hygiene promo�on and the setup of handwashing KOMANDA response. This func�on has proved not only adept in crea�ng trust and sta�ons/ temperature check points in strategic transit loca�ons, and joint 23% 10 confidence with the families and communi�es affected - but also in facilita�ng supervision of health infrastructures to ensure that efficient and sustainable FEMALE access to them from other more sensi�ve areas of interven�on like programmes of high quality are developed. MANGINA 13 BENI de-contamina�on, vaccina�on, safe and dignified burials (etc). 27 77% Funding5 Funding BUTEMBO 59 Available US$ Required Available Gap US$ Required MALE 7,15M 3,47M 18,6M 4,93M 23,54M

Education6 5 Risk Communication and 43 GOMA 54 The educa�on strategy involves key EVD preven�on measures on schools, Community Engagement (RCCE) including the mapping of schools to iden�fy their proximity to a confirmed case The spread of Ebola virus disease is due to inadequate social prac�ces of and iden�fica�on of schools in the affected health areas, training of educa�onal actors (students, teachers, inspectors, school administra�on agents, members of the concerned communi�es on the one hand, and to head of educa�onal provinces, parents’ associa�on) on Ebola preven�on unprotec�ve professional behaviours of some actors in charge of the 6 response pillars on the other. The objec�ve of the RCCE is to iden�fy and Social Science analysis Cell 4 Nutrition 4 act on the determinants of these risk behaviours, and to promote behaviours The nutri�on strategy seeks to provide appropriate nutri�onal care for EVD that are conducive to preven�ng and stopping the epidemic. As individuals The social sciences sec�on aims to increase the effec�veness, appropriateness and pa�ents, including children. UNICEF contributes to the promo�on and live within community and associa�ve networks whose leaders influence accountability of the Ebola response through social and behavioural sciences research. protec�on of infant and young child feeding prac�ces in Ebola contexts, their behaviour, community engagement and ownership of the response is Social sciences research agenda and themes are based on specific programme including ETCs and communi�es. UNICEF strategy addresses orphans, objec�ves and o�en closely linked to epidemiological analysis and requests from separated, and other vulnerable infants and young children such as children the main founda�on of RCCE's interven�ons to ensure the sustainability with lacta�ng mothers who are at high risk of contact with EVD infected of results. technical commissions. Social sciences analyses support UNICEF programme teams individuals. and the overall response to be�er understand and engage the communi�es with which Funding7 Funding we work and to iden�fy more appropriate and accountable public health interven�ons. UNICEF’s Social Sciences team contributes to the integrated Analysis Cell which Available US$ Required Available US$ Required includes Epidemiology and Social Sciences work. 1,68M 0,95M 13,72M 13,17M

1Ebola Opera�on Center. 2Data from the 2014 DRC Sta�s�cal and Popula�on Projec�on h�ps://data.humdata.org/dataset/rdc-sta�s�ques-des-popula�ons. 3Data from MasterLine database: Ministry of Health as of 31 July 2019. 4Of which 72 staﬀ deployed for : Programmes, IM, Opera�ons, Preparedness, Management, Health. 5The budgets men�oned range from SRP1 to SRP3 and do not take into account SRP4 . 6The Educa�on and Social Science budgets were ﬁnanced by the C4D sector (RCCE) - Dashboard and documenta�on link. 7The men�oned budget concerns Nutri�on UNICEF EOC - DRC Ebola Response - Indicators and results Nord-Kivu and Ituri. August 2018 - July 2019 (end SRP3) PSYCHOSOCIAL WASH

Results8 Results Results Results Results 91%9 100% 100% 100% 76%

5 487 7 953 18 765 2 162 6 111 Children as confirmed or suspect Affected families with confirmed, suspects, Contact persons, including Health facili�es in affected health zones Community sites (port, market places, case receiving psychosocial support probable cases who received psychosocial children, who receive provided with essen�al WASH services local restaurant, churches) with hand inside the transit centers and ETCs assistance and/or material assistance psycho-social support washing facili�es in the affected areas

Results Results Results Results Results 100% 88% 66% 91% 78%

2 091 1 960 856 2 183 11 679 Separated children iden�fied who received Orphans iden�fied who received Psychologists and psychosocial agents Target schools in high risk areas Households of confirmed cases, contacts appropriate care and psycho-social appropriate care and psycho-social trained and deployed to respond to the provided with handwashing facili�es and neighbors of confirmed cases who received support as well as material assistance support as well as material assistance needs of affected children and families a hygiene and preven�on kits with adequate messaging

EDUCATION NUTRITION RCCE Results 100%

Results Results Results Results 82% 82% 78% 96% 52 685 Members of inﬂuen�al leaders and groups reached through advocacy, community engagement 891 048 42 310 465 31 576 and interpersonal communica�on ac�vi�es. (CAC, religious /tradi�onal leaders, opinion leaders, Students reached with Ebola < 23 months children caregivers Less than 6 months children who Fron�lne workers (RECO) in aﬀected educators, motorists, military, journalists, indiginous preven�on informa�on in schools who received appropriate cannot be breas�ed and who receive zones mobilized on ebola response and group leaders, special popula�ons, and adolescents) counseling on IYCF in emergency ready-to-use infant formula in ETCs, par�cipatory community engagement approaches nursery’s, orphanages and in the communi�es

Results Results Results Results Results 99% 100% 57% 100% 100% 31 926 6 334 2 855 151 704 9 194 Teachers briefed on Ebola Ebola pa�ents who received nutri�on Targeted children under 5 with Listed eligible people for ring Households for which personalized house preven�on informa�on in schools support during treatment according to SAM admi�ed to treatment in EVD vaccina�on informed of the benefits of visits was undertaken to address serious guidance note (disaggregated by age group) affected health zones the vaccine and convinced to receive mispercep�on about Ebola, refusals to the vaccine within required protocols secure burials or resistance to vaccina�on Sources : UNICEF, Ministry of Health July 2019. 8The target numbers has been changed in rela�on to the evolu�on of the epidemic. 9XX% of planned targets were met UNICEF EOC - DRC Ebola Response - Epidemiological data Nord-Kivu and Ituri. August 2018 - July 2019 (end SRP3) EVD: Spa�o-temporal evolu�on of the number of confirmed cases since August 2018. Sources: Ministry of Health - DRC (MasterLine DB - Epidemiology unit, July 31, 2019) Sept 2018 Nov 2018 Jan 2019 March 2019 May 2019 July 2019

Tchomia Mambasa

Mandima Mandima Conﬁrmed cases Beni Mabalako Beni Beni Kalunguta Butembo Butembo Vuhovi Butembo Butembo Katwa Katwa Katwa Masereka Musienene Kayna Nyiragongo

Cumulated cases as of 31st July 201911 Conﬁrmed cases9 Ariwara 2, 749 1, 813 Conﬁrmed cases Deaths

Rwampara 55% 42% 27% 57% of the Children Bunia Mambasa Nyankunde Tchomia

1, 520 1, 149 745 426 Komanda Females Males Children Children <5 years old Mandima Oicha

Mabalako Beni

1200 Mutwanga Legend Manguredjipa Kalunguta Biena Vuhovi Interna�onal boundaries Katwa 1000 Musienene Kyondo Lakes UGANDA Butembo Lubero Masereka 800 Health zones aﬀected (26) Alimbongo Total conﬁrmed cases 600 1 - 10 Kayna

400 11 - 35 36 - 75 200 76 - 200 201 - 400 0 Adult female Adult male Girls Boys 401 - 640 Nyiragongo RWANDA Goma 10The total of conﬁrmed cases include 80 sex unspeciﬁed (3%). 11Sources MoH - WHO as of 31 July 2019. Interac�ve dashboard link 19 November 2018 DRC EBOLA SITUATION REPORT 31 July 2019

Democratic Republic of the Congo

Ebola Situation Report North Kivu and Ituri

Photo Credit: UNICEF DRC Thomas Photo Credit: UNICEF DRC Mark Naftalin Photo credit:Credit: UNICEF UNICEF RDC DRC Nybo 31 July 2019 SITUATION IN NUMBERS Highlights total reported cases  On 30 July, 15 days after the first confirmed case, a new Ebola confirmed 2,687 (MoH, 29 July 2019) case was reported in Goma. The 46-year-old man was coming from Bunia city and was admitted to the Ebola Treatment Center (ETC) in Goma. 2,593 confirmed cases  On 17 July, the Emergency Committee convened by the WHO Director- (MoH, 29 July 2019) General declared the Ebola outbreak in DRC a Public Health Emrgency of 758 children <18 among confirmed International Concern (PHEIC).  During the last twenty-one days, Beni et Mabalako continued to be the cases (WHO, 28 July 2019) main hotspots for EVD transmission: more than a half (52 per cent) of deaths among confirmed cases the 254 new confirmed cases reported during the last three weeks were 1,622 (MoH, 29 July 2019) 20reported January 2019in Beni and 11 per cent in Mabalako.  GuyThe Ministry of Health (MoH), UNICEF and MSF vaccinated 40,629 20,426 contacts under surveillance persons against measles in IDP camps and health areas of Bunia, (MoH, 28 July 2019)

including 9,055 IDPs and 6,357 children aged 06-59 months. The campaign also incorporated additional measures to protect against UNICEF Ebola Response Appeal Ebola transmission including the use of thermoflash and hand-washing stations. US$ 126.03 million

Ebola Response Funding UNICEF’s Response Status 2018 - 2019 Indicator Target Result # of at-risk people reached through community engagement and Total funding interpersonal communication approaches (door-to-door, church available* 26,500,000* 19,827,934 meetings, small-group training sessions, school classes, briefings 39% with leaders and journalists, other) Ebola NK and Ituri # of listed eligible people for ring vaccination informed of the Phases I, II, III & IV 172,353 * benefits of the vaccine and convinced to receive the vaccine within 171,052 Funding required protocols. requirements* : # of households of confirmed cases, contacts and neighbours of $ 126,039,762 confirmed cases who received a hygiene and prevention kits with 36,437 11,679 Funding Gap adequate messaging 61% # of teachers briefed on Ebola prevention information 47,000 31,926 # of affected families with confirmed, suspects, probable cases who received one or several kits of assistance to support their 22,939** 7,953 * Funding requirement includes budget for phase I ($ 8,798,899), phase II ($ 16,964,905), phase III ($ children 24,385,917) and phase IV ($ 75,890,041) * 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 suspected case, and is adjusted according to the Equateur Response and funds received since August 2018 response

DRC EBOLA SITUATION REPORT 31 July 2019

Epidemiological Overview1 Summary Table (28 July 2019) Confirmed and Probable Cases Deaths Number of days Province Health Zone Total without confirmed Confirmed Probable Total Confirmed Deaths cases Beni 565 9 574 352 361 0 Butembo 259 0 259 299 299 4 Kalanguta 132 15 147 54 69 0 Kyondo 22 2 24 13 15 33 Mabalako 354 16 370 254 270 2 Masereka 49 6 55 16 22 0 Musienene 71 1 72 29 30 33 Mutwanga 14 0 14 8 8 1 Nord- Oicha 50 0 50 24 24 8 Kivu Katwa 623 16 639 434 450 3 Vuhovi 95 13 108 35 48 2 Biena 15 1 16 12 13 25 Kayna 10 0 10 5 5 4 Manguredjipa 20 0 20 12 12 12 Lubero 31 2 33 4 6 3 Alimbongo 4 0 4 2 2 16 Goma 1 0 1 1 1 14 Mambasa 5 0 5 3 3 1 Mandima 207 4 211 114 118 0 Komanda 34 9 43 14 23 1 Nyakunde 1 0 1 1 1 219 Ituri Tchomia 2 0 2 2 2 309 Bunia 4 0 4 4 4 37 Rwanpara 8 0 8 3 3 32 Ariwara 1 0 1 1 1 28 Total 2,577 94 2,671 1,696 1,790 Previous Total 16 July 2019 2,428 94 2,522 1,604 1,698

1 Data source: Daily numbers by the National Coordination Committee (Comité National de Coordination, CNC). 2

DRC EBOLA SITUATION REPORT 31 July 2019 Key Epidemiological Developments Ebola Virus Disease (EVD) transmission continues to spread within several health Zones of North Kivu and Ituri provinces, both affected by conflicts and humanitarian crisis. As of 29 July, a total of 2,687 EVD cases were reported, among which 2,593 confirmed and 94 probable cases. More the two third of EVD confirmed cases died: 1,716 deaths, among which 1,622 confirmed and 94 probable cases (global case fatality ratio 67 per cent). During the reporting period, the number of new reported confirmed cases remained stable, with 174 new confirmed cases in comparison to 171 in the previous two weeks2. The epidemics spread in two new health zones and touched nine health areas for the first time. Out of the 25 health zones affected by EVD3 since the beginning of the outbreak (August 2018), 18 health zones (72 per cent) of North Kivu and Ituri reported at least one confirmed EVD case in the last three weeks, with 65 EVD affected health areas. On 14 July, a first confirmed case was reported in Goma city. The case was a pastor, resident in South Kivu who travelled first to Beni and then, fearing EVD symptoms, to Goma. Tested positive at the Goma ETC, he was ready to be transferred to Butembo ETC, well equipped for receiving EVD treatment, but died during the transportation. On 30 July, 15 days after the first confirmed case, a new Ebola confirmed case was reported in Goma. The 46-year-old man was coming from Bunia city, he presented himself in a clinic the day before with advanced symptoms and was isolated and admitted in the ETC in Goma where he died on 31 July. The rapid response teams have started listing contacts and vaccination is expected to start in the coming hours. The proportion of new confirmed cases listed as contacts remained low but slightly increased in comparison to the previous period (56,7 per cent on average in the last twenty-one days against 54.8 per cent during the previous three weeks). In comparison to the previous two weeks (25.7 per cent), the proportion of EVD deaths at community level increased, reaching 31.6 per cent and remains worrying. Almost one confirmed case out of three dies in the community4. As of 28 July 2019, disaggregated data by gender and age shows that, out of the 2,671 total cases recorded, 56 per cent (1,500) are female and among these 56 per cent are childbearing age (15-49 years). Twenty-eight per cent (758) were children aged less than 18 years. Eighteen (18) healthcare workers were affected by EVD during the last two weeks, reaching a total of 146 health personnel affected since the beginning of the epidemic outbreak (5.5 per cent of total cases).

Humanitarian Leadership and Coordination UNICEF continues to support coordination in all locations with functional strategic or operational Commissions. UNICEF leads the Commissions on Risk Communication and Community Engagement (RCCE) and Psycho-social Support and co- leads Infection Prevention and Control (IPC)/WASH Commission with WHO. The strategic Ebola response coordination based in Goma maintains a strong support to active operational sub-coordinations in Butembo/Katwa, Mangina, Bunia, Goma, Benia and Komanda/Mambasa. In addition, multi-sectoral UNICEF rapid response teams are in place and deployed to new hotspots as required. Together with OCHA, UNICEF is also co-leading the pillar III aimed to strengthen community ownership and support programs in response to community needs to enable Ebola control activities (UNICEF) and strengthen multi-sectorial humanitarian coordination (OCHA). UNICEF and its partners will promote community ownership and implement social and humanitarian programs to respond to critical community needs, mitigate the adverse effects of the response, and strengthen community systems to enable sustained community engagement. On July 17th, the Emergency Committee convened by the WHO Director-General declared that the Ebola outbreak in DRC was a Public Health Emergency of International Concern (PHEIC). On July 20th, a switch in the leadership of the Ebola response in DRC was announced: the response is now no longer under the Ministry of Health but under a

2 New confirmed cases: 83 in week 28 and 91 in week 29. 3 Health zone having reported at least 1 confirmed or probable EVD case. 4 Proportion of death at notification: 28 per cent of confirmed cases during week 28 and 35 per cent during week 29. 3

DRC EBOLA SITUATION REPORT 31 July 2019 Technical Committee directly dependent from the Presidency. Consequently, on July 21st, the Minister of Health, after his visit to Goma and then Beni ETC on July 19th, resigned.

Response Strategy The Public Health Response The Ebola response is based on the joint National Strategic Response Plan (SRP) against the EVD in North Kivu and Ituri provinces. The national SRP was first launched on 01 August 2018 and was revised four times5. The SRP IV will cover the period from July to December 2019 and represents a « final push » for all the stakeholders for ending EVD epidemic in the two provinces.

In support of the SRP, the United Nations also developed a scale-up strategy to end the 10th Ebola outbreak in DRC. This strategy enhances the overall enabling environment within which the response is situated. It is implemented across five main pillars6 identified as essential for an effective response to end the Ebola outbreak. As part of the pillar I “Strengthened public health response in support of the Ministry of Health”, UNICEF continues to scale-up its RCCE interventions to enhance dialogue and partnerships between Ebola response teams and individuals or communities in affected areas enabling community ownership in the response and real time exchange of information. UNICEF also continues to work on improving IPC interventions in communities in affected areas, including the provisions of supplies and household decontamination for confirmed and probable cases. The Psychosocial support interventions is another key area of focus, and UNICEF continues to provide patients with EVD and their families psychosocial support through direct psycho-social care and provision of social support and food assistance to affected individuals and households.

Nearly a year into the Ebola epidemic, experts are increasingly concerned with the persistent EVD transmission in both Nord Kivu and Ituri provinces, with new areas recently affected and ongoing conflicts causing security challenges and humanitarian crisis. The situation in the Ebola-affected areas of DRC is deteriorating and the number of Ebola cases continues to increase. Many people continue to die in the community – either at home or in general healthcare facilities – and significant numbers of new confirmed cases cannot be traced to an existing contact with Ebola. Responding to the Ebola outbreak in the DRC requires a focus beyond specific Ebola prevention, care and treatment interventions to address the vulnerabilities of the affected populations and improve access to quality services in the affected areas. Approaches that strengthen the community resilience and the restoration of health system are critical to sustain the gains beyond the current Ebola Outbreak. These approaches will reinforce those of the Ebola outbreak response and bring a medium to long term perspective to reduce population vulnerability, increase resilience and strengthen primary health care. In addition, these approaches will also strengthen the humanitarian-development continuum linking the outbreak response to the long term sustainable development. Strengthened support to communities affected by Ebola Following the deterioration of the security situation in Ituri with multiple attacks involving the Hema and Lendu groups, 20,000 people have been displaced to Bunia. In the displacement camps, the threat of Ebola is combined with the risk of measles. In response, UNICEF launched on 11 July a measles campaign led by the Ministry of Health, and in collaboration with MSF. The campaign targeted 4 displacement camps in 7 health areas of the city. A total of 40,629 persons were vaccinated, including 9,055 IDPs and 6,357 children between 6 and 59 months. The campaign also incorporated additional measures to protect against Ebola transmission including the use of thermoflash and hand-

5 The National Strategic Response Plan (SRP) was launched on August 1st and was revised four times. The initial Response Plan (SRP 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 October 19th, 2019, the MoH released the revised Ebola Response Plan (SRP 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 December 20th, 2018, the MoH updated the Ebola Response Plan II (SRP II-I, November 2018 – January 2019) to include assumptions and additional needs until January 31st, 2019, estimated at US$ 23,506,000 million. On February 13th, 2019, the MoH launched the Ebola Response Plan III (SRP III, February – July 2019) for a total amount of US$ 147,875,000. Finally, on July 15th, 2019, The MoH released the Ebola Response Plan IV (SRP IV, July – December 2019) for a total amount of $ 287,590,149. 6 The five main pillars of the scale-up strategy are: (i) Strengthened public health response led by WHO in support of the Ministry of Health; (ii) Strengthened political engagement, security and operations support led by EERC; (iii) Strengthened support to communities affected by Ebola led by the EERC and supported by OCHA and UNICEF; (iv) Strengthened financial planning, monitoring and reporting, led by the World Bank and (v) Strengthened preparedness for surrounding countries led by WHO and supported by OCHA and IASC partner. 4

DRC EBOLA SITUATION REPORT 31 July 2019 washing stations. In addition, UNICEF is also developing a multi-sector response to address the other IDPs humanitarian needs.

Main activities during the reporting period On 16 July, on July , UNICEF and OCHA organized a workshop, in Goma, to validate the implementation mechanism of the support programmes for communities affected by Ebola. A coordination cell has been established to serve as an interface between the Ebola response system and the humanitarian system. The enlarged cell will be composed of OCHA, UNICEF, the RCCE Commission, 02 humanitarian NGOs, 02 national NGOs working on Ebola Coordination, the International Federation of the Red Cross (IFRC) and DRC Social Fund and/or World Bank (for extended meetings). In addition, under the UN strategy, promoting community engagement and building capacities of local actors will be key priorities. In this context, the Community Animation Cells (CAC) will play a crucial role. The CAC are existing structures that will be used for the response for community alerts, follow-up of contacts, vaccination and SDB. Wherever the CAC are not active anymore, UNICEF will contribute to the establishment of new ones. During the reporting period, in Beni, UNICEF and RCCE partners established 285 CAC in 18 Health Areas. On 16 July, the launching ceremony took place in Kwanzunlizuli health center, in the presence of the Beni mayor and 250 participants. During the two last weeks, Butembo has seen a considerable drop in EVD cases. The RCCE strategy developed in Butembo contributed to this evolution. It is based on the creation a network of focal points all ensuring at different levels that community resistances are reduced and that the response teams can access to communities to implement their activities. Moreover, as a best practice, a rapid response team intervening in reducing community’s resistances has been put in place. This small team is made of influent leaders (including religious leaders) that participate to community dialogues and facilitate the activities of the response teams. In Butembo, 28 universities have been targeted in a EVD response global strategy and students are being involved. Indeed, since May, UNICEF and partners organized debates in 28 universities, reaching a total of 4,199 students. Following the debates, a total of 449 students and teachers visited the ETC. Besides, three debates on Ebola prevention were held among students and broadcasted on 26 community radios in Butembo. Responding to Refusals/Reticence and Rumors Local committees, rapid response teams and religious leaders play a crucial role in reducing resistances and rumors in the current hotspots. Thanks to their actions, many resistances have been solved, such as: . In Bunia, communicators solved 198 out of 328 community incidents (60.3 per cent) coming from the different Commissions - PCI/WASH handwashing (70 per cent), Entry points (47 per cent), SWAB and safe and dignified burrials (87 per cent), transfer to ETC (80 per cent). . In Komanda, 4 out of 5 refusals (80 per cent) and 4 out of 4 (100 per cent) rumors were solved. . In Butembo, RCCE actors solved 192 out of 308 community incidents (62.3 per cent) enabling the organization of rapid actions on positive cases. 15 community feedbacks were identified: 8 on communication, 1 on treatment, 1 on vaccination, 4 on PCI and 1 on psycho-social – 11 out of 15 were solved.

DRC EBOLA SITUATION REPORT 31 July 2019 Promotion of Preventive Behaviors In Goma, a new ETC is under construction in Monigi. The teams faced many resistances by local population, which slowed down the construction. The community was afraid that building the ETC will bring Ebola in Goma. In this context and to engage the community, UNICEF and RCCE partners conducted eight community dialogue sessions on the role and importance of the ETC gathering a total of 200 young leaders. The participants will then raise awareness among their communities and act as mobilizers. Since the first confirmed case was reported in Goma, the Communication Sub-Commission has conducted a set of activities around the case to support other Commissions’ activities such as decontamination, vaccination, listing of contacts and follow-up of contacts for 21 days. The Commission has also facilitated the spread of preventive messages through the media. To strengthen community engagement activities, the Communication Sub-Commission developed an Emergency Operational Action Plan that included a press conference to raise awareness on current issues such as the use of roads connecting the city of Goma with the epidemic zones, the role of moto-taxis, home visits by community relays. The strategy will also include the recording and dissemination of an audiovisual message of awareness by religious leaders, one by traditional healers and one by children reporters7. In Ariwara, after one case was reported from Beni, the Communication Sub-Commission recruited and trained 40 community mobilizers. Further 29 religious leaders, 12 youth associations, 8 women's associations, 7 local NGOs and 11 community groups were identified and involved in Ebola prevention activities. Media/Communication C4D In Beni, UNICEF targeted owners of music selling kiosks to broadcast Ebola prevention messages in the city. As these kiosks play loud music in the streets, they can reach a large number of people. UNICEF gathered 80 owners of such kiosks during an awareness raising activity and distributed USB flash disks with Ebola messages for broadcast. In Bunia/Ituri, RCCE partners edited and broadcasted the first interactive program across the city's 14 radio stations focusing on Ebola prevention. UNICEF implementing partner SFCG produced four newspapers about testimonies of Ebola survivors French, Swahili and Kinande and broadcasted them on 38 radio stations in Butembo. Key Results Change since Total Result RISK COMMUNICATION AND COMMUNITY ENGAGEMENT Target8 last report UNICEF ▲▼ # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities (CAC, religious /traditional leaders, 67,695 52,685 3,547 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 40,321 31,576 2,172 community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, 26,500,000 19,827,934 1,191,934 adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious 12,981 9,194 450 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 172,353* 171,052 16,025 convinced to receive the vaccine within required protocols. % of respondents who know at least 3 ways to prevent Ebola infection in the affected 80% 73% 0 communities (from Rapid KAP studies) * This figure indicates the number of listed eligible people for ring vaccination from August 8th, 2018 to July 20th, 2019

7 Aged from 10 to 17, Child Reporters are girls and boys of all social backgrounds working for the protection, education, health and participation of children in the DRC. The UNICEF Child Reporters’ Program offers participants the opportunity to advocate for their rights by creating an environment that allows them to voice their concerns, ideas, recommendations and to be heard by decision-makers and leaders at all levels. Through training to understand and master basic journalistic techniques, Child Reporters are able to deliver their vision on the problems they encounter. They also learn to master advocacy tools such as videos, photos, public games and writing articles. For more information: https://ponabana.com/en/child-and-young-reporters/ 8 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 IV (July to December 31st, 2019), covering all health zones in Ituri and North Kivu province.

DRC EBOLA SITUATION REPORT 31 July 2019

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 reinforcement of basic WASH services, which includes the provision of water and WASH kits9 and awareness raising of traditional practitioners (2) hygiene promotion and provision of WASH kits in schools10 , (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) joint11 supervision of health infrastructures to ensure that efficient and sustainable programmes of high quality are developed. Implementing Partners: Mercy Corps, Red Cross, OXFAM GB, MEDAIR, Action Contre la Faim (ACF), Programme de Promotion des Soins de Santé Primaires (PPSSP), Mutuelle de Sante Canaan (MUSACA) and Centre de Promotion Socio- Sanitaire (CEPROSSAN). Main activities during the reporting period Each IPC sub-committee continues to improve the use of the recently introduced data collection tool to provide an overview of all activities in the health centers, schools and communities. The information management team further developed a tool that automatically consolidates these databases resulting in centralized data management for the IPC/WASH coordination to better analyze activities and indicators. In Butembo, the number of cases continues to decrease resulting in less gaps in ring coverage, however, cases are being reported over a larger geographical area. As some health zones in Lubero, Alimbongo, Kayna and Masereka are still under the control of armed groups, this limits access and impacts activities. In the Kalunguta health zone, the security situation in Mbilinga health area remains a barrier and efforts are being made with community leaders to facilitate access. Given the number of health areas in Kalunguta, it is challenging to meet the needs in terms of human resources. In Lubero and Vuhovi, community resistance persists and WHO could not gain access for decontamination and UNICEF remains on standby to implement response activities. Over the reporting period, activities were conducted in 12 affected health zones in response to 31 cases of EVD (including two children and 7 cases from the surrounding health zones of Beni, Mambasa, Mangina and Mabalako). Hygiene kits were distributed by Ministry of Health, WHO and partners CEPROSSAN and Mercy Corps to 459 households and 9 schools and 310 handwashing devices were installed in public places. These activities were accompanied by health messaging. To further strengthen prevention procedures, 169 health facilities received IPC/WASH kits and WASH infrastructure was reinforced with the construction of 6 latrines and 4 showers by CEPROSSAN at the Kitatumba General Reference Hospital. In Beni, in response to an increase of 77 confirmed cases in 11 health areas response activities were scaled up. Partner PPSSP distributed hygiene kits to 558 households. Handwashing points were installed in 24 public places. Donations of IPC/WASH kits were made to 3 health facilities and 19 schools. Prevention activities in schools continued with hygiene promotion and dialogue exchange meetings, attended by 1,202 students and 4,276 teachers. Hygiene promotion sessions were held with 31,902 people. Briefings on protection measures and the use of kits were conducted with 3,846 community sensitizers from grassroots organizations. Group discussions were hosted engaging 2,238 women on EVD prevention. Monitoring of 214 handwashing points ensures consistent access to water, with a consumption of 51,240 liters of chlorinated water. UNICEF provided support to the completion of 20 latrines and 20 showers at the Beni Ebola Transit Centre. In preparation of State exams, provision of 396 WASH kits were made to 37 schools (28 primary schools and 9 secondary schools). In Oicha health zone, 9 confirmed cases were reported within 4 health areas. In preparation of State examinations, provision of 23 schools (19 primary schools and 4 secondary schools) with 417 WASH kits was made. Local partner

9 For 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 supplies 10 For IPC/ WASH kits for schools, items are provided in accordance with three areas of support: (1) Screening (thermoflash), (2) handwashing (with soap), (3) cleaning and decontamination supplies. 11 Multidisciplinary teams comprise health specialists from the MoH and/ or Medical NGOs as well as WHO. 7

DRC EBOLA SITUATION REPORT 31 July 2019 association Organisation de Developpement d'Oicha (ODO) supplied 208 public handwashing points with 69,440 liters of chlorinated water with follow up and monitoring of activities. In Komanda health zone, activities were carried out by Supervisors of the IPC sub-commission in response to 2 confirmed cases. WASH kits were donated to 18 households along with hygiene information sessions were held with 123 people (61 male, 62 female) on the use of the kits and handwashing washing practice. In reaction to evaluations done in two health facilities, IPC/WASH kits were distributed, and 11 health care providers were briefed on the use of the kit items and preventative measures. 7 new handwashing devices were installed, and monitoring continued at an additional 25 handwashing points in public places. Outside the rings, preparedness activities were ongoing with monitoring on the use and functionality of 24 handwashing points and the use of IPC/WASH kit items in 2 health facilities in Salama health area. IPC/WASH kits were distributed to 61 schools, 24 health facilities and 24 public places. The first EVD case being reported in Goma, the dynamic shifted from preparedness to response activities for the Goma IPC/WASH sub-committee. By working closely within the sub-committee, this resulted in an opportunity to strengthen participation and coordination with the other actors. In reaction to this case, a ring approach was initiated and response activities were implemented within 3 rings. UNICEF partners PPSSP and Medair commenced with the distribution of IPC/WASH kits including hygiene kits to 67 households and 26 public places. Upon completion of IPC/WASH evaluations, kits were donated to 16 health facilities in Himbi (10) and Ruthsuru (6) health zones. Upon notification of the second ebola confirmed case in Goma, UNICEF worked closely with WHO and MoH partners to coordinate a rapid response. UNICEF in partnership with OXFAM and PPSP evaluated 7 health facilities and assessed the WASH related needs to coordinate the immediate distribution of hygiene kits that have been prepositioned as part of preparedness activities. Hygiene kits were distributed to 15 households including the house of the new confirmed case.. Key Results Change since Total Result WATER, SANITATION & HYGIENEF Target12 UNICEF last report ▲▼ # of health facilities in affected health zones provided with essential WASH services. 3,884 2,16213 33

# of target schools in high risk areas provided with handwashing facilities 3,800 2,18314 25 # of community sites (port, market places, local restaurant, churches) with hand 11,750 6,11115 238 washing facilities in the affected areas % of schools and public places near confirmed cases locations where handwashing 100% 79% 0% stations are installed and utilized Number of households of confirmed cases, contacts and neighbours of confirmed 36,437 11,67916 1,162 cases who received a hygiene and prevention kits with adequate messaging

12 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 IV (July to December 31st, 2019), covering all health zones in Ituri and North Kivu province. 13 This total has been adjusted to reflect some changes in the database (missing values, corrections, etc.). 14 This total has been adjusted to reflect some changes in the database (missing values, corrections, etc.). 15 This total has been adjusted to reflect some changes in the database (missing values, corrections, etc.). 16 This total has been adjusted to reflect some changes in the database (missing values, corrections, etc.). 8

DRC EBOLA SITUATION REPORT 31 July 2019 Implementing Partners : Enseignement Primaire, Secondaire et Professionnel (EPSP), Associazione Volontari per lo Sviluppo Internazionale (AVSI)

Main activities during the reporting period Sensitisation activities in classroom Thanks to the financial support of UNICEF, AVSI, trained the 114 teachers and school directors in psycho-social support in the Health zones of Beni, Oicha and Mabalako, thus reaching a total of 1,140 teachers and directors trained. Cross-sector and advocacy initiatives In Butembo, since May 2019, UNICEF team started to discuss with EPSP about a student that survived from Ebola but missed his preliminary national test. Thanks to UNICEF advocacy work, the student met all the administrative requirements and was able to take his exam in Beni in July 2019. UNICEF paid for his transport from Butembo to Beni and provided a nutrition kit and pocket money for the whole month he will spend in Beni. In Beni, UNICEF also undertook a similar advocacy initiative for four students (two from primary school and two from secondary schools) who are currently being treated for Ebola in the ETC and were at risk to miss their exams. The initiative allowed successfully the four students to take the exams from their ETC.

Key Results Change since Total Result EDUCATION Target17 last report UNICEF ▲▼ # of students reached with Ebola prevention information in schools 1,458,000* 891,048 18,150 # of teachers briefed on Ebola prevention information in schools 47,000 31,92618 354 Psychosocial Support and Child Protection19 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 strategy include the provision of (1) psychosocial support20 for EVD confirm and suspect cases, including children, in the ETCs; (2) material21 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 care22 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), Alima, DIVAS (Division Provinciale des Affaires Sociales) In/around the Ebola Treatment/Transit Centers During the reporting period, 307 children, of whom 20 confirmed (8 girls, 12 boys) and 287 suspect cases (127 girls, 160 boys) were admitted to the different ETCs or Transit Centers (TCs) and received individual psychological support, reaching a total of 5.487 children since the beginning of the epidemic. In Beni the situation of EVD-affected children is particularly worrying. Since July 8th, the health zone has registered more than 20 confirmed cases among children whose age ranges from 1 month to 14 years. Eight of them died at the ETC/TC or at the health facilities. Three came out cured (two boys and one girl), while nine are still treated in the ETC. The psychosocial commission of Beni actively worked to provide psychological support and material assistance to these children. In nurseries

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 IV (July to December 31st, 2019), covering all health zones in Ituri and North Kivu province. 18 This total has been adjusted to reflect some changes in the database (missing values, corrections, etc.). 19 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), Alima and DIVAS. All results, unless otherwise stated, are UNICEF results with implementing partners. 20 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. 21 Material assistance is assessed on a case by case basis, according to the specific needs of children and their families. 22 According to the local context and socio-cultural norms. 9

DRC EBOLA SITUATION REPORT 31 July 2019 The Beni sub-coordination initiated an Ebola case finding activity within the communities. This activity has involved an increase in the number of admissions to the ETC and therefore an increase in the number of separated children. However, the capacity of the Beni nursery is limited to six beds. Discussions are ongoing with the General Director of Beni General Hospital to obtain space to increase the capacity of the nursery. The Katwa nursery has been hosting two twins born of a cesarean section for the past two weeks. Their mother was first transferred to ETC of Katwa (where she was tested EVD negative), then to the Hospital following the infection of her wound that degenerated into generalized peritonitis. Her treatment was delayed because the family was not able to pay for blood transfusions and other care. UNICEF implementing partner Alima raised funds to help the mother and UNICEF covered the remaining fees. The twins will be soon reunified with their family, with their mother healed, their father and their six other brothers and sisters. In communities During the reporting period, 447 EVD-affected families received psychosocial support and material assistance to continue to have the emotional and material capacity to care for their children. Psychological support was also provided to 3,422 persons who had contact with EVD-infected individuals. A cured 7-years old boy and a 5-months old boy who were rejected by their own biological families because of their EVD status were placed in foster care families (of other cured persons who were discharged the same day as the children). UNICEF child protection team begun the family mediation, which failed until now. UNICEF proceed by "neighborhood" approaches to try to create a community dynamic and an impetus of solidarity so that families adhere. Follow up of non-cases patients and orphans in the community continued through the provision of psychological support to combat the stigmatization they may face after their reintegration into the community. In Komanda, for example, the psychosocial commission followed 53 new non-case discharged including 23 men, 10 women and 20 children (11 boys and 9 girls) and 11 orphans (3 boys and 8 girls). Four of them received assistance in milk as well. Overall, during the reporting period 152 newly separated children and 44 newly orphaned children due to the Ebola epidemic were identified and assisted with appropriate care, in addition to NFI kits and food assistance. A total of 82 newly orphaned children (43 girls and 39 boys) and 147 children (53 girls and 94 boys) newly separated, bringing a total of 1,185 and 1,890 the number of orphans and separated children identified and assisted since the beginning of the response. All of them received. The high number of orphans and separated children for this period is due both to the addition of figures from the last reporting period and an increase in community EVD deaths. Key Results Change since Total Result CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT Target23 last report UNICEF ▲▼ # of children as confirmed or suspect case receiving psychosocial support inside the 10,312* 5,487 307 transit centres and ETCs # of affected families with confirmed, suspects, probable cases who received 22,939* 7,95324 447 psychosocial assistance and/or material assistance # of contact persons, including children, who receive psycho-social support 20,686 ** 17,818 768 # of separated children identified who received appropriate care and psycho-social 2,950 2,091 152 support as well as material assistance # of orphans identified who received appropriate care and psycho-social support as well 1,960 1,229 44 as material assistance # of psychologists and psychosocial agents trained and deployed to respond to the needs 1,300 856 11 of affected children and families * This figure has been adjusted in regard to the high number of persons being admitted daily to the transit centers and ETCs as suspect cases. It includes support provided to families with suspect, probable or confirmed EVD members. ** The target number has been changed in relation to the evolution of the epidemic.

23 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 IV (July to December 31st, 2019), covering all health zones in Ituri and North Kivu province. 24 This total has been adjusted to reflect some changes in the database (missing values, corrections, etc.). 10

DRC EBOLA SITUATION REPORT 31 July 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. Implementing Partners: ALIMA, ADRA, PRONANUT Main activities during the reporting period During the reporting period, nutritional activities in the ETCs continued to be implemented by UNICEF and its implementing partners: 773 new suspects and confirmed cases admitted in the ETC received adequate nutritional care. Among these, 15 were children under six months, 99 children aged from 6 to 59 months, 4 pregnant women and 6 lactating women. At communities and household level, the nutritionists and psychosocial agents of the ECTs, supported by UNICEF, provided nutritional support (Ready-to-Use Infant Formula - RUIF) to 15 infants less than six months old non-breastfed (2 in Butembo, 3 in Mabalako, 5 in Katwa, 3 in Beni, 1 in Bunia and 1 in Goma). Sensitization activities on adequate infant and young child feeding practices (IYCF) in the Ebola context at ETCs and contacts household level increased as well: 3,947 women caregivers (218 in Beni, 1272 in Mabalako, 887 in Butembo, 807 in Katwa, 38 in Goma, 522 in Bunia and 203 in Komanda) were sensitized by the communication agents, health promotion workers and nutritionists, a relevant increase in comparison to the 3,101 people sensitized during the previous reporting period.197 25 children under five suffering of Severe Acute Malnutrition were admitted for treatment in the OTPs (outpatients therapeutic programme) under the supervision of Health Zone nutritionists. On 17-18 July, UNICEF nutrition team, together with implementing partner ADRA, organized a training for 47 health workers (nutritionists, psychosocial agents and pharmacists) coming from 12 EVD-affected health zones on how improve the monitoring of the nutritional status and health development of separated and orphan children in the Ebola context. Key Results Total Result Change since NUTRITION Target26 last report UNICEF ▲▼ # of < 23 months children caregivers who received appropriate counselling on IYCF in 51,865 42,310 3,947 emergency # Ebola patients who received nutrition support during treatment according to guidance 8,750 6,364 773 note # of less than 6 months children who cannot be breastfed and who receive ready-to-use 600 465 15 infant formula in ETCs, nursery’s, orphanages and in the communities

Social Science Analysis Cell (SSAC) The formative, social sciences analysis section seeks to increase the accountability to affected populations through the provision of social sciences analysis to inform response interventions. Social sciences research agenda and themes are primary developed from epidemiological and context analysis as well as directly from response interventions and via requests from the Commissions.

Social sciences analysis supports UNICEF programme teams and the overall response to better understand and engage the communities with which we work. UNICEF’s Social Sciences team contributes to the integrated Analysis Cell which includes Epi and Social Sciences work.

25 Data for ECTs, Komanda, Butembo and Katwa health zones only. 26 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 IV (July to December 31st, 2019), covering all health zones in Ituri and North Kivu province. 11

DRC EBOLA SITUATION REPORT 31 July 2019 UNICEF’s Social Sciences teams includes local, national and international researchers specializing in epidemiology, health demography, anthropology and social sciences health studies. The team involves the exploration of behavioural determinants of health and uses multiple methods to collect data such as questionnaires, structured and guided interviews, focus groups, informal discussions and observation. Data are triangulated and mapped by area and group in order to ensure saturation and representation.

Research results are presented at Commissions and weekly in Sub-Coordinations (or in ad hoc requests) to facilitate access. The UNICEF’s Social Sciences team have ensured that all raw data, presentations and reports as well as workshop tools and training modules are available openly for everyone in the response.

Main results during the reporting period The teams continue to work in Butembo, Katwa, Vuhovi, Lubero and Kyondo in partnership and via the Ministry of Health Epi Cell and together with WHO, Centers for Disease Control and Prevention, IFRC, MSF and Africa Centers for Disease Control and Prevention.

General activities & programmes (1) The team in Mangina has finished the recruitment process of 10 local social scientists including 3 women. The team participated in a 3-day-training on research best practices and was introduced to all the Commissions. (2) Following up on the workshop organized end of June in Goma, the CASS team organized a half day workshop in Mangina for 30 participants to share CASS learning with partners and Commissions and to identify opportunities to facilitate and improve the use of Social Sciences recommendations. (3) In Butembo, two capacity-building-workshop have been organized for local Social Sciences teams (17 participants). Workshops focused on coding qualitative data and analyzing and grouping codes. During the reporting period, Social Sciences Analyses (conducted as part of the Analysis Cell under the Ministry of Health and together with WHO and partners) has focused on:  Perceptions of decentralized transit centers and proximity in health-seeking behaviors in Butembo. Results show that most people feel that these centers increase willingness to seek healthcare and be tested for Ebola and indicate greater trust thanks to the use of local staff and the structure being physically similar to the regular health center (not in plastic sheeting but in wood). In addition, in areas with and without the decentralized transit centers, the same transit center or isolation is not well perceived and study participants reported the importance of having a name similar to “regular” health centers.  The continued delays in health-seeking behaviors which, according to a global epidemiological analysis, reports of up to 12 days delay among Ebola patients whereas mortality rates double after 5 days delay. The study showed that delays result from continued gaps and inability to recognize Ebola symptoms (both in households and by health workers). Moreover, the fear that going to a health center will result in referral to ETC and the perception that everyone dies in ETCs and there is no available treatment for non-Ebola are also some causes of these delays. Recommendations have included scaling up and adapting communication and training on identifying Ebola symptoms and definitions of probable cases. Supply and Logistics UNICEF regularly monitors the supply chain and discusses with the different involved actors in order to ever improve efficiency of the supply and services facilitation for the Ebola response in Ituri and North Kivu provinces. During the reporting UNICEF distributed WASH, C4D, Child Protection, Health, Education and ICT items and supplies for a total value of US$ 145,682.02. The total value of procurement orders was US$ 338,867.19. Offshore procurement orders amounted to a value of US$ 200,526.41 (59 per cent), while local procurement orders amounted to a value of US$ 138,340.78 (41 per cent). Human Resources UNICEF continue to strengthen its presence on the ground to better respond to the expanding outbreak in North Kivu and Ituri provinces. The number of staff dedicated to the Ebola response scaled up up to 188 persons already working in the affected areas, with an additional 66 persons under recruitment. In addition, excluding Ebola staff, UNICEF has a capacity of 33 staffs in Goma sub-office (North Kivu) and 22 in Bunia sub-office (Ituri) to support the overall UNICEF operations in the region.

DRC EBOLA SITUATION REPORT 31 July 2019 External Communication During the reporting period, the UNICEF Communication Office facilitated the coverage of the Ebola-epidemic and the response of UNICEF and its partners in Goma, Beni and Butembo for the BBC and Liberation. Last two weeks press coverage included New York Times, Reuters,, Voice of America, Xinhua, Rai News, Europa press, UN News, Reliefweb, TRT World, The Guardian, Urdupoint, CNBC AFRICA, Irin, CGTN, abc.es, ABC News, le Figaro, Deutshe Welle, Notimex, El Sol de Mexico, AFP, le Figaro Online, France 24, TV5 Monde, Slate Africa and Russia Today. Since the beginning of the outbreak, the UNICEF Communication Office published 90 content pieces on its website http://www.unicef.org/drcongo and the Ebola landing page is updated weekly, linking to key figures, press releases, situation reports and stories. To show the impact of the epidemic on children and UNICEF's response, the Communication team posted almost 750 messages on Facebook, Instagram and Twitter. Several tweets were amplified by UNICEF’s global Twitter account and by Executive Director Henriette H. Fore. New digital publications included Testimony of a child cured of Ebola.

UNICEF expresses its sincere gratitude to all current donors for their substantial contributions to UNICEF's actions in favour of the Ebola response: The World Bank Group’s Pandemic Emergency Financing Facility (PEF), The European Commission (European Civil Protection and Humanitarian Aid Operations (ECHO), Gavi - the Vaccine Alliance, The Central Emergency Response Fund (CERF), the Government of Japan, the German Committee for UNICEF, the Government United Kingdom and the Paul G. Allen Family Foundation.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response Plan 2018 - 2019) Reprogrammed Funds Funds Funding gap funds from Received for Requirements* available Appeal Sector Equateur North Kivu $ ** Response Phase I & II $ % $ $ $ Water, Hygiene and 47,951,276 723,295 17,879,794 18,603,089 29,348,187 61% Sanitation - WASH / IPC Communication for Development (C4D) - Community engagement 51,440,240 371,558 13,356,698 13,728,256 37,711,984 73% and Communication for Campaigns Child protection and 9,402,390 100,000 7,053,900 7,153,900 2,248,490 0% Psychosocial Support *** Nutritional Care and Counseilling in Ebola 4,336,536 0 1,686,118 1,686,118 2,650,418 0% Treatment Center / Community **** Operations support, Security and Coordination costs and Information and 11,067,320 132,761 6,919,369 7,052,130 4,015,189 36% Communications Technology

DRC EBOLA SITUATION REPORT 31 July 2019 Surveillance 1,520,000 720,000 720,000 800,000 53%

Prepardness Plan 322,000 0 322,000 322,000 0 0%

Total 126,039,762 1,327,614 47,937,880 49,265,494 76,774,268 61%

* Funding requirement includes budget for phase I ($ 8,798,899), phase II ($ 13,031,305), phase II.I ($ 3,933,000), Phase III ($ 24,385,917) and Phase IV ($ 75,890,041) ** Funds available include reprogrammed funds from Equateur Response and Funds received since the beginning of the North Kivu & Ituri outbreak (August 2018) Next Situation Report: 04 August 2019

Who to contact for further Edouard Beigbeder Pierre Bry Xavier Crespin information: Representative Deputy Representative ai Chief Health UNICEF DRC UNICEF DRC UNICEF DRC Tel: + (243) 996 050 399 Tel: + (243) 817 045 473 Tel: + (243) 816 058 830 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected]

DRC EBOLA SITUATION REPORT 05 August 2019

Democratic Republic of the Congo

Ebola Situation Report North Kivu and Ituri

Photo Credit: UNICEF DRC Thomas Photo Credit: UNICEF DRC Mark Naftalin Photo© UNICEF Credit: DRC UNICEF Tremeau DRC Nybo 05 August 2019 SITUATION IN NUMBERS Highlights total reported cases 2,763 (MoH, 04 August 2019)  First August 2019 marked one year since the Government of the Democratic Republic of the Congo declared the Ebola outbreak. 2,669 confirmed cases UNICEF, WHO, OCHA and WFP Principals issued a joint statement to (MoH, 04 August 2019) reaffirm their strong commitment to support the Government in intensifying the overall EVD response. 753 children <18 among confirmed

cases (MoH, 04 August 2019)  Following the declaration of the death of the second EVD confirmed case in Goma, Rwanda closed its borders with DRC for a few hours. An deaths among confirmed cases additional two confirmed cases were reported in Goma, thus resulting 1,755 (MoH, 04 August 2019) in total four confirmed cases since the beginning of the outbreak. 20 January 2019

Guy 18,651 contacts under surveillance  From 25 to 27 July, UNICEF organized an internal evaluation of its (MoH, 04 August 2019) contribution to the EVD response under SRP3 and is adjusting its strategy to better respond to the needs of the current epidemiological dynamics under SRP4. UNICEF Ebola Response Appeal

US$ 126 million

# of affected families with confirmed, suspects, probable cases who 22,939** 8,614 * Funding requirement includes budget for phase I ($ received one or several kits of assistance to support their children 8,798,899), phase II ($ 16,964,905), phase III ($ 24,385,917) and phase IV ($ 75,890,041) * 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 suspected case, and is adjusted according to the Equateur Response and funds received since August 2018 response

DRC EBOLA SITUATION REPORT 05 August 2019

Epidemiological Overview1 Summary Table (4 August 2019) Confirmed and Probable Cases Deaths Number of days Province Health Zone Deaths among without Confirmed Probable Total Total Deaths confirmed cases confirmed cases Beni 594 9 603 381 390 0 Butembo 264 0 264 304 304 0 Kalanguta 136 15 151 57 72 1 Kyondo 20 2 22 13 15 40 Mabalako 365 16 381 262 278 2 Masereka 49 6 55 16 22 3 Musienene 73 1 74 29 30 40 Mutwanga 16 0 16 8 8 2 Nord-Kivu Oicha 51 0 51 24 24 1 Katwa 627 16 643 434 450 0 Vuhovi 101 13 114 35 48 2 Biena 16 1 17 12 13 32 Kayna 9 0 9 5 5 11 Manguredjipa 18 0 18 12 12 19 Lubero 31 2 33 4 6 10 Alimbongo 5 0 5 2 2 23 Goma 1 0 1 2 2 21 Nyiragongo 3 0 3 0 0 3 Mambasa 7 0 7 4 4 3 Mandima 231 4 235 123 127 0 Komanda 36 9 45 17 26 8 Nyakunde 1 0 1 1 1 226 Ituri Tchomia 2 0 2 2 2 316 Bunia 4 0 4 4 4 44 Rwanpara 8 0 8 3 3 39 Ariwara 1 0 1 1 1 35 Total 2,669 94 2,763 1,755 1,849 Previous Total 28 July 2019 2,577 94 2,671 1,696 1,790

1 Data source: Daily numbers by the National Coordination Committee (Comité National de Coordination, CNC). 2

DRC EBOLA SITUATION REPORT 05 August 2019 Key Epidemiological Developments Ebola Virus Disease (EVD) transmission continues to spread within several health zones of North Kivu and Ituri provinces, both affected by conflicts and humanitarian crisis.As of 04 August, a total of 2,763 EVD cases were reported, among which 2,669 confirmed and 94 probable cases. More than the two third of EVD confirmed cases died: 1,849 deaths, among which 1,755 confirmed and 94 probable cases (global case fatality ratio 67 per cent). During the reporting period, the number of new reported confirmed cases remained almost the same with 174 new confirmed cases in weeks 28 and 29 and 169 in the weeks 30 and 312. The epidemics spread in one new health zones and touched two health areas for the first time. Out of the 26 health zones affected by EVD since the beginning of the outbreak (August 2018), 16 health zones (62 per cent) of North Kivu and Ituri reported at least one confirmed EVD case in the last three weeks. During the last three weeks, a total of 260 confirmed cases were reported, with the majority coming from the health zones of Beni (46 per cent) and Mandima (21 per cent). During the reporting period, the new affected health zone, Nyiragongo, has reported three cases. The first case was a 46-year-old man coming from Bunia city, admitted on 30 July to the ETC with advanced symptoms and died the following day. The two other cases were related to the first one: his young son and his spouse. In Butembo, there was a slight increase in the number of cases over a large geographical area. A significant challenge remains the inaccessibility due to insecurity particularly in Kalunguta and Vohuvi health zones where 15 confirmed cases were reported. After the declaration of the death of the second EVD confirmed case in Goma on 01 August, the Rwandan government closed its border with Goma for few hours. This act raised fears and panic among the border population of both countries. In addition, two new confirmed cases were reported in Goma, related to the second case already died, thus reaching the number of four confirmed cases. The proportion of new confirmed cases listed as contacts remained low and sensibly decreased in comparison to the previous period (51 per cent on average in the two previous weeks against 42 per cent during the two last weeks). Although the proportion of EVD deaths at community level remains high and worrying, a decreased is observed in comparison to the previous two weeks: 22.5 per cent during week 30 and 31 in comparison to 27.5 per cent during the previous fourteen days. Disaggregated data by gender and age shows that, out of the 2,763 total cases recorded, 57 per cent (1,562) are female and among these 60 per cent are childbearing age (15-49 years). Twenty-eight per cent (787) are children aged less than 18 years. Since the beginning of the outbreak, 149 health personnel have been EVD infected (5 per cent of total cases) and among these ten during the reporting period. Humanitarian Leadership and Coordination Under SRP 4, UNICEF continues to support coordination in all locations with functional strategic or operational Commissions. UNICEF leads the Commissions on Risk Communication and Community Engagement (RCCE) and Psycho- social Support and co-leads Infection Prevention and Control (IPC)/WASH Commission with World Health Organisation (WHO). The strategic Ebola response coordination based in Goma maintains a strong support to active operational sub- coordinations in Butembo/Katwa, Mangina, Bunia, Goma, Beni and Komanda/Mambasa. In addition, multi-sectoral UNICEF rapid response teams are in place and deployed to new hotspots as required. Together with OCHA, UNICEF is also co-leading the programme III of the UN scale-up strategy aimed to strengthen community ownership and support programs in response to community needs to enable Ebola control activities (UNICEF) and strengthen multi-sectorial humanitarian coordination (OCHA). UNICEF and its partners will promote community ownership and implement social and humanitarian programs to respond to critical community needs,

2 New confirmed cases: 79 in week 30 and 90 in week 31.

DRC EBOLA SITUATION REPORT 05 August 2019 mitigate the adverse effects of the response, and strengthen community systems to enable sustained community engagement. In order to review the operational strategy under SRP 3 and, based on challenges, best practices and lessons learnt, identify the best approaches for the implementation of SRP 4 under its areas of responsibility, UNICEF organized a three-day review in Goma from 25 to 27 July. The meeting brought together key UNICEF staff from each sub- coordination, together with key resources at Goma coordination, country, regional and headquarter level. First August 2019 marked one year since the Government of the Democratic Republic of the Congo declared the Ebola outbreak. On the eve, UN partners of the EVD response, UNICEF, WHO, OCHA and WFP issued a joint statement to reaffirm their strong commitment to support the Government in intensifying the EVD response efforts. In addition, they appealed to the community to overcome reticence and facilitate access for an adequate and timely response and advocated with donors for the renew of their engagement to the final push to the EVD transmission. The statement was followed on 01 August by the visit of Mr. David Gressly, UN Emergency Ebola response coordinator, in Mangina, where the first EVD confirmed case was reported in 2018. During the visit, he commemorated all the people brought to death by the EVD and visited the local ETC. During the reporting period, Prof. Jean Jacques Muyembe, the EVD response coordinator, visited Goma. On 29 July he participated and intervened during the EOC meeting in front of the different partners of the EVD response. After few days, on 04 August, he took the opportunity to sensitise the population during the mass in four churches on the importance of seriously observe the recommended preventive measures and to fully adhere and facilitate the overall EVD response.

Response Strategy The Ebola response is based on the joint National Strategic Response Plan (SRP) against the EVD in North Kivu and Ituri provinces. The national SRP was first launched on 01 August 2018 and was revised four times3. The SRP IV will cover the period from July to December 2019 and represents a « final push » for all the stakeholders for ending EVD epidemic in the two provinces. In support of the SRP, the United Nations also developed a scale-up strategy to end the 10th Ebola outbreak in DRC. This strategy enhances the overall enabling environment within which the response is situated. It is implemented across five main pillars4 identified as essential for an effective response to end the Ebola outbreak. As part of the pillar I “Strengthened public health response in support of the Ministry of Health”, UNICEF continues to scale-up its RCCE interventions to enhance dialogue and partnerships between Ebola response teams and individuals or communities in affected areas enabling community ownership in the response and real time exchange of information. UNICEF also continues to work on improving IPC interventions in communities in affected areas, including the provisions of supplies and household decontamination for confirmed and probable cases. The Psychosocial support interventions is another key area of focus, and UNICEF continues to provide patients with EVD and their families psychosocial support through direct psycho-social care and provision of social support and food assistance to affected individuals and households. Nearly a year into the Ebola epidemic, experts are increasingly concerned with the persistent EVD transmission in both Nord Kivu and Ituri provinces, with new areas recently affected and ongoing conflicts causing security challenges and humanitarian crisis. The situation in the Ebola-affected areas of DRC is deteriorating and the number of Ebola cases continues to increase. Many people continue to die in the community – either at home or in general healthcare facilities – and significant numbers of new confirmed cases cannot be traced to an existing contact with Ebola. Responding to the Ebola outbreak in the DRC requires a focus beyond specific Ebola prevention, care and treatment interventions to address the vulnerabilities of the affected populations and improve access to quality services in the affected

3 The National Strategic Response Plan (SRP) was launched on August 1st and was revised four times. The initial Response Plan (SRP 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 October 19th, 2019, the MoH released the revised Ebola Response Plan (SRP 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 December 20th, 2018, the MoH updated the Ebola Response Plan II (SRP II-I, November 2018 – January 2019) to include assumptions and additional needs until January 31st, 2019, estimated at US$ 23,506,000 million. On February 13th, 2019, the MoH launched the Ebola Response Plan III (SRP III, February – July 2019) for a total amount of US$ 147,875,000. Finally, on July 15th, 2019, The MoH released the Ebola Response Plan IV (SRP IV, July – December 2019) for a total amount of $ 287,590,149. 4 The five main pillars of the scale-up strategy are: (i) Strengthened public health response led by WHO in support of the Ministry of Health; (ii) Strengthened political engagement, security and operations support led by EERC; (iii) Strengthened support to communities affected by Ebola led by the EERC and supported by OCHA and UNICEF; (iv) Strengthened financial planning, monitoring and reporting, led by the World Bank and (v) Strengthened preparedness for surrounding countries led by WHO and supported by OCHA and IASC partner. 4

DRC EBOLA SITUATION REPORT 05 August 2019 areas. Approaches that strengthen the community resilience and the restoration of health system are critical to sustain the gains beyond the current Ebola Outbreak. These approaches will reinforce those of the Ebola outbreak response and bring a medium to long term perspective to reduce population vulnerability, increase resilience and strengthen primary health care. In addition, these approaches will also strengthen the humanitarian-development continuum linking the outbreak response to the long term sustainable development. Summary Analysis of Programme Response Risk Communication and Community Engagement The risk communication and community engagement 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 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 (SDB), and ETCs. Implementing Partners (IP): Oxfam GB, Action Contre la Faim (ACF), Search for Common Ground (SFCG), Caritas Congo, Réseau des Medias pour le Développement (ReMed), Association Medias Auto Centré pour le Développement du Maniema (MEDAM) Main activities during the reporting period On 01-02 August, UNICEF RCCE team organized a workshop on Community Engagement in Goma focusing on the design of capacity building training modules and community-based approaches for community radio stations to improve communication capacities about Ebola related thematics. The workshop brought together 22 participants from the National Ministry of Communication and Media, the North Kivu Provincial Communication and Media Division, North Kivu Provincial Division of Health, Communication Task Force, community media platforms, non-governmental organizations and professional media organizations. In Somé and Mayuano in Mandima health zone local government representatives, UNICEF and implementing partners met with 100 village administrative and traditional leaders to discuss the public health situation in the area and to negotiate access and mutual cooperation for the EVD response. To further strengthen activities aimed at community engagement in the EVD response, an emergency operational action plan has been developed by the communications sub-committee in Goma with a focus on raising awareness among the bus and taxi drivers offering transport services between Ebola epidemic areas and Goma town. The action plan also includes activities such as door-to-door awareness raising activities done by community workers, raising awareness on Ebola prevention among moto-taxi drivers in Goma transport hubs by mobile teams of communicators and the sharing of audiovisual material with leaders of different religious denominations. Further RCCE activities in Goma covered over 1,000 people who were sensitized in 9 priority health centers around the Kiziba district – the area of the latest 3 confirmed Ebola cases in Goma town, to facilitate community acceptance of the response for further vaccination, decontamination and contact follow-up. About 8,140 households were visited by community workers who referred 21 patients to the health centers. The RCCE activities also included a meeting with 15 Kiziba religious leaders’ and prayer house managers to explain the ongoing interventions around the latest confirmed cases in the area and to solicit their commitment to refer Ebola suspected cases to the health facilities. Similar activities were organized with 425 catholic religious leaders from 9 parishes in Goma, 76 local branches and 336 core ecclesiastical communities. RCCE commission with support of UNICEF and partners also briefed 62 road inspectors from the Ministry of Transport on the EVD-related risks and ongoing interventions around the confirmed Ebola cases: vaccination, contact monitoring and community-based surveillance. The inspectors promised to collaborate with the Goma response coordination team to inform transport agencies and private businesses to more closely monitor the prevention, surveillance and control of Ebola disease in North Kivu. In Butembo four guided tours were organized in three different ETCs, respectively in Katwa health zone with 50 delegates from youth associations, in Musienene health zone with 40 community leaders and young taxi moto drivers and 2 guided tours with 97 trainee nurses and women leaders to the ETC of the Kambuli and Masiki health areas. Further 146 youth leaders from Katwa, 39 women leaders from Vuhovi, 30 locals from Kyondo, 303 peer-educators and 60 members of the management committees of 28 Universities in the city of Butembo were trained on RCCE. In addition, 7,417 persons participated to RCCE educational talks and mass-sensitizations.

DRC EBOLA SITUATION REPORT 05 August 2019 In Bunia 24 communicators of the points of entry and points of control, including 5 women, were trained on RCCE. During a debate with the communication sub-committee on SDB, vaccination and Ebola case referrals to health centers, 50 religious leaders from Kindia committed themselves to participate in the response activities, while 3,000 young people from different parishes, who came to participate to Diocesan Youth Days in Nyakasanza, and 50 women from Hoho villages 1, 2 and 3 took part in sensitization and community debates on Ebola prevention measures. Responding to Refusals/Reticence and Rumors In Butembo 61 per cent of reported community incidents (181/301) were solved and in Goma 59 per cent of rumors clarified (58/99). Rumors mainly concerned the low rate of recovery from EVD, the inexistence of the virus and presumed business related in the EVD referring mechanism. In Bunia the following cases of refusals were solved: 25 per cent of refusals to go to a health facility due to lack of money (71 families), 41 per cent refusals for SDB/SWABs (55 families), 41 per cent of refusals to check temperature (287 people) and 69 per cent of refusal linked to handwashing (415 people). The actions undertaken to solve community incidents, rumors and refusals were the achieved through awareness raising sessions conducted during educational talks, home visits and community dialogues. Additionally, interactive programs broadcasted on all partner radio stations helped address various concerns and assisted the population to better understand the importance of Ebola prevention and response. Promotion of Preventive Behaviors At the request of the vaccination sub-committee of Butembo strategic coordination, UNICEF implementing partner SFCG organized a training on mediation and alternative Ebola-related conflict resolution techniques for 65 civilian police officers who support vaccination teams to carry out their activities. Further 60 members of Katwa health commission, including 27 females, were trained in mediation and techniques of Ebola related peaceful resolution of conflicts. Media Testimonies from Ebola survivors and programs on screening, hand washing, SDB and transfer to ETC continue to be published in several newspapers and broadcast on numerous radio stations in local Swahili language every Wednesday and Friday afternoon as well as in French and Kinande in the evening time. SFCG continued to organize Popular Expression Tribunes: during the last 14 tribunes 2,374 people, including 1,413 females, were sensitized on Ebola prevention, vaccination, transfer to ETCs and TCs, ETC management, SDB and risk communication. Furthermore, the NGO continues to support series of RCCE youth community activities such as alert management, ETC support and ETC guided tours. During the reporting period 304 youth, including 105 females, participated to guided tours and committed to deconstruct rumors about the ETC care of patients, to raise awareness among their peer-groups, to facilitate alert findings and to persuade the Ebola deniers to get vaccinated. SFCG also works with youth influencers, who try to persuade youth Ebola resistant/denying groups, that Ebola is real and to inform them on Ebola prevention and control measures. Key Results Change since Total Result RISK COMMUNICATION AND COMMUNITY ENGAGEMENT Target5 UNICEF last report ▲▼ # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities (CAC, religious /traditional leaders, 67,695 56,355 3,670 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 40,321 33,076 1,500 community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, 26,500,000 21,626,788 1,798,854 adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious 12,981 9,752 558 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 185,490* 185,289 14,237 convinced to receive the vaccine within required protocols. * This figure indicates the number of listed eligible people for ring vaccination from August 8th, 2018 to August 03rd, 2019

DRC EBOLA SITUATION REPORT 05 August 2019 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 reinforcement of basic WASH services, which includes the provision of water and WASH kits6 and awareness raising of traditional practitioners (2) hygiene promotion and provision of WASH kits in schools7 , (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) joint8 supervision of health infrastructures to ensure that efficient and sustainable programmes of high quality are developed. Implementing Partners: Mercy Corps, Red Cross, OXFAM GB, MEDAIR, Action Contre la Faim (ACF), Programme de Promotion des Soins de Santé Primaires (PPSSP), Mutuelle de Sante Canaan (MUSACA) and Centre de Promotion Socio- Sanitaire (CEPROSSAN). Main activities during the reporting period As the outbreak evolves, response measures continue to adapt and accelerate. At the Ebola Operations Center in Goma, as co-lead, UNICEF works with the IPC commission to strengthen and harmonize activities within the overall coordination. The IPC/WASH task force has been focused on finalizing the action plan and budget for the next strategic phase (SRP 4). Considering the recent developments in the outbreak, discussions were centralized on the need for intensified and coordinated efforts which is reflected in the revised strategy. Further to the Memo of Understanding between WHO and UNICEF, next steps are in motion for the transition of decontamination activities from WHO to UNICEF as of 01 September. The information management team conducted follow up visits to selected IPC Sub-Committees (SC) to reinforce and evaluate the use of the data collection tools. In Mangina, a new Ministry of Health (MoH) data encoder was trained on the use of the database to ensure integrated data collection. A presentation was held in Beni with the SC Chair and two MoH data encoders on their responsibilities in managing data. In Bunia, working sessions with UNICEF partners, ACF, PPSSP and MUSACA were held and eight M&E staff were trained on effective data management of activity reporting. With 149 health care workers affected, transmission of EVD related infections in health facilities remains among a key concern in decreasing the exposure of infectious risks and nosocomial infections. In response to this, a scale up is underway on the strengthening of WASH facilities, improving access to water and reinforced training of health personnel in proper infection prevention and control measures to reduce these risks. One year since the declaration of this outbreak, response strategies continue to be adapted to the evolving circumstances. In this light, an innovative approach has been initiated by UNICEF, the Integrated Capacity Enhancement Project (Projet Intégré de Renforcement de Capacités or PIRC), a results-based approach to improve health services by rewarding health centers directly based on the quantity of essential services they delivered and the improved quality of care. Incentives include financial payments, supplies and public recognition. PIRC is currently being implemented in Butembo and Katwa health zones and supports the MoH’s goal to improve adherence to IPC practices and enhance the capacity of health staff to avoid the transmission of Ebola and other highly contagious diseases. In this framework, UNICEF and its partners (MoH, WHO and Africa CDC) evaluated 150 priority health facilities and provided IPC and WASH supplies and services. In Butembo, activities were conducted in 10 affected health zones in response to the 33 confirmed cases of EVD. Hygiene kits were distributed by MoH, WHO and partners CEPROSSAN and Mercy Corps to 382 households and 363 handwashing devices were installed in public places. These activities were accompanied by health messaging. To further strengthen prevention measures, 97 health care facilities (HCF) received IPC/WASH kits with an additional 74 receiving replacement consumable items and metal waste burners were provided to 22 HCFs.

6 For 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 supplies 7 For IPC/ WASH kits for schools, items are provided in accordance with three areas of support: (1) Screening (thermoflash), (2) handwashing (with soap), (3) cleaning and decontamination supplies. 8 Multidisciplinary teams comprise health specialists from the MoH and/ or Medical NGOs as well as WHO. 7

DRC EBOLA SITUATION REPORT 05 August 2019 Field visits were conducted with all partners for the monitoring of the implementation of activities and supervision of ongoing construction works. Partner CEPROSSAN continued the monitoring of the use of 153 handwashing points and 26 chlorination points. In Beni, where sustained EVD transmission continues and 75 cases were confirmed, partner PPSSP distributed hygiene kits to 701 affected households and supplied 525,997 liters of treated drinking water. UNICEF WASH-IPC teams strengthened the capacities of 792 health facilities staff, through on-site training and supervision. In addition, they briefed 917 health care workers on Ebola IPC measures. IPC/WASH kits were distributed by PPSSP to 78 HCFs. Ebola prevention sessions were conducted with 158 patients and caregivers. To ensure consistent access to water, 126,857 liters were provided to 196 handwashing points and 1,530 kg of chlorine was donated to the Beni TC for disinfection activities. Although the most parts of North Kivu school is out for the summer, due to the EVD outbreak the school period has been delayed in Beni so 40 schools were provided with WASH/IPC kits by UNICEF supported IPC supervisors. Prevention information sessions were held in 118 schools on hygiene promotion and Ebola information and education, attended by 2,128 teachers and students. UNICEF supported the government utility Service National d’Hydraulique Rurales (SNHR) on the construction of a deep well and handpump to provide access to safe water to a vulnerable community of 136 households who previously relied on a nearby river for drinking water. Inaccessibility of the IPC/WASH teams in Oicha health zone makes it difficult to implement and regularly monitor activities. Despite this, 24 hygiene kits were distributed to affected households. Local partner association Organisation de Developpement D’Oicha supplied 219 public handwashing points with 91,955 liters of chlorinated water with follow up and monitoring of activities. Withdrawal of partner MEDAIR from Oicha including the Ebola Transit Centre impacts response activities and there is currently a gap. Mandima health zone remains a hot spot with persistent transmission of confirmed cases. The response has poor access to this health area due to insecurity and community resistance, and this leads to more cases. Challenges in accessing some communities such as Somé health area have been mitigated by coordinating between the Mambasa and Mangina IPC Sub-Coordinations, intervention activities have been successful and affected households have been accessed. Response activities were implemented by partners OXFAM and FAEVu, distributed 639 hygiene kits to households surrounding confirmed cases. Donation of IPC/WASH kits was completed in 18 health facilities, 17 schools and 22 public places along with Ebola prevention messaging to 1,111 people. In Komanda, a slight increase of transmission was reported, and activities were in response to 4 confirmed cases and OXFAM distributed hygiene kits to 118 households. MUSACA installed handwashing devices in 17 public places and provided 510,370 liters of drinking water, of which 334,400 liters were treated in 8 chlorination points serving approximately 2,500 people daily. An additional 81,897 liters of water were supplied in 69 public places in Komanda and Irumu health areas. In response to two confirmed cases that were reported in Mambasa health zone, rings were opened in Mambasa and Salama health areas and partner MUSACA responded with the distribution of hygiene kits to 85 households. A donation of IPC/WASH kits was also made to 3 health facilities that had been visited by the cases. Evaluations were conducted in 2 health centers, 2 schools, 26 public places and 6 places of worship resulting in the installation of handwashing devices in 18 public places and the supply of 10,740 liters of chlorinated water and 238,630 liters of drinking water were provided to the community. In support of Mangina Sub-Coordinaton, supplementary activities were carried out around confirmed cases in Somé with the distribution of hygiene kits to 32 households and the installation of handwashing points in 137 public places. Ebola awareness and prevention sessions were held with 295 people. As no new cases were reported in Bunia, preparedness activities were supported by partner ACF with the supply of 110,065 liters of chlorinated to 3 health facilities and 105 public places and 2 health facilities and 14 public places in Rwampara health zone. Further north in Ariwara, IPC/WASH kits were provided to 21 health facilities and 6 public places. A briefing was held with 18 Supervisors and Hygienists of the IPC Sub-Commission on Ebola transmission and prevention measures. After new confirmed cases were reported in Goma, the IPC Sub-Committee remained in response mode and the need for close collaboration between the actors was paramount to ensure a coordinated implementation of activities. One ring was opened in Kiziba health area and after initial evaluations were conducted, UNICEF partners PPSSP commenced

DRC EBOLA SITUATION REPORT 05 August 2019 with the distribution of hygiene kits to 16 households and WASH kits to 7 public places. IPC/WASH kits were provided by UNICF to 8 health facilities. OXFAM installed water storage tanks and provided 9,000 liters/day to 8 health facilities in Himbi health area. Partner Medair led several information sessions with 944 people on Ebola transmission, hand hygiene and prevention measures. PPSSP sustained regular prevention activities and supported ongoing management and monitoring of 20 public handwashing points with the delivery of 141,589 liters of water and hygiene promotion messaging benefiting 274,483 people (123,354 women, 132,138 men, 9,536 boys and 9,405 girls). Key Results Total Result Change since WATER, SANITATION & HYGIENE Target9 last report UNICEF ▲▼ # of health facilities in affected health zones provided with essential WASH services. 3,884 2,556 394

# of target schools in high risk areas provided with handwashing facilities 3,800 2,284 101 # of community sites (port, market places, local restaurant, churches) with hand 11,750 6,560 449 washing facilities in the affected areas % of schools and public places near confirmed cases locations where handwashing 100% 83% 4% stations are installed and utilized Number of households of confirmed cases, contacts and neighbours of confirmed 36,437 12,741 1,062 cases who received a hygiene and prevention kits with adequate messaging

Main activities during the reporting period During the report period, 8 EVD confirmed cases (5 girls and 3 boys) being students were reported, coming from Beni and Oicha health zones. Among them, two are students of the secondary school and six of the primary school. Six (6) cases have been admitted to the ETC for treatment, the other 2 died in the community. Together with UNICEF WASH teams, Education teams have focused their activities on the preparation of the opening of the school year on 2 September 2019 including the assessment of the available and missing WASH resources in schools. In Butembo and Katwa, the UNICEF Education team, supported by the RCCE team, organized a training on EVD prevention measures for 311 members, including 109 females, of peer students’ committees and for 78 members, including 19 females, of the Student Management Committees, in 22 universities in Butembo, Katwa, Masereka and Kyondo. At the same time, during the traditional events organized to sensitized parents on the importance of education and promote the school enrollment, the EPSP has conducted different awareness raising activities on EVD prevention measures. The UNICEF Education team distributed 280 Guidance Notes of EVD prevention to 28 universities. In addition, Education and RCCE teams organized a guided tour of ETC of Katwa for 99 students (55 females) of two universities. The visit was the occasion to meet with five Ebola survivors who talked about their experience. This reinforced the commitment of the students to raise awareness on the importance for both suspect and confirmed cases to go to the ETC for appropriate care.

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 IV (July to 31 December 2019), covering all health zones in Ituri and North Kivu province. 9

DRC EBOLA SITUATION REPORT 05 August 2019 UNICEF Education team, EPSP and implementing partner AVSI conducted follow up visits in 6 primary schools in Beni and Mabalako, that has previously benefited of a psychosocial support training with a focus on Ebola context, conducted by AVSI and a training on Ebola Guidance Notes by the EPSP. During the visit, the vast majority of participants (33 teachers and directors and 689 students) expressed their positive feedback on the two trainings in terms of improved capacity of understanding trauma, listen and provide support to a traumatized person and the importance of recreational activities as a mean to attenuate trauma among students. The visits also allowed to notice the application of the guidance note in terms of practice of hand washing. The joint team also visited a TENAFEP exam center in Beni, where the sixth graders were taking their exams. The follow up visit revealed that WASH materials, distributed earlier, are regularly used by both teachers and students. Finally, the team participated to a series of awareness raising activities, including on Ebola prevention measures, through theater for students and teachers from primary, secondary schools and a catch-up center as well. About 450 students (287 girls and 163 boys), 16 teachers and directors (9 women) and 90 community members (77 women) participated in the activities, organized by a local NGO under the framework of the AVSI partnership agreement with UNICEF. Key Results Change since Total Result EDUCATION Target10 last report UNICEF ▲▼ # of students reached with Ebola prevention information in schools 1,458,000* 892,597 1,549 # of teachers briefed on Ebola prevention information in schools 47,000 32,053 127

Psychosocial Support and Child Protection11 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 strategy include the provision of (1) psychosocial support12 for EVD confirm and suspect cases, including children, in the ETCs; (2) material13 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 care14 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 SDB etc). Implementing Partners: Danish Refugee Council (DRC), Alliance for International Medical Action (Alima), Division Provinciale des Affaires Sociales (DIVAS) Main activities during the reporting period During the reporting period, UNICEF and its partners provided psychological support to 475 children suspected and confirmed cases (239 girls and 236 boys) admitted to the TC/ETC and to 661 newly affected families. 3,901 contacts were followed by the psychosocial team. To better respond to the epidemic evolution and psychosocial needs, the UNICEF psychosocial team has been strengthened with the recruitment of six new clinical psychologists in Bunia, fifteen psychosocial assistants in Mambasa (including four for Somé) and ten in Ariwara and 4 cured people to work as care providers in the Goma ETC. The 25 new psychosocial assistants were identified in the local communities and recruited, among 80 participants, based on the test results coming at the end of a three-day training conducted in Ariwara from 27 to 19 July and Mambasa from 22 to 24 July. Activities around confirmed cases Activities around confirmed cases have progressively become the focus of the current response. All commissions including the Psychosocial Commission are able to organise, within 24-72 hours, a maximum of activities around new

10 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 IV (July to 31 December 2019), covering all health zones in Ituri and North Kivu province. 11 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), Alima and DIVAS. All results, unless otherwise stated, are UNICEF results with implementing partners. 12 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. 13 Material assistance is assessed on a case by case basis, according to the specific needs of children and their families. 14 According to the local context and socio-cultural norms. 10

DRC EBOLA SITUATION REPORT 05 August 2019 confirmed cases to try to stop the Ebola transmission chain. All families of all confirmed cases reported during this reporting period received psychological support. The family of the second confirmed case of Goma, including the orphans, was assisted and benefited from regular support visits. The psychosocial team contributed to the listing of contacts and facilitated the preparation of two households for decontamination. Extra nutritional support, complementary to the WFP food ration, was provided to the family as well as a funeral kit. A briefing on psychosocial support in the Ebola context was organized for the managers of the different health facilities who had received the confirmed case before he was transferred to the ETC. In Komanda, following the confirmation of four new cases, the Psychosocial Commission conducted eight psychoeducation sessions with a total of 143 participants, including 13 girls and 10 boys. Psychological support was provided to 32 households to help them to accept the decontamination of their homes, and 208 contacts were prepared for vaccination. Activities in ETC/TC/Nurseries During the reporting period the Bunia ETC received 61 suspect cases, among which 27 were adults (9 men and 18 women) and 34 children (10 girls and 24 boys). All suspected cases received psychosocial support and all family members who visited patients as well as all nurses were regularly supported. The high number of children admitted to the Beni nursery has disrupted the reception and care of children whose parents are admitted to the ETC/TC. UNICEF continued its advocacy with the MoH to find some space for it to expand the nursery. The director of the hospital in Beni finally endorsed the idea of strengthening the reception capacities by freeing up two rooms that will be renovated during the month of August. The construction of the nursery in Mangina is completed and an official authorisation for the building of the Bunia one has been granted to the Psychosocial Commission. Activities in the community The follow up of EVD-related orphaned children continued all Orphans of Ebola: a secondary impact of the along the reporting period. In addition, 51 cured persons were epidemic followed up in the community and 44 others respected the Baraka is an 18-month-old girl and is part of a sibling calendar recommended by the National healing program by of 8 orphans, including 5 boys and 3 girls, left by a 50- attending medical visits, psychological support sessions and year-old widow who passed away at ETC in Butembo. biological screening. A total of 95 cured patients received The widow had come from the Isonga health area. The psychosocial assistance in the community. whole family was driven out of Isonga because they had agreed to collaborate and accept public health In addition to sessions around confirmed cases, to break down interventions. When the widow died, the children many resistances by the local population, UNICEF and its continued to live with a very vulnerable aunt, only partners conducted 687 psychoeducation sessions touching a relying on the eldest of the orphans, who is 16 years total of 7,986 participants (2,411 men, 2,638 women and old. Baraka happens to be malnourished, has reported 1,379 children - including 735 boys and 644 girls). functional problems and can't walk yet. UNICEF, the The psychosocial commission actors continued to provide PSS commission and partner DRC provided support to support to the other commissions in the community and in the the family since the beginning. More recently, they ETC. In particular, psychosocial support was provided at the organized a case management meeting and a more in- moment of the disclosure of the test results to families and depth assessment of the situation to be able to patients, to facilitate the acceptance of the treatment respond to the family needs in the most appropriate process, vaccination or decontamination and during the pre- way. In the meantime, UNICEF implementing partner ADRA, through its nutritionists, have begun to provide listing of contacts. nutritional care. Key Results

Total Result Change since CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT Target15 last report UNICEF ▲▼ # of children as confirmed or suspect case receiving psychosocial support inside the 10,312* 5,962 475 transit centres and ETCs # of affected families with confirmed, suspects, probable cases who received 22,939* 8,614 661 psychosocial assistance and/or material assistance

15 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 IV (July to December 31st, 2019), covering all health zones in Ituri and North Kivu province. 11

DRC EBOLA SITUATION REPORT 05 August 2019 # of contact persons, including children, who receive psycho-social support 18,651** 15,972 0 # of separated children identified who received appropriate care and psycho-social 2,950 2,288 197 support as well as material assistance # of orphans identified who received appropriate care and psycho-social support as well 1,960 1,339 110 as material assistance # of psychologists and psychosocial agents trained and deployed to respond to the needs 1,300 902 46 of affected children and families * This figure has been adjusted in regard to the high number of persons being admitted daily to the transit centers and ETCs as suspect cases. It includes support provided to families with suspect, probable or confirmed EVD members. ** The target number has been changed in relation to the evolution of the epidemic.

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. Implementing Partners: ALIMA, Adventist Development and Relief Agency (ADRA), Programme National de Nutrition (PRONANUT) Main activities during the reporting period During the reporting period, UNICEF and its implementing partners continued to implement the nutritional activities in the ETCs, community and at household’s level. About 785 new suspects and confirmed cases admitted in the ETC received nutritional support, including 12 children under six months, 130 children aged from 6 to 59 months, 7 pregnant women and 5 lactating women. At community and household level, the nutritionists and psychosocial agents of the ECTs, supported by UNICEF, provided nutritional support (Ready-to-Use Infant Formula - RUIF) to 120 infants less than six months old non-breastfed (37 in Butembo, 11 in Mabalako, 28 in Katwa, 39 in Beni and 5 in Komanda). UNICEF and its partners raised awareness among 3,294 women caregivers (127 in Beni, 977 in Mabalako, 760 in Butembo, 692 in Katwa, 34 in Goma, 396 in Bunia and 308 in Komanda) on adequate infant and young child feeding practices (IYCF) in the Ebola context at ETCs and contacts household level. Fifty-one (51) children under five suffering of Severe Acute Malnutrition were admitted for treatment in the OTPs (outpatients therapeutic programme) under the supervision of Health Zone nutritionists. In Butembo, on 28 July, UNICEF Nutrition team organized a training on the collection methodology for nutritional data in the Ebola context for 10 nutritionists, the director of the CTE and the medical care coordinator of the ETC. Key Results Change since Total Result NUTRITION Target16 last report UNICEF ▲▼ # of < 23 months children caregivers who received appropriate counselling on IYCF in 51,865 45,604 3,294 emergency # Ebola patients who received nutrition support during treatment according to guidance 8,750 7,149 785 note # of less than 6 months children who cannot be breastfed and who receive ready-to-use 600 639 174 infant formula in ETCs, nursery’s, orphanages and in the communities

DRC EBOLA SITUATION REPORT 05 August 2019 are primary developed from epidemiological and context analysis as well as directly from response interventions and via requests from the Commissions. Social sciences analysis supports UNICEF programme teams and the overall response to better understand and engage the communities with which we work. UNICEF’s Social Sciences team contributes to the integrated Analysis Cell which includes Epi and Social Sciences work. UNICEF’s Social Sciences teams includes local, national and international researchers specializing in epidemiology, health demography, anthropology and social sciences health studies. The team involves the exploration of behavioural determinants of health and uses multiple methods to collect data such as questionnaires, structured and guided interviews, focus groups, informal discussions and observation. Data are triangulated and mapped by area and group to ensure saturation and representation. Research results are presented at Commissions and weekly Sub-Coordination level (or in ad hoc requests) to facilitate access. The UNICEF’s Social Sciences team have ensured that all raw data, presentations and reports as well as workshop tools and training modules are available openly for everyone in the response. Main results during the reporting period The teams continue to work in Butembo, Katwa, Vuhovi, Lubero and Kyondo in partnership and via the MoH Epi Cell and together with WHO, Centers for Disease Control and Prevention, IFRC, MSF and Africa Centers for Disease Control and Prevention. General activities & programmes  On 02-03 August, the CASS team organized 2 half-day workshops with all sub-coordinations in Butembo and Katwa and identified concrete actions to ensure increased visibility of CASS, strengthen the follow up of recommendations issued from research and maintain dialogue with partners by continuously identifying and responding to research needs.  As part of planned routine activities, a capacity building session for the Beni/Mangina local research team was held in Mangina on 1 August. The session focused on addressing challenges identified during data collection as well as best methodological approaches for working with communities and other stakeholders. Ongoing social sciences analysis Beni-Mangina To better understand the current second wave of the epidemic in Beni, particularly in hotspot areas, the CASS has focused on implementing and documenting research on potential reasons and causes for the recent outbreak in the health areas of Ngongolio, Butsili and Kanzulizuli in Beni health zone. Data were collected from 26 to 29 July. Key recommendations include the strengthening of community-based interventions, a more discrete and less frequent home visits by EVD response team to affected and neighboring households to avoid unnecessary attention from surrounding communities, the need to increase knowledge among local population around symptoms and transmission routes, the strengthening of communication and dialogue about ETC, how they work and why they are important and the improvement of communication about survivors experience and the importance of seeking treatment early. The CASS team participated in a briefing session on CAC approach organized by the UNICEF RCCE team in Mandima and explained its mandate and presented some key finding from other studies and examples of how they were used to inform EVD response programs. Participants included UNICEF teams along with 38 community leaders. These latter expressed their full commitment to support implementation of CAC and CASS activities. During regular meetings with health stakeholder such as traditional healers and modern health personnel in both Mabalako and Mandima, concerns were raised by participants regarding recent community deaths and EVD confirmed cases of people who had consulted traditional healers. As a result, a rapid research study was commissioned by the Mangina CASS team together with the WASH/IPC sub-commission to better understand the views of traditional healers and their perception of risk and willingness to be part of response programming, perception of communities who prefer to consult them rather than modern health facilities, as well as the WASH teams’ perceptions on engaging traditional healers in activities with the aim of developing recommendations on how to effectively involve traditional healers in the response.

DRC EBOLA SITUATION REPORT 05 August 2019 Goma A study on perceptions of the community on the new MSF treatment center in Kanyaruchinya (Nyiragongo health zone, Goma) was presented during a meeting with the communication sub-commission and partners (MSF, Premiere Urgence, OMS) in Goma on 26 July. Results show mixed viewpoints related to the ETC with 45 per cent of respondent having a negative view and 43 per cent a positive one. Collaboratively, CASS, the sub-commission leads, and partners decided to improve communication on the ETC function, its importance during the screening and treatment of suspected and confirmed cases and the different steps from arrival to admission. Based on findings, young men, bikers and traditional healers were found to be the most resistant to the idea of the CTE and thus, in addition to the community, these groups will be specifically targeted by communication activities. Butembo-Katwa A result of a study conducted on the distribution of hygiene kits to households and WASH/IPC kits to schools were presented at the sub-coordination level in Butembo and Katwa. The objective of the research was to better understand knowledge on use of kit contents, acceptance and perceptions of kit contents and whether kits were perceived to have an impact on reducing the transmission risk of Ebola. The study was conducted with kit recipients as well as households in the community who were not recipients. Preliminary findings are summarized below:  Majority of respondents know the kit was provided to enable them to protect themselves against Ebola and for some this protection extended to other hygiene related illnesses.  Majority of respondents think that regular and proper use of the kit contents can help block transmission routes  Increasing the number of kit recipient households around the case and raising community awareness on the eligibility criteria for kits are measures proposed by the community to mitigate post-distribution problems within the community.

Supply and Logistics UNICEF regularly monitors the supply chain and discusses with the different involved actors to ever improve efficiency of the supply and services facilitation for the Ebola response in Ituri and North Kivu provinces. During the reporting UNICEF distributed WASH, C4D, Child Protection, Health, Education and ICT items and supplies for a total value of US$ 470,174.06. The total value of procurement orders was US$ 203,560,100 per cent local procurement.

Human Resources UNICEF continue to strengthen its presence on the ground to better respond to the expanding outbreak in North Kivu and Ituri provinces. The number of staff dedicated to the Ebola response scaled up to 190 persons already working in the affected areas, with an additional 59 persons under recruitment. In addition, excluding Ebola staff, UNICEF has a capacity of 36 staffs in Goma sub-office (North Kivu) and 22 in Bunia sub-office (Ituri) to support the overall UNICEF operations in the region.

External Communication During the reporting period, the UNICEF Communication Office facilitated the coverage of the Ebola-epidemic and the response of UNICEF and its partners in Goma, Beni and Butembo for the BBC, TV Globo, SABC and Liberation. Last three weeks press coverage included New York Times, Reuters, Voice of America, Xinhua, Rai News, Europa press, UN News, Reliefweb, TRT World, The Guardian, Urdupoint, CNBC AFRICA, Irin, CGTN, abc.es, ABC News, le Figaro, Deutshe Welle, Notimex, El Sol de Mexico, AFP, le Figaro Online, France 24, TV5 Monde, Slate Africa and Russia Today. Since the beginning of the outbreak, the UNICEF Communication Office published 90 content pieces on its website http://www.unicef.org/drcongo and the Ebola landing page is updated weekly, linking to key figures, press releases, situation reports and stories. To show the impact of the epidemic on children and UNICEF's response, the Communication team posted almost 750 messages on Facebook, Instagram and Twitter. Several tweets were amplified by UNICEF’s global Twitter account and by Executive Director Henriette H. Fore. New digital publications included Testimony of a child cured of Ebola.

DRC EBOLA SITUATION REPORT 05 August 2019 Funding The SRP4 provisional funding requirement for the public health response is US$ 287.6 million for activities until end December 2019. The DRC grand total budget for the Ebola response in North Kivu and Ituri provinces from August 2018 to December 2019 is estimated at US$ 563.8 million. As part of this joint response plan, the UNICEF estimated public health response requirements stands at US$75.9 million, out of a total of US$ 126 million. To date, the UNICEF response is 39 per cent funded. UNICEF expresses its sincere gratitude to all current donors for their substantial contributions to UNICEF's actions in favour of the Ebola response: The World Bank Group’s Pandemic Emergency Financing Facility (PEF), The European Commission (European Civil Protection and Humanitarian Aid Operations (ECHO), Gavi - the Vaccine Alliance, The Central Emergency Response Fund (CERF), the Government of Japan, the German Committee for UNICEF, the Government United Kingdom and the Paul G. Allen Family Foundation.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response Plan 2018 - 2019) Reprogrammed Funds Funds Funding gap funds from Received for Requirements* available Appeal Sector Equateur North Kivu $ ** Response Phase I & II $ % $ $ $ Water, Hygiene and 47,951,276 723,295 17,879,794 18,603,089 29,348,187 61% Sanitation - WASH / IPC Communication for Development (C4D) - Community engagement 51,440,240 371,558 13,356,698 13,728,256 37,711,984 73% and Communication for Campaigns Child protection and 9,402,390 100,000 7,344,617 7,444,617 1,957,773 0% Psychosocial Support *** Nutritional Care and Counseilling in Ebola 4,336,536 0 2,136,118 2,136,118 2,200,418 0% Treatment Center / Community **** Operations support, Security and Coordination costs and Information and 11,067,320 132,761 6,619,369 6,752,130 4,315,189 39% Communications Technology

Surveillance 1,520,000 720,000 720,000 800,000 53%

Prepardness Plan 322,000 0 322,000 322,000 0 0%

Total 126,039,762 1,327,614 48,378,597 49,706,211 76,333,551 61%

DRC EBOLA SITUATION REPORT 12 August 2019

Democratic Republic of the Congo

Ebola Situation Report North Kivu and Ituri

Photo Credit: UNICEF DRC Thomas Photo Credit: UNICEF DRC Mark Naftalin Photo© UNICEF Credit: DRC UNICEF Rice-Chudeau DRC Nybo 12 August 2019 SITUATION IN NUMBERS Highlights total reported cases 2,831  The number of new reported confirmed cases slightly decreased in (MoH, 11 August 2019) comparison to the previous week (68 cases vs 94).  Beni continues to be the major hotspot of EVD transmission, followed 2,737 confirmed cases (MoH, 11 August 2019) by Mandima and Mambasa.  Given the high number of EVD cases reported in Mambasa and based 776 children <18 among confirmed on the need to increase the community engagement in the EVD cases (MoH, 11 August 2019) response, UNICEF opened an operational office in Mambasa town.  On 8 August, a ceremony was held in Mangina for the official handover 1,798 deaths among confirmed cases of the nursery to the health zone. Built by UNICEF partners, it will allow (MoH, 11 August 2019) 20up Januaryto eighteen 2019 children whose parents are admitted at the ETC to avoid Guyfamily separation. 16,328 contacts under surveillance (MoH, 11 August 2019)  In Goma, the emissary of Pope Francis in charge of human and integral development in the Vatican, surrounded by two emeritus bishops and

the new bishop of Goma, reaffirmed the importance of adhering to the UNICEF Ebola Response Appeal EVD response and raising awareness among local populations. US$ 126.03 million

UNICEF’s Response Ebola Response Funding Status 2018 - 2019 Indicator Target Result # of at-risk people reached through community engagement and Total funding interpersonal communication approaches (door-to-door, church 26,500,000* 22,099,834 available* meetings, small-group training sessions, school classes, briefings 39% with leaders and journalists, other) # of listed eligible people for ring vaccination informed of the Ebola NK and Ituri benefits of the vaccine and convinced to receive the vaccine within 191,660* 191,237 Phases I, II, III & IV required protocols. Funding requirements* : # of households of confirmed cases, contacts and neighbours of $ 126,039,762 confirmed cases who received a hygiene and prevention kits with 36,437 13,484 Funding Gap adequate messaging 61% # of teachers briefed on Ebola prevention information 47,000 32,228 # of affected families with confirmed, suspects, probable cases who received one or several kits of assistance to support their 22,939** 8,927 * Funding requirement includes budget for phase I ($ children 8,798,899), phase II ($ 16,964,905), phase III ($ 24,385,917) and phase IV ($ 75,890,041) * 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 suspected case, and is adjusted according to the Equateur Response and funds received since August 2018 response

DRC EBOLA SITUATION REPORT 12 August 2019

Epidemiological Overview1 Summary Table (11 August 2019) Confirmed and Probable Cases Deaths Number of days Province Health Zone Deaths among without Confirmed Probable Total Total Deaths confirmed cases confirmed cases Beni 623 9 632 390 399 0 Butembo 269 0 269 315 315 0 Kalanguta 137 15 152 57 72 0 Kyondo 20 2 22 13 15 47 Mabalako 366 16 382 268 284 0 Masereka 49 6 55 16 22 10 Musienene 75 1 76 30 31 0 Mutwanga 18 0 18 8 8 1 Oicha 51 0 51 24 24 8 Nord-Kivu Katwa 631 16 647 436 452 0 Vuhovi 103 13 116 37 50 1 Biena 16 1 17 12 13 39 Kayna 10 0 10 6 6 0 Manguredjipa 18 0 18 12 12 26 Lubero 31 2 33 4 6 17 Alimbongo 5 0 5 2 2 30 Goma 1 0 1 1 1 28 Nyiragongo 3 0 3 1 1 10 Lolwa 1 0 1 0 0 4 Mambasa 15 0 15 7 7 1 Mandima 242 4 246 128 132 0 Komanda 37 9 46 20 29 3 Ituri Nyakunde 1 0 1 1 1 233 Tchomia 2 0 2 2 2 323 Bunia 4 0 4 4 4 51 Rwanpara 8 0 8 3 3 46 Ariwara 1 0 1 1 1 42 Total 2,737 94 2,831 1,798 1,892 Previous Total 5 August 2019 2,669 94 2,763 1,755 1,849

1 Data source: Daily numbers by the National Coordination Committee (Comité National de Coordination, CNC). 2

DRC EBOLA SITUATION REPORT 12 August 2019 Key Epidemiological Developments With more than 1,800 confirmed recorded deaths since the beginning of the outbreak, Ebola Virus Disease (EVD) transmission continues to spread within several health zones of North Kivu and Ituri provinces, both affected by conflicts and humanitarian crisis. As of 11 August, a total of 2,831 EVD cases were reported, among which 2,737 confirmed and 94 probable cases. More than two thirds of all EVD confirmed cases have died: 1,892 deaths, among which 1,798 confirmed and 94 probable cases (global case fatality ratio remains 67 per cent). During the reporting period (week 32), the number of new reported confirmed cases decreased from 94 confirmed cases in the previous week to 68 confirmed cases. One new health zone was affected by the outbreak, Lolwa, in Ituri province during the reporting period. The cumulative number of health zones having reported at least one confirmed or probable case of EVD since the beginning of the epidemic has increased to 27. Seventeen of them (63 per cent) have reported at least one confirmed EVD case in the last three weeks. A total of 218 health areas have reported at least one confirmed or probable case of EVD since the beginning of the outbreak, of which 69 reported confirmed cases in the past three weeks. During the reporting period, three health zones were reported with the most cases, including Beni (29 cases out of the 68 confirmed cases, 43 per cent), Mandima (11 cases, 16 per cent) and Mambasa (8 cases, 12 per cent). Although the overall total number of cases has decreased, there was an increase in the number of confirmed cases in three health zones: Beni (29 in week 32 vs 26 in week 31), Mambasa (8 in week 32 vs 2 in week 31), and Musienene (2 in week 32 in comparison to zero cases in the previous period). This may indicate an intensification of viral circulation. The proportion of new confirmed cases listed as contacts remained low and decreased in comparison to the previous period (51 per cent on average in the two previous weeks against 42 per cent during the two last weeks). Among the new confirmed cases listed as contacts, the proportion of contacts followed on a regular basis increased significantly compared to the week before (74 per cent vs 67 per cent). The proportion of community deaths among all confirmed cases increased and remains worrying (26 per cent in week 32 vs 23 per cent in week 31). Disaggregated data by gender and age shows no change in the sex ratio: out of the 2,763 total cases recorded, 57 per cent (1,570 cases) are female and among these 60 per cent are of childbearing age (15-49 years). Twenty-nine per cent (810) are children aged less than 18 years old. Since the beginning of the outbreak, 151 health personnel have been affected by EVD (5.3 per cent of total cases) and among these cases, two cases were recorded during the reporting period. Humanitarian Leadership and Coordination Under the Strategic Response Plan (SRP) 4, UNICEF continues to support coordination in all locations with functional strategic or operational Commissions. UNICEF leads the Commissions on Risk Communication and Community Engagement (RCCE) and Psycho-social Support and co-leads Infection Prevention and Control (IPC)/WASH Commission with World Health Organisation (WHO). The strategic Ebola response coordination maintains a strong support to active operational sub-coordinations in Butembo/Katwa, Mangina, Bunia, Goma, Beni, Komanda and Mambasa, a new UNICEF operational hub. In addition, multi-sectoral UNICEF rapid response teams are in place and deployed to new hotspots as required. Given the high number of EVD cases reported in Mambasa and the significant distance with Bunia and Mangina, UNICEF decided to reinforce its presence in the field by opening an operational office in Mambasa town. This decision will also allow the local community to be more involved in the response. A P-3 Team leader and teams from the different UNICEF-led programs are already deployed and all the necessary support services have been provided. Together with OCHA, UNICEF is also co-leading the programme III of the UN scale-up strategy aimed to strengthen community ownership and support programs in response to community needs to enable Ebola control activities (UNICEF) and strengthen multi-sectorial humanitarian coordination (OCHA). UNICEF and its partners will promote community ownership and implement social and humanitarian programs to respond to critical community needs, mitigate the adverse effects of the response, and strengthen community systems to enable sustained community engagement.

DRC EBOLA SITUATION REPORT 12 August 2019 On 8 August, a ceremony was held in Mangina for the official handover of a new nursery to the health zone. Built by UNICEF partners, the nursery has a capacity of supporting eighteen children whose parents have been admitted at the Ebola Treatment Center (ETC). During his visit in the area, Prof. Muyembe, the director of the multi-sectorial technical committee of the EVD response, expressed his satisfaction for the high-quality standards of the nursery. At the same occasion he visited the ETC accompanied by EVD partners, including UNICEF and encouraged the different EVD actors to boost their activities for the final push to end the epidemic.

On the same day in Goma, cardinal Peter Kodwo Appiah Turkson, emissary of Pope Francis in charge of human and integral development in the Vatican, surrounded by two emeritus bishops and the new bishop of Goma, organized a conference at Amani High School. 55 priests and 135 nuns were present at the event to raise awareness about EVD prevention measures and on the importance to adhere to the EVD response among Christians. The cardinal took advantage of his visit in Beni to sensitize local population on the same key issues.

Response Strategy The Ebola response is based on the joint National Strategic Response Plan (SRP) against the EVD in North Kivu and Ituri provinces. The national SRP was first launched on 01 August 2018 and was revised four times2. The SRP IV will cover the period from July to December 2019 and represents a « final push » for all the stakeholders for ending EVD epidemic in the two provinces. In support of the SRP, the United Nations also developed a scale-up strategy to end the 10th Ebola outbreak in DRC. This strategy enhances the overall enabling environment within which the response is situated. It is implemented across five main pillars3 identified as essential for an effective response to end the Ebola outbreak. As part of the pillar I “Strengthened public health response in support of the Ministry of Health”, UNICEF continues to scale-up its RCCE interventions to enhance dialogue and partnerships between Ebola response teams and individuals or communities in affected areas enabling community ownership in the response and real time exchange of information. UNICEF also continues to work on improving IPC interventions in communities in affected areas, including the provisions of supplies and household decontamination for confirmed and probable cases. The Psychosocial support interventions is another key area of focus, and UNICEF continues to provide patients with EVD and their families psychosocial support through direct psycho-social care and provision of social support and food assistance to affected individuals and households. A year into the Ebola epidemic, experts are increasingly concerned with the persistent EVD transmission in both Nord Kivu and Ituri provinces, with new areas recently affected and ongoing conflicts causing security challenges and humanitarian crisis. The situation in the Ebola-affected areas of DRC is deteriorating and the number of Ebola cases continues to increase. Many people continue to die in the community – either at home or in general healthcare facilities – and significant numbers of new confirmed cases cannot be traced to an existing contact with Ebola. Responding to the Ebola outbreak in the DRC requires a focus beyond specific Ebola prevention, care and treatment interventions to address the vulnerabilities of the affected populations and improve access to quality services in the affected areas. Approaches that strengthen the community resilience and the restoration of health system are critical to sustain the gains beyond the current Ebola Outbreak. These approaches will reinforce those of the Ebola outbreak response and bring a medium to long term perspective to reduce population vulnerability, increase resilience and strengthen primary health care. In addition, these approaches will also strengthen the humanitarian-development continuum linking the outbreak response to the long term sustainable development.

2 The National Strategic Response Plan (SRP) was launched on August 1st and was revised four times. The initial Response Plan (SRP 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 October 19th, 2019, the MoH released the revised Ebola Response Plan (SRP 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 December 20th, 2018, the MoH updated the Ebola Response Plan II (SRP II-I, November 2018 – January 2019) to include assumptions and additional needs until January 31st, 2019, estimated at US$ 23,506,000 million. On February 13th, 2019, the MoH launched the Ebola Response Plan III (SRP III, February – July 2019) for a total amount of US$ 147,875,000. Finally, on July 15th, 2019, The MoH released the Ebola Response Plan IV (SRP IV, July – December 2019) for a total amount of $ 287,590,149. 3 The five main pillars of the scale-up strategy are: (i) Strengthened public health response led by WHO in support of the Ministry of Health; (ii) Strengthened political engagement, security and operations support led by EERC; (iii) Strengthened support to communities affected by Ebola led by the EERC and supported by OCHA and UNICEF; (iv) Strengthened financial planning, monitoring and reporting, led by the World Bank and (v) Strengthened preparedness for surrounding countries led by WHO and supported by OCHA and IASC partner. 4

DRC EBOLA SITUATION REPORT 12 August 2019

Summary Analysis of Programme Response Risk Communication and Community Engagement The risk communication and community engagement 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 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 (SDB), and ETCs. Implementing Partners (IP): Oxfam GB, Action Contre la Faim (ACF), Search for Common Ground (SFCG), Caritas Congo, Réseau des Medias pour le Développement (ReMed), Association Medias Auto Centré pour le Développement du Maniema (MEDAM) Main activities during the reporting period In preparation of the coming international conference of the Yira-Nande community in Mangina, the RCCE sub- commission, led by UNICEF, reinforced sensitization activities on EVD prevention measures together with the WASH/IPC team. On 9 August in Goma UNICEF and the International Federation of the Red Cross (IFRC) co-facilitated a RCCE workshop organized by the United States Agency for International Development (USAID) and the Office of Foreign Disaster Assistance (OFDA) to reinforce partners’ capacities on RCCE in the Ebola context. In addition, more than 750 university students participated at a debate facilitated by the RCCE coordination teams and university professors on the importance of the EVD prevention and response measures. On 10 August, in the Kiziba health area in Goma, young people threatened to attack Ebola response vehicles not far from the ETC, which treated the last three confirmed cases. Supported by the RCCE sub-commission, the administrative chief and the head of district engaged in raising awareness among local population on the importance of the EVD response. In Butembo, the RCCE sub-commission participated in a multi-commission assessment on mobility and EVD transmission routes at three points of entry in the town. The objective was evaluating the availability of the communication and media tools and the staff capacity to conduct adequate EVD prevention measures (use of termoflash and communication on handwashing). In Katwa, through dialogues with local authorities, the local rapid response team, supported by UNICEF, succeeded in supporting the EVD response teams to access Kivetya health area in Kalunguta health zone, an area previously inaccessible due to insecurity and community resistance. In Butembo and Katwa the RCCE partners continued to organize guided visits in the ETCs and related nurseries in the attempt of diminishing the fear and reticence of local population: 58 community workers and community leaders participated in this activity. In addition, RCCE partners raised awareness on risk communication and community engagement, public health interventions and the importance of vaccination, swabs and SDB to 2500 catholics, adventists and over 500 community members in the affected health zones 4 . Furthermore, 150 members of management and student committees, local leaders, health staff and traditional health practitioners received briefings on risk communication and community feedback mechanism. In the Mabolio area of Beni, where a significant increase of confirmed cases was reported, the RCCE teams held several community dialogue sessions with community leaders, youth and religious leaders to overcome the strong resistance observed in the area. Due to these efforts, a vaccination ring was opened on 10 August and nearly 150 young people committed themselves to adhere and promote the EVD prevention and response measures. After a few hours, in Halungupa in Mutwanga health zone (Beni) the local health center was attacked and the stock of death body bags were stolen and burnt. Advocacy efforts were carried out by RCCE local teams with local and provincial territorial authorities to calm the situation and diminish resistance among population. After a new confirmed Ebola patient in Lolwa health area in Komanda, the RCCE teams organized dialogues with local group leaders, police authorities, village chiefs and the health zone management team on the importance of their role

4 Alimobongo, Biena, Kalunguta, Katwa, Kayna, Kyondo Lubero, Masereka, Musienene, Vuhovi

DRC EBOLA SITUATION REPORT 12 August 2019 in engaging their community to accept and contribute to the response interventions. The team also sensitized 31 community members to accept decontamination and contact tracing around the Ebola deceased cases. Responding to Refusals/Reticence and Rumors In Mangina 59 per cent (20 out of 34) of community incidents directly involving response activities were resolved, together with 86 per cent (174 out of 202) of refusals related to handwashing and 71 per cent (5 out of 7) of negative feedbacks. These latter dealt with vaccination (three feedbacks), multi-commission activities (two), surveillance and response coordination. In Beni, 15 refusals out of 26 (58 per cent) were resolved. Refusals mainly concerned surveillance (13), vaccination (9), screening at the point of entry (three) and handwashing (one). In Katwa, Butembo, Masereka Musienene, Vuhovi and Kalunguta, 225 out of 356 refusals were addressed and solved (63 per cent): 63 per cent (27/43) concerning vaccinations, 62 per cent (125/200) concerning referrals to the ETC, 77 per cent (40/52) on EDS and 52 per cent (25/48) on decontamination. In addition, 14 negative feedbacks were collected (four on communication, three on medical support, four on IPC, two on surveillance and one on EDS) among which seven were solved. In Goma, 82 per cent (180/220) of reported rumors were clarified by risk communication teams. About 40 unresolved rumors need further clarifications from vaccination, medical referral and psycho-social teams. Promotion of Preventive Behaviors During the reporting period, about 18,100 people were sensitized on Ebola in Mangina town and 1,492 people participated at 184 educational talks in Mabalako and Mandima districts. Almost 500 community leaders, community workers and members of associations in Katanga, Aloya, Mayuano and Biakato Mayi health areas were briefed on importance of Ebola risk communication and community engagement. Further 103 women and church members in Gite, Some, Mangina and Lwemba participated at Ebola awareness dialogues. Over 500 people including the adventist youth, lobby groups, singers of the catholic church and community leaders participated in community dialogues on risk communication and Ebola public health actions. The dialogues were held in Butembo, Vuhovi, Alimbongo, Musienene, Kalunguta and Mangurijipa health zones. In Butembo town hall, the RCCE team organized a targeted a presentation with 109 religious leaders and 30 journalists to explain the epidemiologic trends as well as the importance of spreading messages on EVD preventive behaviors. In Ituri region 8,364 households were visited by community animation cell members (CAC) with about 12,718 people sensitized on Ebola prevention and response measures. In Goma UNICEF implementing partners sensitized around 2,363 people in Kiziba, Bugamba 1 et Bugamba 2 on Ebola prevention and response measures. They also briefed 70 transport agents (including 5 women), 36 Kiziba pharmacists and eight opinion leaders on EVD-related risks identification, prevention measures and community alert mechanisms. Media Fourteen media partners in Goma town broadcasted key messages on interventions around the preparation of “Stop Ebola” outreach newsletter. In Beni the sub-commission communication this week pre-tested new awareness messages in Swahili and Kinande, leaflets with awareness raising messages, and images on clinical management/medical treatment of Ebola cases, vaccination, ETCs and SDB in French. During the reporting period, in Mangina and Mabalako, three radios broadcasted spots and messages 42 times on Ebola prevention, importance of Ebola screening and hand washing and Ebola songs in Swahili and local language Kinande. Twenty-six radio stations in Butembo and Katwa broadcasted programs on EVD-related issues such as: the difference between the ongoing insecticide-treated bed nets distribution campaigns and the Ebola response activities, the importance of community leaders in the surveillance and the importance of countervailing the false rumors about the use of a second vaccine in the response. In Vuhovi four interactive programs produced and broadcast by Bashu radio aired messages on hygiene measures to prevent Ebola, importance of swabs and SDB and medical and psychosocial care in the ETCs.

DRC EBOLA SITUATION REPORT 12 August 2019 In addition, the RCCE teams distributed about 1,500 leaflets and 300 posters on Ebola prevention and response measures in the new affected zone of Lolwa (Ituri). Key Results Change since Total Result RISK COMMUNICATION AND COMMUNITY ENGAGEMENT Target5 last report UNICEF ▲▼ # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities (CAC, religious /traditional leaders, 67,695 58,259 1,904 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 40,321 33,625 549 community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, 26,500,000 22,099,834 473,046 adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious 12,981 10,076 324 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 191,660* 191,237 5,948 convinced to receive the vaccine within required protocols. * This figure indicates the number of listed eligible people for ring vaccination from 8 August 2018 to 10 August 2019

5 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 IV (July to 31 December 2019), covering all health zones in Ituri and North Kivu province. 6 For 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 supplies 7 For IPC/ WASH kits for schools, items are provided in accordance with three areas of support: (1) Screening (thermoflash), (2) handwashing (with soap), (3) cleaning and decontamination supplies. 8 Multidisciplinary teams comprise health specialists from the MoH and/ or Medical NGOs as well as WHO. 7

DRC EBOLA SITUATION REPORT 12 August 2019 In Butembo, the number of cases remains consistent with 13 new confirmed cases including two confirmed cases from Beni and Bunia. In response to these cases, hygiene kits were distributed by MoH, WHO and UNICEF partners CEPROSSAN and Mercy Corps to 202 households, 47 health facilities received IPC/WASH kits and 82 health facilities received replenishment of consumable items. Handwashing devices were installed in 99 public places. An ongoing challenge of inaccessibility remains as the security situation deteriorated in Muchanga and Wayene health zones in Katwa. In some areas of insecurity, houses were decontaminated by briefed family members. In Beni, EVD transmission remained consistent with 31 confirmed cases. UNICEF partner PPSSP distributed hygiene kits to 60 households and 46 health facilities were supported with the donation of IPC/WASH kits. UNICEF installed handwashing devices in 8 public places for the community. There was a delay in response activities due to community resistance in the hotspot of Mabolio health area. In Oicha, the response was impacted by security incidents, so activities were disrupted, and supplies were delayed. Local partner association Organisation de Developpement D’Oicha supplied 326 public handwashing points with 60,900 litres of chlorinated water with follow up and monitoring of activities along with PPSSP. In Mangina, the surrounding health zones remains a hot spot with persistent transmission of confirmed cases. Response activities were implemented by partners OXFAM and FAEVu and hygiene kits were distributed to 347 households surrounding confirmed cases. Donation of IPC/WASH kits was completed in seven health facilities and seven public places along with Ebola prevention messaging to 1,575 people. The response in Somé health area remains challenging due to inaccessibility in some villages because of the presence of rebel groups, logistic access constraints and tensions between local communities and Ebola response teams. The coordination of activities between the Mangina and Komanda Sub-Coordinations improved the coverage of the response by UNICEF implementing partners Oxfam and MUSACA. About 115 handwashing points were installed in public places together with sensitization of local population In Komanda, activities continued around previous and two new confirmed cases: 96 household hygiene kits were distributed by UNICEF along with awareness sessions on preventative measures reaching 277 people. Support was provided by UNICEF to two affected health facilities with the supply of 8,500 liters of water and 33 health care providers were briefed on the use of IPC/WASH kits and standard and Ebola precautions along with the continued monitoring of the use of handwashing points in 23 health facilities. Evaluations were conducted in four health centers and 32 public places resulting in the installation of 121 handwashing devices by UNICEF and partner MUSACA supplied 42,740 liters of chlorinated water in 71 public places. About 286,490 liters of drinking water were provided to the community serving approximately 2,500 people daily. In response to three confirmed cases that were reported in Mambasa, partner MUSACA provided hygiene kits to 75 households and one IPC/WASH kit to the health post Bandimwame and EVD awareness sessions were held with 41 people. Handwashing kits were installed in 30 public places and 155,840 liters of water were distributed of which 125,205 liters were treated for 5 chlorination points serving approximately 700 people a day. As the incubation period ended without any new reported cases, Bunia remains in prevention mode. To strengthen these measures, UNICEF supplied 55,625 liters of chlorinated water in 3 health facilities and 91 public places in Bunia and two health facilities and 14 public places in Rwampara. Partner ACF supplied 51,600 liters of chlorinated water to 60 public places. New handwashing devices were installed in seven public points by partner MUSACA which also continued monitoring the use of additional hand washing devices in Bunia (19) and Rwampara (22). Further north in the Ariwara health zone, community water source surveys were conducted on 352 domestic wells and 51 commercial wells to establish mapping for the distribution of water treatment products. Follow up delivery was made to 24 health facilities with missing items (soap, cleaning gloves, buckets and thermoflash) from the IPC/WASH kits that were delivered two weeks prior. Goma remains on alert as the two confirmed cases remain within the incubation period, response activities continue around the cases to reduce the risk of transmission within the contacts and community. To reinforce preparedness activities, meetings were held between UNICEF and new potential partners for contingency planning in case new cases are reported in Goma in the future. Close collaboration has been vital between the IPC/WASH and Communication Sub-Committees to support the integration of activities in the community.

DRC EBOLA SITUATION REPORT 12 August 2019 In response to the lack of access to water, UNICEF partner Oxfam supplied 98,250 liters of treated water to 8 health facilities in Himbi and 6 health facilities in Kiziba health zone and an additional 128,000 liters of water in the community of Kiziba. To improve water supply in the community, two water storage bladders of 20,000 liters were installed in each affected health zone health zone to serve a population of 37,520 people. In addition to regular activities, partner PPSSP supported 3 public events with EVD prevention activities by supplying 78,140 litres of chlorinated water to 26 handwashing points in the Goma, Karisimbi, Kirotshe and Nyaragongo health zones accompanied by hygiene promotion messaging at the University of Goma, the Cathedral of Notre Dame and the celebration of the Feast of Tabasky. UNICEF implementing partner Medair continued its support within the health centers of Hebron and Methodiste where regular prevention activities continued. A training was held on Ebola transmission, hand hygiene and prevention measures in the two centers with a total of 16 health workers trained and 50 community leaders briefed. Key Results Change since Total Result WATER, SANITATION & HYGIENE Target9 UNICEF last report ▲▼ # of health facilities in affected health zones provided with essential WASH services. 3,884 2,567 11

# of target schools in high risk areas provided with handwashing facilities 3,800 2,332 48 # of community sites (port, market places, local restaurant, churches) with hand 11,750 6,937 377 washing facilities in the affected areas % of schools and public places near confirmed cases locations where handwashing 100% 98% 15% stations are installed and utilized Number of households of confirmed cases, contacts and neighbours of confirmed 36,437 13,484 743 cases who received a hygiene and prevention kits with adequate messaging

Main activities during the reporting period UNICEF Education teams continued their preparation activities for the school year opening. In particular, together with WASH teams, WASH/IPC needs are assessed in several schools in EVD hotspot areas. During the ongoing events for school enrollment promotion and the administrative opening of the school year, UNICEF’s education team jointly with the EPSP organized a three-day workshop in Butembo, gathering together 175 EPSP inspectors and executive managers, of which 30 were women. These latter were briefed on the importance of EVD prevention measures in schools, with a focus on the respect of the Guidance Notes and their follow up. All participants engaged closely with EVD prevention measures, spreading the message among students and teachers and conducting follow up visits in schools. In addition, participants advocated for an extension of the WASH-IPC program in schools beyond the hotspots to include at affected and at-risk health zones.

DRC EBOLA SITUATION REPORT 12 August 2019 Education teams accompanied the RCCE and WASH/IPC teams in conducting EVD prevention activities in universities and secondary school centers of exam in Beni, Butembo, Oicha and Mabalako10. In Beni, Oicha and Mabalako health zones, UNICEF implementing partner AVSI, in partnership with a local NGO, organized awareness raising activities in 83 primary and secondary schools and from catch-up centers for through participatory theatre focused on the importance of schooling, water-borne linked diseases, importance of using WASH devices in schools and Ebola prevention practices. About 24,092 students attended these activities, including 9,989 girls. Key Results Change since Total Result EDUCATION Target11 last report UNICEF ▲▼ # of students reached with Ebola prevention information in schools 1,458,000* 916,689 24,092 # of teachers briefed on Ebola prevention information in schools 47,000 32,401 175

Psychosocial Support and Child Protection12 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 strategy include the provision of (1) psychosocial support13 for EVD confirm and suspect cases, including children, in the ETCs; (2) material14 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 care15 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 SDB etc). Implementing Partners: Danish Refugee Council (DRC), Alliance for International Medical Action (Alima), Division Provinciale des Affaires Sociales (DIVAS), Division de l’Interieur (DIVInter) Main activities during the reporting period During the reporting period, UNICEF and its partners provided psychological support to 254 children, including 253 suspected cases and one confirmed case (in total, 119 girls and 134 boys) admitted to the TC/ETC and to 313 newly affected families. 1,113 contacts were followed by the psychosocial team. About 181 new separated children (87 boys and 94 girls) identified during the reporting period received appropriate care and support. Activities in ETC, TC and nurseries During the reporting period, an Ebola survivor working as care giver for infected patients at the ETC of Beni, died after having been reinfected by EVD. This extremely rare event provoked panic among health personnel working in the ETC. In response, UNICEF and its partners set up a plan of psychological support to be provided to health workers in the short and medium terms and started individualized psychological support sessions. In Katwa, UNICEF psychosocial teams reinforced the capacities of the psychologists of implementing partners Alima on case management. On 8 August in Mangina, the nursery was opened. Built by UNICEF through to the support of the Psychosocial Commission, the nursery will contribute to avoid separation of children from their parents admitted at the ETC. Activities in communities The psychosocial commission agents conducted follow up visits to three EVD-related orphaned children, who lost their mother two months ago. They particularly insisted with the family on the importance and best approaches to be used

10 See IPC/WASH and RCCE paragraphs. 11 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 IV (July to 31 December 2019), covering all health zones in Ituri and North Kivu province. 12 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), Alima and DIVAS. All results, unless otherwise stated, are UNICEF results with implementing partners. 13 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. 14 Material assistance is assessed on a case by case basis, according to the specific needs of children and their families. 15 According to the local context and socio-cultural norms. 10

DRC EBOLA SITUATION REPORT 12 August 2019 for informing the children, still unaware of their mother’s death, about this traumatic event in order for them to progressively accept it. Follow up activities with affected families slowed down during the reporting period, because of insecurity and access constraints, especially in Bunia health zone. In addition, a challenge was represented by the follow up of affected families living in areas which are far from the ETC were their family member is admitted. UNICEF and its partners are trying to improve the coordination among the PSS teams in the different EVD hotspot areas. Thanks to the support of UNICEf and its partners, 67 new discharged cases (18 men, 23 women, 9 girls and 17 boys), including 3 cured persons (a man, a woman and a boy) were reintegrated into their community and received an hygiene and a food kit as well as individualized assistance based on a need evaluations conducted by the PSS teams. In Bunia, out of the 23 non-cases discharged from ETC, 9 (39 per cent) were referred to a hospital facility for the treatment of other diseases. During this referral, the PSS teams provided psychosocial support to these persons. To break down community resistance to the EVD response and allow the population to be better informed about it, UNICEF and its partners conducted 387 psychoeducation sessions through individual or group talks in the community. About 5,665 people (2,007 men, 2,323 women, 708 girls and 627 boys) participated in these sessions during which topics such as the EVD transmission routes, the importance of timely referral to the ETC, the importance of EDS, and the functioning of the ETC were discussed with participants. Key Results Change since Total Result CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT Target16 last report UNICEF ▲▼ # of children as confirmed or suspect case receiving psychosocial support inside the 10,312* 6,216 254 transit centres and ETCs # of affected families with confirmed, suspects, probable cases who received 22,939* 8927 313 psychosocial assistance and/or material assistance # of contact persons, including children, who receive psycho-social support 16,328** 14,111 0 # of separated children identified who received appropriate care and psycho-social 2,950 2,469 181 support as well as material assistance # of orphans identified who received appropriate care and psycho-social support as well 1,960 1,382 43 as material assistance # of psychologists and psychosocial agents trained and deployed to respond to the needs 1,300 90617 0 of affected children and families * This figure has been adjusted in regard to the high number of persons being admitted daily to the transit centers and ETCs as suspect cases. It includes support provided to families with suspect, probable or confirmed EVD members. ** The target number has been changed in relation to the evolution of the epidemic.

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 IV (July to 31 December 2019), covering all health zones in Ituri and North Kivu province. 17 This total has been adjusted to reflect some changes in the database (missing values, corrections, etc.). 11

DRC EBOLA SITUATION REPORT 12 August 2019 three children under six months, 63 children aged from 6 to 59 months and one pregnant women. Among these, more than 40 per cent, 156 cases, were admitted in the ETC of Butembo. At communities and household level, the nutritionists and psychosocial agents of the ETCs, supported by UNICEF, provided nutritional support Ready-to-Use Infant Formula (RUIF) to 24 infants less than six months old non-breastfed (11 in Butembo, 7 in Katwa, 3 in Goma, 2 in Bunia and 1 Beni). In addition, 14 children under five suffering of Severe Acute Malnutrition were admitted for treatment in the Outpatients Therapeutic Programme (OTPs) under the supervision of health zone nutritionists. Awareness raising activities on adequate Infant and Young Child Feeding practices (IYCF) in the Ebola context continued to be implemented by UNICEF and its partners, such as communication agents, health promotion workers and nutritionists: about 1,918 women caregivers participated to these activities at ETCs and contacts household level (425 in Butembo, 244 in Katwa, 85 in Beni, 537 in Mabalako, 354 in Komanda, 258 in Bunia and 15 in Goma). Key Results Total Result Change since NUTRITION Target18 last report UNICEF ▲▼ # of < 23 months children caregivers who received appropriate counselling on IYCF in 51,865 47,522 1,918 emergency # Ebola patients who received nutrition support during treatment according to guidance 8,750 7,519 370 note # of less than 6 months children who cannot be breastfed and who receive ready-to-use 600 663 24 infant formula in ETCs, nursery’s, orphanages and in the communities

Social Science Analysis Cell (CASS) The formative, social sciences analysis section seeks to increase the accountability to affected populations through the provision of social sciences analysis to inform response interventions. Social sciences research agenda and themes are primary developed from epidemiological and context analysis as well as directly from response interventions and via requests from the Commissions. Social sciences analysis supports UNICEF programme teams and the overall response to better understand and engage the communities with which we work. UNICEF’s Social Sciences team contributes to the integrated Analysis Cell which includes Epi and Social Sciences work. UNICEF’s Social Sciences teams includes local, national and international researchers specializing in epidemiology, health demography, anthropology and social sciences health studies. The team involves the exploration of behavioural determinants of health and uses multiple methods to collect data such as questionnaires, structured and guided interviews, focus groups, informal discussions and observation. Data are triangulated and mapped by area and group to ensure saturation and representation. Research results are presented at Commissions and weekly in Sub-Coordinations (or in ad hoc requests) to facilitate access. The UNICEF’s Social Sciences team have ensured that all raw data, presentations and reports as well as workshop tools and training modules are available openly for everyone in the response. Main results during the reporting period The teams continue to work in Butembo, Katwa, Vuhovi, Lubero and Kyondo in partnership and via the MoH Epi Cell and together with WHO, CDC, IFRC, Médecins Sans Frontières (MSF) and Africa CDC. General activities & programmes UNICEF team organized capacity building sessions for local researchers in Butembo on the use of a new qualitative analysis tool (Atlas.ti) to be used for social research. In Goma, local researchers were briefed on the use of a new monitoring tool for the implementation of recommendations issued by the CASS to the different EVD-response programs.

18 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 IV (July to 31 December 2019), covering all health zones in Ituri and North Kivu province. 12

DRC EBOLA SITUATION REPORT 12 August 2019 On 8 August, in Mangina, UNICEF organized a half-day session with local researchers to discuss how to better identify and approach key stakeholders who could support and facilitate the research process at community level, particularly in areas where there continues to be a great deal of distrust and suspicion around response activities. Ongoing social sciences analysis In Beni-Mangina, a rapid research study was launched to better understand the views of traditional healers, their perception of risk and willingness to be part of response programming. The study also sought to understand the perception of communities who prefer to consult traditional healers rather than modern health facilities, as well as the WASH teams’ perceptions on how to effectively engage them in the response. In Butembo-Katwa, CASS teams shared key recommendations with IPC/WASH and RCCE teams issued by a study conducted from 3 to 11 July on the perception of households of the hygiene kits distributed by IPC/WASH teams to prevent EVD transmission. The study focused on knowledge related to the use of kit contents, acceptance and perceptions of kit contents and whether kits were perceived to have an impact on reducing the transmission risk of Ebola. Recipients as well as non-recipients of the kits participated in focus group discussions. During the reporting period, the CASS team presented two key recommendations: to increase communication on the eligibility criteria to mitigate potential conflict between beneficiaries and non-beneficiaries and to vary the colors of kit contents and patterned fabric to prevent stigmatization of kit recipients. IPC/WASH and RCCE teams are working together to align their operational approach to these recommendations. In Goma, CASS and RCCE teams worked together on the recommendations issued by a study on perceptions of the community on the new MSF treatment center in Kanyaruchinya (Nyiragongo health zone). In particular, the CASS analysis identified the need to focus communication on specific target groups, such as young men, bikers and traditional healers, who more reluctant to accept the new ETC. In addition, following the CASS recommendation, the RCCE team is improving communication on the ETC and how it works.

Supply and Logistics UNICEF regularly monitors the supply chain and discusses with the different involved actors to ever improve efficiency of the supply and services facilitation for the Ebola response in Ituri and North Kivu provinces. During the reporting UNICEF distributed WASH, C4D, Child Protection, Health, Education and ICT items and supplies for a total value of US$ 100,474.74. The total value of procurement orders was US$ 264,763.83, totally offshore procurement.

Human Resources UNICEF continue to strengthen its presence on the ground to better respond to the expanding outbreak in North Kivu and Ituri provinces. The number of staff dedicated to the Ebola response scaled up to 197 persons already working in the affected areas, with an additional 53 persons under recruitment. In addition, excluding Ebola staff, UNICEF has a capacity of 36 staffs in Goma sub-office (North Kivu) and 22 in Bunia sub-office (Ituri) to support the overall UNICEF operations in the region.

External Communication The Country Office (CO) continued to focus its external communication activities on the consequences of the Ebola epidemic on children and UNICEF’s response. During the reporting period, press coverage included Radio Okapi, The Telegraph, CIPRAD, R7, RTV and EFE. The OC also had contacts with Public Broadcasting Service (PBS), Agence Française de Presse (AFP) and Radio Télévision Belge Francophone (RTBF). Since the beginning of the outbreak, the CO published 95 content pieces on its website http://www.unicef.org/drcongo and the Ebola landing page is updated weekly, linking to key figures, press releases, situation reports and stories. The CO also posted more 822 messages on Facebook, Instagram and Twitter. Several tweets were amplified by UNICEF’s global Twitter account and by Executive Director Henriette H. Fore.

DRC EBOLA SITUATION REPORT 12 August 2019 to December 2019 is estimated at US$ 563.8 million. As part of this joint response plan, the UNICEF estimated public health response requirements stands at US$75.9 million, out of a total of US$ 126 million. To date, the UNICEF response is 39 per cent funded. UNICEF expresses its sincere gratitude to all current donors for their substantial contributions to UNICEF's actions in favour of the Ebola response: The World Bank Group’s Pandemic Emergency Financing Facility (PEF), The European Commission (European Civil Protection and Humanitarian Aid Operations (ECHO), Gavi - the Vaccine Alliance, The Central Emergency Response Fund (CERF), the Government of Japan, the German Committee for UNICEF, the Government United Kingdom and the Paul G. Allen Family Foundation.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response Plan 2018 - 2019) Reprogrammed Funds Funds Funding gap funds from Received for Requirements* available Appeal Sector Equateur North Kivu $ ** Response Phase I & II $ % $ $ $ Water, Hygiene and 47,951,276 723,295 17,879,794 18,603,089 29,348,187 61% Sanitation - WASH / IPC Communication for Development (C4D) - Community engagement 51,440,240 371,558 13,356,698 13,728,256 37,711,984 73% and Communication for Campaigns Child protection and 9,402,390 100,000 7,344,617 7,444,617 1,957,773 0% Psychosocial Support *** Nutritional Care and Counseilling in Ebola 4,336,536 0 2,136,118 2,136,118 2,200,418 0% Treatment Center / Community **** Operations support, Security and Coordination costs and Information and 11,067,320 132,761 6,619,369 6,752,130 4,315,189 39% Communications Technology

Surveillance 1,520,000 720,000 720,000 800,000 53%

Prepardness Plan 322,000 0 322,000 322,000 0 0%

Total 126,039,762 1,327,614 48,378,597 49,706,211 76,333,551 61%

DRC EBOLA SITUATION REPORT 19 August 2019

Democratic Republic of the Congo

Ebola Situation Report North Kivu, Ituri and South Kivu

Photo Credit: UNICEF DRC Thomas Photo Credit: UNICEF DRC Mark Naftalin Photo© UN Credit: Perret UNICEF DRC Nybo 19 August 2019 SITUATION IN NUMBERS

Highlights total reported cases 2,888  On 15 August, two confirmed Ebola cases were reported for the first (MoH, 18 August 2019) time in South-Kivu province, in Mwenga health zone (Chowe). The same health zone reported a third confirmed case on 17 August. On 17 August, 2,794 confirmed cases one confirmed Ebola case was recorded in a new health area located (MoH, 18 August 2019) 150 km North-West of Goma in Pinga health zone. To date, 29 health zones in three provinces have been affected by the Ebola outbreak. 776 children <18 among confirmed cases (MoH, 11 August 2019)  In Mangina, UNICEF took the opportunity of the Yira/Nande International Conference that took place from 10 to 18 August to mobilize the community and share Ebola prevention messages. 1,844 deaths among confirmed cases (MoH, 18 August 2019) Moreover, an agreement between Mangina response teams and the 20Yira/Nande January 2019 community was signed during the closing ceremony. Guy 16,231 contacts under surveillance  Since 12 August, UNICEF provided summer school centers with 20 (MoH, 18 August 2019)

recreational kits, reaching 11,876 children, including 3,980 girls, with Ebola prevention messages in Nyankunde, Komanda, and Mambasa health zones, Ituri province. UNICEF Ebola Response Appeal

US$ 126.03 million

UNICEF’s Response Ebola Response Funding Status 2018 - 2019 Indicator Target Result # of at-risk people reached through community engagement and Total funding interpersonal communication approaches (door-to-door, church 26,500,000* 22,894,908 available* meetings, small-group training sessions, school classes, briefings 39% with leaders and journalists, other) # of listed eligible people for ring vaccination informed of the Ebola NK and Ituri benefits of the vaccine and convinced to receive the vaccine within 199,533* 198,076 Phases I, II, III & IV required protocols. Funding requirements* : # of households of confirmed cases, contacts and neighbours of $ 126,039,762 confirmed cases who received a hygiene and prevention kits with 36,437 14,000 Funding Gap adequate messaging 61% # of teachers briefed on Ebola prevention information 47,000 32,253 # of affected families with confirmed, suspects, probable cases who received one or several kits of assistance to support their 22,939** 9,273 * Funding requirement includes budget for phase I ($ children 8,798,899), phase II ($ 16,964,905), phase III ($ 24,385,917) and phase IV ($ 75,890,041) * 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 suspected case, and is adjusted according to the Equateur Response and funds received since August 2018 response

DRC EBOLA SITUATION REPORT 19 August 2019

DRC EBOLA SITUATION REPORT 19 August 2019 Epidemiological Overview1 Summary Table (18 August 2019) Confirmed and Probable Cases Deaths Deaths Number of days Province Health Zone among Total without confirmed Confirmed Probable Total confirmed Deaths cases cases Ariwara 1 0 1 1 1 49 Bunia 4 0 4 4 4 58 Komanda 40 9 49 23 32 0 Lolwa 2 0 2 1 1 6 Ituri Mambasa 18 0 18 8 8 0 Mandima 249 4 253 130 134 0 Nyakunde 1 0 1 1 1 240 Rwanpara 8 0 8 3 3 53 Tchomia 2 0 2 2 2 330 Alimbongo 5 0 5 2 2 37 Beni 638 9 647 405 414 0 Biena 16 1 17 12 13 46 Butembo 272 0 272 319 319 0 Goma 1 0 1 2 2 35 Kalanguta 144 15 159 61 76 0 Katwa 636 16 652 443 459 1 Kayna 14 0 14 6 6 0 Kyondo 20 2 22 13 15 54 North- Lubero 31 2 33 4 6 24 Kivu Mabalako 366 16 382 271 287 7 Manguredjipa 18 0 18 12 12 33 Masereka 49 6 55 16 22 17 Musienene 78 1 79 32 33 0 Mutwanga 20 0 20 10 10 2 Nyiragongo 3 0 3 0 0 17 Oicha 51 0 51 24 24 15 Pinga 1 0 1 0 0 1 Vuhovi 103 13 116 37 50 8 South Mwenga 3 0 3 2 2 1 Kivu Total 2,794 94 2,888 1,844 1,938 Previous Total 11 August 2019 2,737 94 2,831 1,798 1,892 Key Epidemiological Developments Since August 2018, confirmed cases of Ebola Virus Disease (EVD) continue to be reported both in North Kivu and Ituri provinces. During the reporting period, an additional province, South Kivu, was reached by the EVD for the first time. As of 18 August, a total of 2,888 EVD cases were reported, among which 2,794 confirmed and 94 probable cases. More than two thirds of EVD confirmed cases have died: 1,938 deaths, among which 1,844 confirmed and 94 probable cases (global case fatality ratio remains 67 per cent). During the reporting period (week 33), the number of new reported

1 Data source: Daily numbers by the National Coordination Committee (Comité National de Coordination, CNC).

DRC EBOLA SITUATION REPORT 19 August 2019 confirmed cases continued to decrease slightly from 68 cases in the previous week to 57 confirmed cases2. However, while the intensity of transmission may have reduced, there has been geographic expansion. South Kivu province was newly affected by the EVD outbreak with three confirmed cases in the health area of Chowe in Mwenga health zone, 150km South-West of the provincial capital Bukavu. The first two cases were a mother and her child who had been in contact with a confirmed case in Beni before travelling back to South Kivu. Both victims have died. The third case is a contact of the first case. EVD has also spread to an additional health zone in North Kivu, Pinga, in the territory of Walikale. The cumulative number of health zones that have reported at least one confirmed and/or probable case of EVD since the beginning of the epidemic has increased to 29 since the beginning of the outbreak. Eighteen of them (62 per cent) have reported at least one confirmed EVD case in the last three weeks. A total of 220 health areas have reported at least one confirmed or probable case of EVD since the outbreak began, of which 65 have been active in the past three weeks. Beni and Mandima health zones remained the hotspots of the epidemic, with respectively 33 and 20 per cent of 215 confirmed cases reported during the last three weeks. Among the new confirmed cases listed as contacts, the proportion of contacts followed on a regular basis in week 33 (31 per cent) decreased significantly compared to the week before (74 per cent), partly due to security constraints. The proportion of community deaths among all confirmed cases of EVD continued to increase (26 per cent in week 32 vs 32 per cent in week 33). Two additional health personnel have been infected by EVD during the last week, thus reaching 154 health staffs since the beginning of the outbreak. Of the total confirmed and probable cases with reported sex and age, 58 per cent (1,672) were female. Humanitarian Leadership and Coordination Under the Strategic Response Plan (SRP) 4, UNICEF continues to support coordination in all locations with functional strategic or operational Commissions. UNICEF leads the Commissions on Risk Communication and Community Engagement (RCCE) and Psycho-social Support and co-leads Infection Prevention and Control (IPC)/WASH Commission with World Health Organisation (WHO). The strategic Ebola response coordination maintains a strong support to active operational sub-coordinations in Butembo/Katwa, Mangina, Bunia, Goma, Beni, Komanda and Mambasa, a new UNICEF operational hub. In addition, multi-sectoral UNICEF rapid response teams are in place and deployed to new hotspots as required. Following the confirmation of three cases in South Kivu, two UNICEF multisectoral teams have been simultaneously established to support the activities in Chowe and Bukavu. As the first confirmed case travelled through Bukavu and remained in the city during 24 hours after having developed Ebola symptoms, the city is considered at risk of additional EVD cases. In the meantime, in the remote area of Pinga, a multisectoral team was sent from Goma, via helicopter, to set-up local teams on 19 August. This unsecure health zone is not covered by telecom and is very difficult to access. In addition, the epidemiological chain is not yet known, and investigations are ongoing. The spread of the virus to a third province requires the upscale of UNICEF’s response and significant efforts in terms on human resources and logistics capacities. Beni and Mangina3 remain as outbreak hotspots and important traveling hubs as affected cases travel through these cities to new health zones. For instance, on 11 August, the confirmed case in Lolwa Health Zone, which was the first confirmed case in that health zone to date, travelled from Mandima to Lolwa, where the case then became symptomatic.

2 This decrease could be partially due to security constraints in some hotspot health areas which could have slowed down the response activities, including surveillance. 3 Mangina is a city located in Mandima Health Zone.

DRC EBOLA SITUATION REPORT 19 August 2019 Response Strategy The Ebola response is based on the joint National Strategic Response Plan (SRP) against the EVD in North Kivu and Ituri provinces. The national SRP was first launched on 01 August 2018 and was revised four times4. The SRP IV will cover the period from July to December 2019 and represents a « final push » for all the stakeholders for ending EVD epidemic in the two provinces. As part of the Pillar I “Strengthened public health response in support of the Ministry of Health”, UNICEF continues to scale-up its RCCE interventions to enhance dialogue and partnerships between Ebola response teams and individuals or communities in affected areas enabling community ownership in the response and real time exchange of information. UNICEF also continues to work on improving IPC interventions in communities in affected areas, including the provisions of supplies and household decontamination for confirmed and probable cases. The Psychosocial support interventions is another key area of focus, and UNICEF continues to provide patients with EVD and their families psychosocial support through direct psycho-social care and provision of social support and food assistance to affected individuals and households. In support of the Pillar I of the SRP 4, the Pillar III co-led by UNICEF and OCHA aims to strengthen community ownership and support programs in response to community needs to enable Ebola control activities (UNICEF) and strengthen multi-sectorial humanitarian coordination (OCHA). Indeed, after one year, the situation in the Ebola-affected areas of DRC is deteriorating and the number of Ebola cases continues to increase. Many people continue to die in the community – either at home or in general healthcare facilities – and significant numbers of new confirmed cases cannot be traced to an existing contact with Ebola. Responding to the Ebola outbreak in the DRC thus requires a focus beyond specific Ebola prevention, care and treatment interventions to address the vulnerabilities of the affected populations and improve access to quality services in the affected areas. Approaches that strengthen the community resilience and the restoration of health system are critical to sustain the gains beyond the current Ebola Outbreak. In this line, to date, a measles campaign was organized in Bunia, in July, specifically in displacement camps and a second one is about to start in the same area, with partners like Médecins Sans Frontières (MSF). The campaign also incorporates additional measures to protect against Ebola transmission including the use of thermoflash and handwashing stations.

4 The National Strategic Response Plan (SRP) was launched on August 1st and was revised four times. The initial Response Plan (SRP 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 October 19th, 2019, the MoH released the revised Ebola Response Plan (SRP 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 December 20th, 2018, the MoH updated the Ebola Response Plan II (SRP II-I, November 2018 – January 2019) to include assumptions and additional needs until January 31st, 2019, estimated at US$ 23,506,000 million. On February 13th, 2019, the MoH launched the Ebola Response Plan III (SRP III, February – July 2019) for a total amount of US$ 147,875,000. Finally, on July 15th, 2019, The MoH released the Ebola Response Plan IV (SRP IV, July – December 2019) for a total amount of $ 287,590,149. 5

DRC EBOLA SITUATION REPORT 19 August 2019 Ebola. Among the recommendations for the community is the improvement of its engagement in the EVD response and encouragement of the population to go to the closest ETC or transit centers (TC) in case of first EVD symptoms. At the same time, the response engaged itself to build essential facilities like schools and roads in the villages affected by Ebola and to hire more local staff to work on the response. In South Kivu, following the identification of the first three EVD cases, the RCCE team deployed one staff that was able to spread prevention messages during the Sunday mass on 18 August. Moreover, UNICEF also sent 474 flyers and 235 posters to support RCCE activities in the city. On 13 August, newspapers, TV and radio media covered the celebration of the release of the first two Ebola survivors in Goma and their social reintegration in their village. In total, 42 journalists were present to cover this event. Risk Communication and Community Engagement (RCCE) In Mutwanga health zone, RCCE partners organized 51 raising awareness campaigns and individual briefings in public areas reaching out to 727 persons on EVD, vaccination, hygiene practices and SDB. In Butembo, UNICEF strengthened the capacities of 221 participants including teachers, students and students’ committees representatives from three universities on risk communication and on the different topics to develop in audiences and classrooms to fight against Ebola virus. In Mangina, in the context of the Yira conference, UNICEF and partners took the opportunity of this major gathering to brief 128 traditional healers, community workers and 40 young people from five different neighborhoods on RCCE, Ebola prevention, and response measures while 68 community workers were trained on community-based surveillance and risk communication. Responding to Refusals/Reticence and Rumors During the past weeks, Beni, Mabolio and Mukulia health zones, that reported an increase in the number of confirmed. In these affected health zones, the youth continued to threaten response teams. UNICEF RCCE and communication sub-commission partners thus continued negotiations and community dialogues with community leaders, youth and religious entities to resolve residual pockets of reluctance against response activities. In Goma, communicators resolved 212 cases of handwashing and screening refusal at 12 points of entry (PoE) and points of control (PoC) and out of 63 rumors, 53 were clarified by the teams. In Butembo, 70 per cent (210/301) of refusals namely 63 per cent on vaccination (24/38), 71 per cent (134/189) on referrals to ETC, 74 per cent (32/43) on SDB and 65 per cent (20/31) on decontamination were resolved with the support of the communication teams. In Mangina, communication teams managed to resolve 81 per cent (250/306) of community incidents related to Ebola response and 96 per cent (236/246) of hand washing refusals. In Mambasa, out of 119 cases of refusals to wash hands, 89 per cent were resolved, together with 72 per cent out of 78 refusals of screening, 30 per cent out of 16 SDB, and 40 per cent out of 12 refusals to go to the ETC. In Bunia, among 119 refusals for handwashing – 79 per cent were resolved, together with 51 per cent of the 111 refusals of screening, 50 per cent of 18 refusals of SDB and 20 per cent of 12 refusals to visit the ETC. In Ariwara, the communication teams helped resolve 306 cases of refusal of hand washing at PoC/PoE and 36 per cent (5/14) related to SWAB and SDB. Promotion of Preventive Behaviors In Goma, UNICEF with the support of Nyiragongo territorial authorities raised awareness to about 600 people in 6 villages on Ebola prevention, symptoms, transmission chains, testing and treatment options. In Oicha, 447 people (including 220 women) took part in 186 individual discussions to raise awareness on EVD prevention measures. In Butembo, UNICEF raised awareness among 5,381 Catholics and Adventists on EVD while 1,154 people were briefed on Ebola related to public health interventions. In Mambasa, 20,779 people were also made aware of EVD prevention and response actions during educational talks and further 22,063 people were reached through home visit dialogues. In Bunia, UNICEF raised awareness of 21,297 people on EVD and promotion of hygiene measures in 5,126 households while Caritas/Procaire trained 45 community workers on RCCE. Media UNICEF and the Sub-Commissions translated key messages on EVD symptoms and prevention measures for new leaflets and posters in local Kinande and Swahili and finalized the pre-testing of new communication tools in Beni, Butembo, Mangina and Makangala. Students, women, community leaders were targeted. On the basis of the community feedback, the revised communication tools have been validated and will soon be distributed. In addition,

DRC EBOLA SITUATION REPORT 19 August 2019 in Beni and Butembo, 38 radio stations continued to disseminate messages on EVD preventive measures, interviews with Ebola survivors and testimonies of individuals and families who benefited from the response activities. In Mangina, 3 radios broadcasted 42 spots and messages in Swahili and Kinande (6 per day for 30 min) on EVD preventive measures and the importance of Ebola screening and handwashing. In Ituri, three community radios continued to broadcast the interactive and participatory programs on the importance of community-based surveillance, of the prompt transfer to the ETC in case of EVD-related symptoms and of correct handwashing. In order to pass these messages, few Ebola survivors were already identified to testimony. Goma radios continued to broadcast 15 programmes and rebroadcast Ebola prevention and response related messages. In addition, on 14 August, UNICEF and the Communication sub-commission published the #6 “Stop Ebola” newsletter. On 15 and 16 August, the Commission organized two meetings with the UNPC (National Union of the Congo Press) and media program implementing partners (SFCG, InterNews, Coracon, Remed and Mercy Corps) and, on the other hand, Goma media managers and media professional associations. The aim of both meetings was to engage Goma media in covering Ebola response activities and in supporting the work of the response teams. During the meetings, stakeholders discussed the modalities of such involvement in the response. In total, about a hundred local radios are currently broadcasting Ebola prevention messages on a regular basis. Key Results Change since Total Result RISK COMMUNICATION AND COMMUNITY ENGAGEMENT Target5 UNICEF last report ▲▼ # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities (CAC, religious /traditional leaders, 67,695 59,328 1,069 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 40,321 34,174 549 community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, 26,500,000 22,894,908 795,074 adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious 12,981 11,251 1,175 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 199,533* 198,076 6,839 convinced to receive the vaccine within required protocols. * This figure indicates the number of listed eligible people for ring vaccination from 8 August 2018 to 17 August 2019

DRC EBOLA SITUATION REPORT 19 August 2019 As the outbreak evolves and with the spread of the virus to a third province, response measures continue to adapt to the context. 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. In preparation of the transition of decontamination activities from WHO to UNICEF as of 01 September, the handover of HR, materials and resources are being finalised along with inter-sectional meetings to ensure a common approach is in place. To share IPC/WASH experiences and review approaches and tools that are implemented in the various sub- coordination, UNICEF organized a 3-day workshop in Goma gathering 31 UNICEF WASH Supervisors from the EVD affected zones. The workshop was also the occasion for a joint discussion on the future decontamination activities to be supervised by UNICEF. According to the new Strategic Response Plan, nosocomial transmission of EVD is considered one of the key challenges to stop the chain of transmission with the number of health workers affected at 154. To prevent infection in health facilities and protect staff, UNICEF and its partners Ministry of Public Health, WHO and Africa CDC have initiated the Integrated Capacity Enhancement Project (Projet Intégré de Renforcement de Capacités or PIRC), an innovative approach to health system strengthening that incentivizes providers based on their achievement of agreed-upon and measurable performance targets. The PIRC is implemented in Butembo and Katwa health zones since April 2019 and its duplication in Mabalako and Mandima health zones is currently under assessment. With a slight increase in cases in Butembo, activities were launched around 19 confirmed cases (including 2 health personnel). Partners Mercy Corps and CEPROSSAN provided hygiene kits to 209 households and 14 health facilities received IPC/WASH kits along with briefings of 28 health care staff. Handwashing devices were installed in 52 public places. In Katwa, partner OXFAM construction of latrines and waste management facilities continues in several health facilities. And in Butembo, Musienene, Kyondo and Vuhovi health zones, partner CEPROSSAN has several construction projects in progress for improving water storage, WASH facilities and waste management in health facilities. In response to the 15 reported confirmed cases in Beni, partner PPSSP distributed hygiene kits to 131 affected households and IPC/WASH kits to 68 health facilities. UNICEF provided 1,350 kg of chlorine to WHO for decontamination activities. Local partner association Organisation de Developpement D’Oicha supplied 317 public handwashing points with 95,235 litres of chlorinated water with follow up and monitoring of activities along with PPSSP. To ensure handwashing is available at the mobile vaccination sites, ten WASH kits were provided by UNICEF to a local first aid association. The coordination of activities around seven confirmed cases in the Mandima health zone between the new Mambasa and Mangina Sub-Coordination continued to improve the response to new cases. Although access to some health areas remains a challenge due to insecurity and pockets of community resistance, response activities were implemented by partners OXFAM and local association FAEVu and hygiene kits were distributed to 346 households surrounding confirmed cases. An increase of donation of IPC/WASH kits was completed in 70 health facilities and 42 public places along with Ebola prevention messaging to 2,204 people. In Mabalako health zone, where fewer cases are being reported, the focus remains on community awareness on hygiene practices, training of water management committees, supporting health facilities and the ongoing construction of WASH infrastructure by partner Oxfam. In Mangina, support was provided to the one-week Nandés Yira cultural conference that was attended by over 5,000 people. UNICEF provided materials for 15 handwashing points and 21 thermoflash for screening of attendees along with the briefing of 71 staff of the organising committee on EVD prevention measures by 4 IPC/WASH Supervisors made available throughout the event. A slight increase in cases was reported in Komanda with four new confirmed cases in three affected health areas: Komanda, Lolwa and Idohu. In Lolwa health zone, partner MUSACA distributed IPC/WASH kits to seven health facilities. A meeting was held with the Surveillance, Psychosocial and IPC teams to improve the sharing of contact household information to ensure that delays are avoided in the allocation of household hygiene kits. IPC/WASH Commission Supervisors supported by UNICEF provided hygiene kits to 156 households and kits to three health facilities and a traditional practitioner. New handwashing devices were installed in 50 public places along with Ebola and hand hygiene awareness sessions, reaching 372 people. Ongoing support was provided with the monitoring of the use of IPC/WASH kits in five health facilities along with the briefing of nine healthcare providers in Idohu and Mangiva health areas.

DRC EBOLA SITUATION REPORT 19 August 2019 Partner MUSACA supplied 32,140 litres of chlorinated water to 67 public places in the Komanda and Irumu health areas and 207,560 litres of drinking water were provided to the community serving approximately 2,500 people daily. In response to two confirmed cases reported in Mambasa, partner MUSACA provided hygiene kits to 31 households, installed handwashing devices in 32 public places and provided 109,460 litres of water of which 94,740 litres was treated for handwashing points serving approximately 600 people daily. Activities continued around the cases from the previous week with the distribution of hygiene kits to 49 households and IPC/WASH kits to three health facilities and one school. As there have been no new cases reported, Bunia remains in prevention mode. To improve the access to water, UNICEF supplied 55,505 litres of chlorinated water in three health facilities and 91 public places in Bunia and two health facilities and 14 public places in Rwampara health zone. An assembly of Jehovah’s Witnesses was supplied with 1,400 litres of water and two handwashing devices to provide facilities for 3,000 attendees. In preparation of an upcoming measles vaccination campaign, UNICEF provided 110 WASH kits to the Ministry of Health (MoH) to ensure handwashing is available at the vaccination sites. Partner ACF supplied 52,300 litres of chlorinated water to 60 public places in Ngezi, Bora-Uzima and Adventist health areas of Bunia. Partner MUSACA supplied 2,840 litres of chlorinated water for 8 tanks in public places in Shari in the Rwampara health zone and continued monitoring of hand-washing devices installed in public places in Bunia (19) and Rwampara (22). No new confirmed cases have been reported in Goma, however, the city remains on alert until the end of the 21-day incubation period. To reinforce preventative measures in the affected health zones, partner OXFAM continued to ensure access to water with the supply of 30,330 liters of water in 8 health facilities in Himbi, 48,900 liters in 6 health facilities and 381,000 liters in the community of Kiziba. To develop a more sustainable option for Kiziba, UNICEF initiated discussions with the national company Régideso for the implementation of a water supply system. UNICEF partner PPSSP supported handwashing points in 26 public places, supplying 92,460 liters of chlorinated water in Goma, Karisimbi, Nyaragongo and Kirtothse health zones. In Karisimbi health zone, prevention activities continued with partner Medair that held briefings on Ebola transmission, hand hygiene and prevention measures within the health centers of Hebron and Methodiste. Ebola information sessions were held with 1,377 community members (247 men, 144 women and 986 children). In response to a confirmed case reported in Pinga, a multisectoral rapid response team was deployed from Goma to conduct the initial assessment. In South Kivu, UNICEF deployed a WASH/IPC officer to respond to the three confirmed cases in Mwenga region. Based on the identified places around the cases, handwashing points were installed in the community and supplied with chlorinated water. In Bukavu the IPC sub commission was reactivated, and WASH actors briefed about the needs in terms of IPC activities in Mwenga and Bukavu. Handwashing stations at entry points and publics places that were already in place have been reinforced. Key Results Change since Total Result WATER, SANITATION & HYGIENE Target9 last report UNICEF ▲▼ # of health facilities in affected health zones provided with essential WASH services. 3,884 2,597 30

# of target schools in high risk areas provided with handwashing facilities 3,800 2,332 0 # of community sites (port, market places, local restaurant, churches) with hand 11,750 7,004 67 washing facilities in the affected areas % of schools and public places near confirmed cases locations where handwashing 100% 87% 0 stations are installed and utilized Number of households of confirmed cases, contacts and neighbours of confirmed 36,437 14,000 516 cases who received a hygiene and prevention kits with adequate messaging

DRC EBOLA SITUATION REPORT 19 August 2019 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 behaviors, (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 Partners : Enseignement Primaire, Secondaire et Professionnel (EPSP), Associazione Volontari per lo Sviluppo Internazionale (AVSI), Femmes Congolaises pour le Développement (FECONDE)

Main activities during the reporting period To anticipate for the 2019-2020 school year starting in September, UNICEF prepared a specific strategy on EVD prevention in schools including activities implemented by IPC/WASH, Education and Communication teams. It will be presented on 23 August 2019 to the Ebola General coordination /EOC-Goma for validation. From 16 to 18 August, in Butembo, the Ministry of Education organized a workshop to share experiences on the prevention and control of EVD in schools. The workshop gathered 25 participants, including six women, among which representatives from the Provincial Ministry of Education EPSP North Kivu 2, the Educational Sub-provinces of Butembo I and II, Education Inspectors, Coordinators of Catholic and Protestant Conventional Schools, representative of the association of private schools, parents' associations, social affairs services, NGOs, UNICEF and UNESCO, were present. Participants discussed key field results, challenges and proposed solutions and new operational approaches to improve EVD prevention measures and related awareness raising activities in schools. In addition, the training module for teachers on the Guidance Note on prevention and control of the EVD was finalized during the workshop and the new picture box10 on Ebola validated. They will serve as a sensitization tool for younger pupils. Since 12 August, with the support of the UNICEF’s implementing partner AVSI, EPSP inspectors organized extracurricular activities in ten school structures, used as play centers, and equipped the centers with 20 UNICEF recreational kits in Nyankunde, Komanda and Mambasa health zones, Ituri province. About 11,876 students including 3,980 girls, coming from 60 schools participated to these recreational activities and were sensitized on key EVD prevention and control measures to be observed both in schools and in their family setting. In addition, partner AVSI distributed recreational, expressive and psychosocial kits in 83 different structures (kindergarten, secondary primary and school catch-up centers) in Beni, Oicha and Mabalako health zones (North Kivu). Key Results: Change since Total Result EDUCATION Target11 UNICEF last report ▲▼ # of students reached with Ebola prevention information in schools 1,458,000* 928,565 11,876 # of teachers briefed on Ebola prevention information in schools 47,000 32,253 25

10 This tool box contains key images and messages on EVD and prevention measures. It is used for awareness raising activities organized in schools by teachers and targeting younger pupils. It serves as pedagogical and didactic material during class teaching.

11 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 IV (July to 31 December 2019), covering all health zones in Ituri and North Kivu province.

DRC EBOLA SITUATION REPORT 19 August 2019 Psychosocial Support and Child Protection12 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 strategy include the provision of (1) psychosocial support13 for EVD confirm and suspect cases, including children, in the ETCs; (2) material14 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 care15 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 SDB etc). Implementing Partners: Danish Refugee Council (DRC), Alliance for International Medical Action (Alima), Division Provinciale des Affaires Sociales (DIVAS), Division de l’Interieur (DIVInter) Main activities during the reporting period During the reporting period, UNICEF and its partners provided psychological support to 254 children, including 253 suspected cases and one confirmed case (in total, 119 girls and 134 boys) admitted to the TC/ETC and to 313 newly affected families. 1,113 contacts were followed by the psychosocial team. About 181 new separated children (87 boys and 94 girls) identified during the reporting period received appropriate care and support. Activities in ETC, TC and nurseries During the reporting period, UNICEF and its partners provided psychological support to 212 children, including 204 suspected cases (109 boys and 95 girls) and 8 confirmed cases (3 boys and 5 girls) admitted to the TC/ETC. Following the epidemic transmission trend, UNICEF psychosocial team reinforced its presence in the field. In Mambassa, where a surge of new confirmed cases has been observed, two new psychologists have been deployed. In Pinga health zone following a first confirmed case notification, a multisectoral team has been sent with one psychologist and one psychosocial agent. In South Kivu, following confirmation of new Ebola cases, a rapid response team composed of a child protection specialist, four psychologists and three psychosocial agents has been deployed to respond to the urgent psychosocial needs of the EVD affected family including the 7-months orphaned baby. Among the three psychosocial agents, two are Ebola survivors coming from North Kivu and Ituri and they are providing psychosocial care of patients including EVD suspects or confirmed children cases currently placed in the TC of Chowe and the ETC of Bukavu (two suspects cases are in this ETC). The two EVD affected families in Chowe, including the family of the baby, received appropriate emotional and food assistance from the Psychosocial Commission. The team also supported the Surveillance and Vaccination Commissions for the listing of contacts as well as the opening of a vaccination ring. 124 (72 men, 31 women, 5 girls and 16 boys) benefited from psychoeducation in the health structures to reduce fear and anxieties associated with the EVD. In addition, ten psychosocial agents and six psychologists have been locally identified and will be trained soon to set up psychosocial commissions in South Kivu. Activities in communities As a way to support affected families so that they continue to have the emotional and material capacity to care for their children, a total of 346 newly affected families received psychosocial support and material assistance in all Ebola- impacted health zones during the reporting period. A total of 1,698 kits of material assistance (hygiene, funeral, NFI, new-born kits and food assistance) were distributed to discharged and recovered patients as well as affected families. Recreational kits have been distributed in the ETC of Mangina and in the new nursery. Twelve Ebola survivors have been trained and recruited as care givers for children in the nursery.

12 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), Alima and DIVAS. All results, unless otherwise stated, are UNICEF results with implementing partners. 13 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. 14 Material assistance is assessed on a case by case basis, according to the specific needs of children and their families. 15 According to the local context and socio-cultural norms. 11

DRC EBOLA SITUATION REPORT 19 August 2019 In addition, a total of 1,650 contacts were followed by the psychosocial team. About 164 new separated children (87 boys and 77 girls) and 42 new orphans (29 boys and 13 girls) were identified during the reporting period and received appropriate care and support. Regarding follow-up of vulnerable children, UNICEF Child Protection Team of Katwa and Butembo conducted a rapid assessment on birth registration rate and possession of official certificates. It appeared that 34 children cured of Ebola lost their documents during decontamination operations. 54 children (30 girls and 24 boys) of cured parents or orphans were not yet registered. Similar assessment will be conducted in other health areas to implement a rapid and adequate response (such as registration and negotiations with appropriate authorities to obtain new documents) on a case by case basis. Follow up activities with Ebola survivors showed that some of them suffer from severe behavioral problems following the disease and must be referred to mental health centers. During the reporting period, two cured patients have been referred to mental health structures in Beni. In addition, psychologists conducted couple’s therapies to address sexual disorders (such as sexual impotence, reticence for condom use, rejection by spouse etc) as a direct consequence of the EVD. Key Results Change since Total Result CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT Target16 last report UNICEF ▲▼ # of children as confirmed or suspect case receiving psychosocial support inside the 10,312* 6,428 212 transit centres and ETCs # of affected families with confirmed, suspects, probable cases who received 22,939* 9,273 346 psychosocial assistance and/or material assistance # of contact persons, including children, who receive psycho-social support 16,231** 13,531 0 # of separated children identified who received appropriate care and psycho-social 2,950 2,633 164 support as well as material assistance # of orphans identified who received appropriate care and psycho-social support as well 1,960 1,424 42 as material assistance # of psychologists and psychosocial agents trained and deployed to respond to the needs 1,300 918 12 of affected children and families * This figure has been adjusted in regard to the high number of persons being admitted daily to the transit centers and ETCs as suspect cases. It includes support provided to families with suspect, probable or confirmed EVD members. ** The target number has been changed in relation to the evolution of the epidemic.

DRC EBOLA SITUATION REPORT 19 August 2019 months, four pregnant women and six lactating women. Among these, more than two third were admitted in the ETC of Butembo (170 cases) and Katwa (138). At communities and household level nutritional support activities for separated infants non-breastfeed also increased during the last week: in comparison to 24 infants supported in the previous week, 94 separated infants non-breastfeed received nutritional support (Ready-to-Use Infant Formula - RUIF) from nutritionists and psychosocial agents of the ETCs, supported by UNICEF, at communities and household level (13 in Butembo, 36 in Katwa, 26 in Beni, 9 in Mabalako, 7 in Komanda and 3 in Bunia). Among these, 20 are children less than six months old and 74, six to twenty-three months. In addition, 47 children under five suffering of Severe Acute Malnutrition were admitted for treatment in the Outpatients Therapeutic Programme (OTPs) under the supervision of health zone nutritionists. Nutritional assistance was accompanied by awareness raising activities on adequate Infant and Young Child Feeding practices (IYCF) in the Ebola context: UNICEF and its partners, such as communication agents, health promotion workers and nutritionists sensitized 1,767 women caregivers (421 in Butembo, 319 in Katwa, 124 in Beni, 449 in Mabalako, 230 in Komanda, 191 in Bunia and 33 in Goma) both at ETCs and contact households level. Key Results Change since Total Result NUTRITION Target17 last report UNICEF ▲▼ # of < 23 months children caregivers who received appropriate counselling on IYCF in 51,865 49,289 1,767 emergency # Ebola patients who received nutrition support during treatment according to guidance 8,750 7,990 471 note # of less than 6 months children who cannot be breastfed and who receive ready-to-use 600 757 94 infant formula in ETCs, nursery’s, orphanages and in the communities

Social Science Analysis Cell (CASS) The formative, social sciences analysis section seeks to increase the accountability to affected populations through the provision of social sciences analysis to inform response interventions. Social sciences research agenda and themes are primary developed from epidemiological and context analysis as well as directly from response interventions and via requests from the Commissions. Social sciences analysis supports UNICEF programme teams and the overall response to better understand and engage the communities with which we work. UNICEF’s Social Sciences team contributes to the integrated Analysis Cell which includes Epi and Social Sciences work. UNICEF’s Social Sciences teams includes local, national and international researchers specializing in epidemiology, health demography, anthropology and social sciences health studies. The team involves the exploration of behavioural determinants of health and uses multiple methods to collect data such as questionnaires, structured and guided interviews, focus groups, informal discussions and observation. Data are triangulated and mapped by area and group to ensure saturation and representation. Research results are presented at Commissions and weekly in Sub-Coordinations (or in ad hoc requests) to facilitate access. The UNICEF’s Social Sciences team have ensured that all raw data, presentations and reports as well as workshop tools and training modules are available openly for everyone in the response. Main results during the reporting period General activities & programmes The teams continue to work in Butembo, Katwa, Vuhovi, Lubero and Kyondo in partnership and via the MoH Epi Cell and together with WHO, CDC, IFRC, MSF and Africa CDC. In Goma, the CASS team presented during a WASH workshop held from the 14 to 16 August. During this workshop, WASH related CASS results were discussed with WASH teams and recommendations were modified and validated in collaboration with WASH teams. This included recent recommendations from the hygiene kit community perceptions

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 IV (July to 31 December 2019), covering all health zones in Ituri and North Kivu province. 13

DRC EBOLA SITUATION REPORT 19 August 2019 study as well as those from previous studies which recommended the inclusion of women in WASH activities related to the response. Ongoing social sciences analysis A comparative study on treatment seeking behaviors was implemented in Beni, Mabalako and Mandima to understand barriers, motivators and other potential factors which could contribute to delays from onset of Ebola symptoms to admission to the Ebola Treatment Centre (ETC). The objective was to identify factors behind the different delays in seeking treatment among communities. Given the link between increased chance of survival with early treatment, learnings from communities who showed up with a short delay (0 to 3 days) will be used to inform programs in areas where the average delays are longer. The areas selected for the study were based on an epidemiological micro analysis of median delays over the last 3 months (May-July). Analysis is currently underway. A similar comparative qualitative study on treatment seeking behaviors was implemented in Butembo and Katwa from 14 to 18 August. The objective of the study was to better understand motivators and barriers related to the delay between onset of symptoms and admission to the ETC.

From August 15 to 18, a quantitative KAP study was conducted with 400 households and health care workers together with a qualitative study with religious leaders in Goma. The objective of these studies is to better understand knowledge, attitudes, practices and perceptions of Ebola among men, women and health care workers in recently affected areas. Moreover, given the key role that religious leaders can play in the community, the qualitative study looked at their perceptions and willingness to be engaged in Ebola response activities. Study results and recommendations will be used to inform programs currently being implemented in Goma.

Supply and Logistics UNICEF regularly monitors the supply chain and discusses with the different involved actors to ever improve efficiency of the supply and services facilitation for the Ebola response in Ituri and North Kivu provinces. During the reporting UNICEF distributed WASH, C4D, Child Protection, Health, Education and ICT items and supplies for a total value of US$ 86,347. The total value of procurement orders was US$ 703,513. Offshore procurement orders amounted to a value of US$ 467,626 (66 per cent), while local procurement orders amounted to a value of US$ 235,887 (34 per cent).

Human Resources UNICEF continue to strengthen its presence on the ground to better respond to the expanding outbreak in North Kivu and Ituri provinces. The number of staff dedicated to the Ebola response scaled up to 215 persons already working in the affected areas, with an additional 49 persons under recruitment. In addition, excluding Ebola staff, UNICEF has a capacity of 35 staffs in Goma sub-office (North Kivu) and 22 in Bunia sub-office (Ituri) to support the overall UNICEF operations in the region.

External Communication The Country Office (CO) continued to focus its external communication activities on the consequences of the Ebola epidemic on children and UNICEF’s response. During the reporting period, the CO issued a press release Number of children orphaned or left unaccompanied by Ebola in the Democratic Republic of the Congo rising fast and pitched it to the media at the Biweekly Geneva Press Briefing. Press coverage included VOA, New Delhi Times, NHK, NY Daily News, BBC, Repubblica, Il Corriere della Sera and Citizen Digital. Following the announcement of two cases of Ebola in South Kivu province, the CO issued a statement distributed through social networks. Since the beginning of the outbreak, the CO published 98 content pieces on its website https://www.unicef.org/drcongo/ and the Ebola landing page is updated weekly, linking to key figures, press releases, situation reports and stories. The CO also posted more 850 messages on Facebook, Instagram and Twitter. Several tweets were amplified by UNICEF’s global Twitter account. A videographer recruited by the CO is travelling across the affected areas to gather new material on the impact of Ebola on children and UNICEF’s action.

DRC EBOLA SITUATION REPORT 19 August 2019 Funding The SRP4 provisional funding requirement for the public health response is US$ 287.6 million for activities until end December 2019. The DRC grand total budget for the Ebola response in North Kivu and Ituri provinces from August 2018 to December 2019 is estimated at US$ 563.8 million. As part of this joint response plan, the UNICEF estimated public health response requirements stands at US$75.9 million, out of a total of US$ 126 million. To date, the UNICEF response is 39 per cent funded. UNICEF expresses its sincere gratitude to all current donors for their substantial contributions to UNICEF's actions in favour of the Ebola response: The World Bank Group’s Pandemic Emergency Financing Facility (PEF), The European Commission (European Civil Protection and Humanitarian Aid Operations (ECHO), Gavi - the Vaccine Alliance, The Central Emergency Response Fund (CERF), the Government of Japan, the German Committee for UNICEF, the Government United Kingdom and the Paul G. Allen Family Foundation.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response Plan 2018 - 2019) Reprogrammed Funds Funds Funding gap funds from Received for Requirements* available Appeal Sector Equateur North Kivu $ ** Response Phase I & II $ % $ $ $ Water, Hygiene and 47,951,276 723,295 17,879,794 18,603,089 29,348,187 61% Sanitation - WASH / IPC Communication for Development (C4D) - Community engagement 51,440,240 371,558 13,356,698 13,728,256 37,711,984 73% and Communication for Campaigns Child protection and 9,402,390 100,000 7,344,617 7,444,617 1,957,773 0% Psychosocial Support *** Nutritional Care and Counseilling in Ebola 4,336,536 0 2,136,118 2,136,118 2,200,418 0% Treatment Center / Community **** Operations support, Security and Coordination costs and Information and 11,067,320 132,761 6,619,369 6,752,130 4,315,189 39% Communications Technology

Surveillance 1,520,000 720,000 720,000 800,000 53%

Prepardness Plan 322,000 0 322,000 322,000 0 0%

Total 126,039,762 1,327,614 48,378,597 49,706,211 76,333,551 61%

DRC EBOLA SITUATION REPORT 26 August 2019

Democratic Republic of the Congo

Ebola Situation Report North Kivu, Ituri and South Kivu

Photo© UNICEF Credit: DRC UNICEF Nybo DRC Photo Credit: UNICEF DRC Thomas Nybo 26 August 2019 SITUATION IN NUMBERS Highlights total reported cases 2,976 • Week 34 has seen an increase in newly reported and confirmed cases (MoH, 25 August 2019) (77). This follows two weeks where the number of reported confirmed cases had been declining (68 in week 32; 57 in week 33). 2,871 confirmed cases (MoH, 25 August 2019) • Beni, Mandima and Kalunguta are the main hotspots and together they reported 53 per cent of confirmed cases in the last three weeks. 801 children <18 among confirmed • On 22 August, the Governor of Goma convened a march, bringing cases (MoH, 25 August 2019) together 16 community representatives and close to 7,000 participants

to mark the 21 days since the notification of the second case in Goma. 1,885 deaths among confirmed cases • Infection Prevention and Control (IPC)/WASH activities (as agreed in the (MoH, 25 August 2019) memorandum of understanding) will be transferred from WHO to 20 January 2019 UNICEF in early September 2019. Guy 17,086 contacts under surveillance (MoH, 25 August 2019) • Preparations are underway for the 2 September start of the school year to ensure a safe learning environment for children in affect ed and at-risk areas. UNICEF Ebola Response Appeal

US$ 126.03 million

UNICEF’s Response Ebola Response Funding Indicator Target Result Status 2018 - 2019 # of at-risk people reached through community engagement and interpersonal communication approaches (door-to-door, church Total funding 26,500,000* 24,030,824 meetings, small-group training sessions, school classes, briefings available* with leaders and journalists, other) 39% # of listed eligible people for ring vaccination informed of the Ebola NK and Ituri benefits of the vaccine and convinced to receive the vaccine within 206,835* 205,321 Phases I, II, III & IV required protocols. Funding # of households of confirmed cases, contacts and neighbors of requirements* : confirmed cases who received a hygiene and prevention kits with 36,437 14,485 $ 126,039,762 adequate messaging Funding Gap # of teachers briefed on Ebola prevention information 47,000 32,436 61% # of affected families with confirmed, suspects, probable cases

who received one or several kits of assistance to support their 22,939** 9,626 * Funding requirement includes budget for phase I ($ children 8,798,899), phase II ($ 16,964,905), phase III ($ * The target is dynamic as listing of eligible persons is defined 24,385,917) and phase IV ($ 75,890,041) **The target is estimated based on both the number of confirmed, probable and suspected case, and is adjusted according to the **Funds available include Reprogrammed funds from response Equateur Response and funds received since August 2018

SITUATION IN NUMBERS 1

DRC EBOLA SITUATION REPORT 26 August 2019

DRC EBOLA SITUATION REPORT 26 August 2019 Epidemiological Overview1 Summary Table (25 August 2019) Confirmed and Probable Cases Deaths Number of days Province Health Zone Deaths among without Confirmed Probable Total Total Deaths confirmed cases confirmed cases Ariwara 1 0 1 1 1 56 Bunia 4 0 4 4 4 65 Komanda 41 9 50 24 33 1 Lolwa 3 0 3 1 1 2 Ituri Mambasa 21 0 21 8 8 2 Mandima 258 4 262 135 139 1 Nyakunde 1 0 1 1 1 247 Rwanpara 8 0 8 3 3 60 Tchomia 2 0 2 2 2 337 Alimbongo 5 0 5 2 2 5 Beni 654 9 663 413 422 0 Biena 16 1 17 12 13 53 Butembo 277 0 277 329 329 1 Goma 1 0 1 1 1 42 Kalanguta 155 15 170 64 79 0 Katwa 643 23 666 449 472 1 Kayna 22 0 22 8 8 0 Kyondo 20 4 24 13 17 61 North Kivu Lubero 31 2 33 4 6 31 Mabalako 369 17 386 275 292 1 Manguredjipa 18 0 18 12 12 40 Masereka 50 6 56 17 23 4 Musienene 81 1 82 33 34 3 Mutwanga 25 0 25 10 10 0 Nyiragongo 3 0 3 1 1 24 Oicha 54 0 54 24 24 5 Pinga 1 0 1 0 0 8 Vuhovi 103 14 117 37 51 15 South Kivu Mwenga 4 0 4 2 2 6 Total 2,871 105 2,976 1,885 1,990 Previous Total 18 August 2019 2,794 94 2,888 1,844 1,938 Key Epidemiological Developments2 Since August 2018, confirmed cases of Ebola Virus Disease (EVD) continue to be reported in North Kivu, Ituri and, recently in South Kivu provinces. As of 25 August, a total of 2,976 EVD cases were reported, among which 2,871 confirmed and 1053 probable cases. More than two thirds of EVD confirmed cases have died: 1,990 deaths, among which 1,885 confirmed and 105 probable cases (global case fatality ratio remains 67 per cent).

1 Data source: Daily numbers by the National Coordination Committee (Comité National de Coordination, CNC). 2 Data source : Rapport de situation N. 372, N°372, Récapitulatif de la semaine 34, du 19 au 25 août 2019 – Ministry of Health and WHO. 3 On 19 August 2019, 11 additional probable cases were validated. These were cases who died in Katwa, Kyondo, Vuhovi, and Mabalako health zones during March through June 2019 with epidemiological links to the outbreak, but who could not be sampled for laboratory testing to confirm/exclude EVD (Source: WHO). 3

DRC EBOLA SITUATION REPORT 26 August 2019 After two weeks during which the number of new reported confirmed cases declined, there was an increase in week 34 (77 cases) in comparison to 57 cases during week 33 and 68 cases during week 32. As in the previous week, 29 health zones have reported at least one confirmed and/or probable case of EVD since the beginning of the epidemic and 18 of them (62 per cent) have reported at least one confirmed EVD case in the last three weeks. A total of 213 health areas have reported at least one confirmed or probable case of EVD since the outbreak began, of which 60 have been active in the past three weeks. This represents a slight decrease in geographical extension of EVD transmission in comparison to the previous week when active health areas were 65. Beni and Mandima health zones remained the hotspots of the epidemic together with Kalunguta health zone, with respectively 30, 13 and ten per cent of 202 confirmed cases reported during the last three weeks. Among the new confirmed cases listed as contacts, the proportion of contacts followed on a regular basis in week 34 (33 per cent) slightly increased compared to the week before (31 per cent), but it remains low. The proportion of community deaths among all confirmed cases of EVD decreased compared to the previous week: 22 per cent in week 34 against 32 per cent during week 33. However, the incidence of community deaths remains disturbing with more than one confirmed case out of four dying at community level. Two additional health workers have been infected by EVD during the last week, thus reaching 156 health staffs since the beginning of the outbreak (5 per cent of total cases). Of the total 2,898 confirmed and probable cases with reported sex and age, 58 per cent (1,667) were female and among these 59 per cent are of childbearing age (15-49 years). Twenty-eight per cent (838)4 are children aged less than 18 years old. Humanitarian Leadership and Coordination Under the Strategic Response Plan (SRP) 4, UNICEF continues to support coordination in all locations with functional strategic or operational Commissions. UNICEF leads the Commissions on Risk Communication and Community Engagement (RCCE) and Psycho-social Support and co-leads Infection Prevention and Control (IPC)/WASH Commission with WHO. The strategic Ebola response coordination maintains a dedicated support to active operational sub- coordinations in Butembo/Katwa, Mangina, Bunia, Goma, Beni, Komanda and Mambasa, a new UNICEF operational hub. In addition, multi-sectoral UNICEF rapid response teams are in place and deployed to new hotspots as required. Since four cases were confirmed in the South Kivu provinces, UNICEF reinforced its presence in the field5 through the deployment of additional staffs and equipment both in Bukavu and Chowe. The teams provided psychosocial support to the four confirmed cases and engaged with community in churches and markets to promote community engagement and awareness-raising activities and trainings have been implemented to strengthen preparedness. In addition, almost 1,500 persons have been vaccinated with the support and facilitation of UNICEF RCCE teams. In the Pinga health zone, no additional cases were reported. At the same time, two EVD tests on the case declared confirmed on 17 August came back negative to EVD virus from the Goma laboratory. Beni and Mangina6 remain important traveling hubs as affected cases travel through these cities to new health zones. For instance, on 20 August, one new case, coming from Beni, was confirmed in Aloya health area after 21 days without cases. In this context, implementation of the response in Beni and Mandima Health Zones remain challenging due to security issues or difficult access, particularly in Kalunguta, Mabolio and Mukulya health areas.

4 Data source: EVD RDC External Situation Report 56 - WHO 5 UNICEF has offices in Goma (North Kivu) and Bunia (Ituri) to support the ongoing emergency response, however, Beni has been established as a coordination hub. UNICEF also has an office in Bukavu (South Kivu)

6 Mangina is a city located in Mabalako Health Zone. The sub-office based in Mangina covers 2 Health Zones: Mandima and Mabalako.

DRC EBOLA SITUATION REPORT 26 August 2019 Response Strategy The Ebola response is based on the joint National Strategic Response Plan (SRP) against the EVD in North Kivu and Ituri provinces. The national SRP was first launched on 01 August 2018 and was revised four times7. The SRP IV covers the period from July to December 2019 and represents a « final push » for all the stakeholders for ending EVD epidemic in the two provinces. The United Nations developed a scale-up strategy to end the 10th Ebola outbreak in DRC. This strategy enhances the overall enabling environment within which the response is situated. It is implemented across five main pillars8 identified as essential for an effective response to end the Ebola outbreak. As part of the Pillar I “Strengthened public health response in support of the Ministry of Health”, UNICEF scaled-up its RCCE interventions to enhance dialogue and partnerships between Ebola response teams and individuals or communities in affected areas enabling community ownership in the response and real time exchange of information. UNICEF also continues to work on improving IPC interventions in communities in affected areas, including the provisions of supplies and household decontamination for confirmed and probable cases. The Psychosocial support interventions is another key area of focus, and UNICEF continues to provide psychosocial support to EVD patients and their families through direct psycho-social care and provision of social support and food assistance to affected individuals and households. Indeed, after over a year, the situation in the Ebola-affected areas is still dire and the Ebola outbreak continues to spread to new territories with a rising number of cases. Many people continue to die in the communities, either at home or in healthcare facilities. Key recommendations of the UNICEF Ebola Action Review concluded, among others, that tackling the DRC Ebola outbreak would require focusing beyond solely Ebola-specific prevention, care and treatment interventions to address the vulnerabilities of the affected populations and increase access to basic social services in affected areas. Multisectoral approaches that strengthen the community resilience including the restoration of health systems are critical to sustain the gains beyond the current Ebola outbreak. Thus, in line with the Government and international community’s Integrated Ebola Response Strategy, the Pillar III, in support of the SRP 4 Pillar I, aims to strengthen community ownership and support programs responding to community needs to enable Ebola control activities (UNICEF and World Bank) while strengthening multi-sectorial humanitarian coordination (OCHA). The Pillar III is supported by UNICEF, The World Bank and OCHA, under the leadership of the Ebola Emergency Response Coordinator (EERC). Under Pillar III, the “Community ownership and essential services” component led by UNICEF aims to strengthen community ownership and provision of basic social services as a way to address community needs in order to increase community acceptance to create a conducive environment for the EVD response. UNICEF will continue implementing activities such as measles campaigns and malaria prevention, while selecting existing and available partners to deliver multisectoral assistance addressing communities needs in Ebola affected areas. Thus, two measles campaigns were organized in Bunia, one in July, specifically in displacement camps while the second one took place from 19 to 25 August in the same area. To date, a total of 81,534 persons were vaccinated, among them 73,529 children from 6 to 59 months, in four health zones, namely Bunia, Rwampara, Nyankunde and Tchomia. More than 6,000 persons vaccinated were internally displaced persons (IDPs) in Bunia Health Zone. The campaign also incorporates additional measures to protect against Ebola transmission including the use of thermoflash, protective gloves and hand-washing stations.

7 The National Strategic Response Plan (SRP) was launched on August 1st and was revised four times. The initial Response Plan (SRP 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 October 19th, 2019, the MoH released the revised Ebola Response Plan (SRP 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 December 20th, 2018, the MoH updated the Ebola Response Plan II (SRP II-I, November 2018 – January 2019) to include assumptions and additional needs until January 31st, 2019, estimated at US$ 23,506,000 million. On February 13th, 2019, the MoH launched the Ebola Response Plan III (SRP III, February – July 2019) for a total amount of US$ 147,875,000. Finally, on July 15th, 2019, The MoH released the Ebola Response Plan IV (SRP IV, July – December 2019) for a total amount of $ 287,590,149. 8 The five main pillars of the scale-up strategy are: (i) Strengthened public health response led by WHO in support of the Ministry of Health; (ii) Strengthened political engagement, security and operations support led by EERC; (iii) Strengthened support to communities affected by Ebola led by the EERC and supported by OCHA and UNICEF; (iv) Strengthened financial planning, monitoring and reporting, led by the World Bank and (v) Strengthened preparedness for surrounding countries led by WHO and supported by OCHA and IASC partner. 5

DRC EBOLA SITUATION REPORT 26 August 2019 Summary Analysis of Programme Response Risk Communication and Community Engagement The risk communication and community engagement strategy aims 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 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 (SDB), and Ebola Transit Centers (ETC)s. Implementing Partners (IP) : Oxfam GB, Action Contre la Faim (ACF), Search for Common Ground (SFCG), Caritas Congo, Réseau des Medias pour le Développement (ReMed), Association Medias Auto Centré pour le Développement du Maniema (MEDAM) Main activities during the reporting period Community Engagement On 22 August, after 21 days since the second case in Goma9, the Governor and the provincial authorities of North Kivu organized a march gathering almost 7,000 participants to mark the 21st days without Ebola in the city. During this event, political and religious leaders, women's organizations and the private sector operators, were represented and 16 of them made a speech to raise awareness about Ebola among the community. In South Kivu, following the reporting of four confirmed cases, the RCCE partners developed a prevention and response workplan for risk communication and promotion of community engagement to the EVD response. In Chowe, initial activities focused on the organization of educational talks for the population, health providers and political- administrative authorities, as well as the production and distribution of 235 posters and 474 leaflets on EVD prevention. RCCE teams organized awareness sessions for 124 patients and health workers in two health centers. In support of the Vaccination Commission activities, they also sensitized the members of the two families affected by EVD and the 161 contacts on the importance of accepting vaccination. Despite these efforts, ten high-risk-contacts refused to get vaccinated. The RCCE teams further organized several awareness campaigns in numerous churches and markets and raised awareness among 10 people living in the mining areas around Mwenga. On 20 August, in Goma, seven journalists covered the initiative taken by the 34th Military District Commander and his troops that visited the points of control in Kanyarutchinya and Mubambiro. They took the opportunity to address EVD prevention messages to all the militaries and acted as a role model by doing a correct handwashing and accepting the temperature screening. Responding to Refusals/Reticence and Rumours During the reporting period, RCCE teams helped to solve 347 out of 527 handwashing and screening refusals through interpersonal communication in Goma. At the same time, they clarified 78 out of 111 rumours issued by the community. Among these, for example, many were focused on Ebola as a business for foreigners. The release of the healed wife of the second case on 13 August was an opportunity to address some of these rumours by specifying the life-saving support that she received from the response. In Beni and Mangina, RCCE teams clarified 20 out of 25 rumours and helped to solve 177 out of 199 handwashing refusals. At the same time, they supported the SDB commission in conducting 10 out of 11 SWAB/SDB. Similarly, in Mambasa, the team helped resolved 138 handwashing and 107 screening refusals, seven SDB and 13 refusals to go to the ETC, while the team in Komanda was involved in solving of 46 out of 66 handwashing, 36 out of 66 screening and 12 out of 16 SWAB/SDB refusals. The RCCE teams intensified their activities in Mabolio, in Beni health zone, a health area that recently registered a lot of resistances. Activities included a visit of the ETC with community workers and political leaders and a raising awareness session through theatre sketches targeting the community.

9 The EVD incubation period, that is, the time interval from infection with the virus to onset of symptoms, is from 2 to 21 days.

DRC EBOLA SITUATION REPORT 26 August 2019 Promotion of Preventive Behaviors In North Kivu, RCCE teams continued to conduct public awareness activities on risks communication and community engagement on Ebola prevention and response measures which targeted 12,183 men and women among which were militaries, religious leaders and modern health and traditional practitioners. Activities included three popular forums organized in Nyiragongo, Goma, with 321 participants and 27 educational talks and nine community dialogues in Beni which reached respectively 400 participants (including 190 women) and 474 participants (including 282 women). In Ituri, in Mandima health zone, targeting Mayuano as a hotspot area, the RCCE teams organized discussion forums with 673 people while in Mambasa health zone, they raised awareness among 619 primary and secondary school pupils on EVD prevention measures. In Komanda, a total of 280 people (including 85 women) were briefed on Ebola prevention and response measures. In Mambasa health zone, Red Cross community workers and volunteers visited 5,181 households and reached 23,121 people through community dialogues. Moreover, during home visits, they identified 66 visitors from epidemic areas - Some, Mayiwane, Mandima and Beni - and informed them on Ebola transmission and prevention measures. In Beni and Mangina, the RCCE teams continued to organize a side visit to ETCs: four side visits in two ETCs were organized with 27 visitors, among them women, moto-taxi drivers, pastors, youth and members of various civil society organisations. In total during the reporting period, 16 training sessions were held in Beni, Mangina, Mambasa and Komanda health zones, targeting religious and community leaders, health workers, teachers, community workers, directors of mining companies and 29 members of Cellules d’Animation Communautaires (CAC). In Mangina, UNICEF and partners held a briefing for 67 members of the Mangina Hairdressers Association on EVD-related hygiene practices and the clarification on the different rumors. After the briefing, the hairdressers requested protective equipment (gloves) and handwashing devices to carry out their job without being exposed to the EVD. Media During the reporting period, in Beni, radios produced four interactive and participatory programs and documented testimonies of 28 Ebola survivors. In Mangina, nine radios broadcasted 189 spots and messages on Ebola preventive measures and on the importance of screening and hand washing. In Mambasa, two radio programs were produced on Ebola preventive and response measures and on the importance of the early transfer to ETC in case of EVD symptoms. They also broadcasted testimonies of survivors discharged from the Makayanga ETC as well as a programme on the importance of the vaccination. In Komanda, three community radio stations rebroadcasted Ebola survivors’ testimonies in Swahili language and messages on the importance of proper hand washing. In Mwenga and Bukavu, 40 actors from RCCE provincial commission and journalists from local radio stations were informed on Ebola prevention and response measures and key messages of the RCCE which need to be conveyed to the public. Key Results Change since Total Result RISK COMMUNICATION AND COMMUNITY ENGAGEMENT Target10 last report UNICEF ▲▼ # of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities (CAC, religious /traditional leaders, 67,695 61,232 1,904 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 40,321 35,094 920 community engagement approaches. # of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, 26,500,000 24,030,824 1,135,916 adolescent groups, administrative employees, armed forces. # of households for which personalized house visits was undertaken to address serious 12,981 11,795 544 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 206,835* 205,321 7,245 convinced to receive the vaccine within required protocols. * This figure indicates the number of listed eligible people for ring vaccination from 8 August 2018 to 17 August 2019

DRC EBOLA SITUATION REPORT 26 August 2019 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 reinforcement of basic WASH services, which includes the provision of water and WASH kits11 and awareness raising of traditional practitioners (2) hygiene promotion and provision of WASH kits in schools12, (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) joint13 supervision of health infrastructures to ensure that efficient and sustainable programmes of high quality are developed. Implementing Partners: Mercy Corps, Red Cross, OXFAM GB, MEDAIR, Action Contre la Faim (ACF), Programme de Promotion des Soins de Santé Primaires (PPSSP), Mutuelle de Sante Canaan (MUSACA) and Centre de Promotion Socio- Sanitaire (CEPROSSAN). Main activities during the reporting period Preparedness and prevention activities remain a priority within the response. 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. In preparation of the transfer of IPC/WASH activities from WHO to UNICEF as of 01 September, UNICEF IPC/WASH management visited Beni, Mangina and Butembo sub-coordinations to identify the needs and review the status of the existing mechanisms and prepare for transition of teams, supply and transport to ensure a smooth continuation of activities. Case reporting remained consistent in Butembo and activities were implemented around 18 confirmed cases. IPC/WASH Commission supervisors supported by UNICEF distributed hygiene kits to 162 households and WASH/IPC kits to 21 health facilities together with briefing sessions on the use of the items for 115 health workers. Handwashing points were installed in 41 public places. In collaboration with Mercy Corps and CEPROSSAN, UNICEF provided hygiene kits to 237 households and nine health facilities received IPC/WASH kits along with briefings by Mercy Corps of 24 health care staff. Handwashing devices were installed in 59 public places. On 19 August, a demonstration to protest against continued insecurity was organized in Beni. A “ville morte” was also declared and all response activities were suspended for the day increasing the risk of virus transmission. An increase of cases was reported, and response activities took place around 17 cases. UNICEF partnering with PPSSP, distributed hygiene kits to 113 households and IPC/WASH kits to three health facilities and two schools. Handwashing points were installed in 16 public places. Information sessions were held on Ebola prevention measures with 3,910 vulnerable people affected by Ebola around cases. A specific group discussion was held with 184 women on the same subject. To share EVD prevention messaging through community-based organizations, 697 community members were briefed on the use of hygiene kits to support kit usage of future distribution in their neighborhoods. In addition, UNICEF provided ten WASH kits to two health centers in Mukulya health area. In Oicha health zone, in partnership with the local association Organisation de Developpement D’Oicha supplied 208 public handwashing points with 42,580 liters of chlorinated water and distributed 19,881 liters of water supplied to health facilities. In Mabalako sub-coordination with the reduction in reported confirmed cases compared to the previous week, the team was able to emphasize preventive activities such as awareness campaigns on Ebola for 1,974 people. Although access to some affected areas remains a concern due to persistent insecurity, hampering response efforts, UNICEF and partners OXFAM and FAEVu distributed hygiene kits to 270 households surrounding confirmed cases. Compared to last week, fewer health facilities have been provided with kits due to lack of supplies. IPC/WASH kits were distributed to 28 health facilities (previously 70) and WASH kits were provided to 75 public places. In Komanda, where confirmed cases decreased to two compared to four last week, IPC/WASH Commission supervisors supported by UNICEF provided hygiene kits to 265 households and IPC/WASH kits to 18 health facilities and 44 public places. New handwashing devices were installed in two public places along with Ebola related and hand hygiene awareness sessions reaching 842 people. Six health facilities were also supported with the monitoring of the use of

11 For 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 supplies 12 For IPC/ WASH kits for schools, items are provided in accordance with three areas of support: (1) Screening (thermoflash), (2) handwashing (with soap), (3) cleaning and decontamination supplies. 13 Multidisciplinary teams comprise health specialists from the MoH and/ or Medical NGOs as well as WHO. 8

DRC EBOLA SITUATION REPORT 26 August 2019 WASH kits and briefings sessions conducted for 71 healthcare providers. In addition, partner MUSACA supplied 32,830 litres of chlorinated water to 67 public places in the Komanda and Irumu health areas and 194,950 litres of drinking water were provided to the community serving approximately 39,917 people. In response to three confirmed cases reported in Mambasa, UNICEF and partner MUSACA provided hygiene kits to 81 households and WASH kits to 41 public places. Prevention activities included the installation of waste burners in seven health facilities and monitoring of IPC/WASH practices in 18 health facilities. Access to water was ensured by the supply of 13,300 litres of chlorinated water to 17 public places and three control points. A further 144,250 litres of treated drinking water were provided to 937 households (4,758 people). As there have not been any new confirmed cases reported in Bunia, prevention activities remained the priority with the installation of two hand washing devices for a Gospel campaign at the Baptiste au Centre de l'Afrique (CBCA) which facilitated handwashing for nearly 1,500 participants. In collaboration with MUSACA, UNICEF conducted monitoring visits to hand-washing devices in 19 public places. UNICEF also supplied 47,430 litres of chlorinated water in three health facilities and 91 public places in Bunia and two health facilities and 14 public places in Rwampara. Partner ACF supplied 51,440 litres of chlorinated water to 60 public places in Ngezi, Bora-Uzima and Adventist in the Bunia health zone in addition to the central market and the Bunia fairground chamber. The IPC supervisors provided WASH support to 122 measles vaccination sites including waste management. In Rwampara health zone, just in time for the return to school, partner MUSACA completed the construction of two blocks of six latrines in two schools in Hoho. A supply of 4,200 litres of chlorinated water was provided to eight public places in Shari and monitoring of hand-washing devices continued in 22 public places. Nyiragongo Health Zone passed 21 days without additional confirmed cases detected, as risks of further introduction within Goma city and surrounding areas are high, the team remains vigilant. To reinforce preventative measures in the affected health zones, partner OXFAM continued to ensure access to water with the supply of 25,500 liters of water in eight health facilities in Himbi, 27,000 liters in six health facilities and 383,500 liters in the community of Kiziba. In addition to regular activities, UNICEF partner PPSSP supported handwashing points in 26 public places, supplying 95,720 liters of chlorinated water in Goma, Karisimbi, Nyaragongo and Kirtothse health zones. On 22 August, North Kivu Governor Carly Kasivita organized a march to support Ebola response teams during which UNICEF implementing partner PPSSP supplied 1,380 liters of water to handwashing points installed for the crowds. In Karisimbi health zone, partner Medair continues the construction of sanitation infrastructure within the health centers of Methodiste and Hebron where the ash pit has been completed and two tanks were installed for rainwater collection. UNICEF supported supervisors from the IPC sub-commission remained in Pinga health zone in response to the activities around the confirmed case that has since been discharged. However, due to insecurity, most of the planned activities have been postponed. A new confirmed case was reported in South Kivu. UNICEF worked with the MoH to reinforce response measures to prevent expansion of EVD transmission at community level and collaborate with the Commission on the development of the Plan of Action for South Kivu including WASH programme components. The coordination center in Bukavu managed the IPC Commission and the WASH activities in response to the four confirmed cases in Mwenga health zone. UNICEF provided WASH items to the MoH in support of the distribution of hygiene kits to 42 affected households and the installation of hand washing points in eight public places. At the Mwenga General Reference Hospital, UNICEF briefed 12 hygienists on Ebola IPC principals and procedures. Key Results Change since Total Result WATER, SANITATION & HYGIENE Target14 last report UNICEF ▲▼ # of health facilities in affected health zones provided with essential WASH services. 3,884 2,709 112

14 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 IV (July to 31 December 2019), covering all health zones in Ituri and North Kivu province. 9

DRC EBOLA SITUATION REPORT 26 August 2019 % of schools and public places near confirmed cases locations where handwashing 100% 72% 0 stations are installed and utilized Number of households of confirmed cases, contacts and neighbours of confirmed 36,437 14,485 485 cases who received a hygiene and prevention kits with adequate messaging

Main activities during the reporting period The beginning of the 2019-2020 school year is planned for Monday 2 September. The Educational Divisions of North Kivu and Ituri jointly with UNICEF consolidated a strategy for the school opening, focused on fighting Ebola in schools. The strategy has a three ponged-approach: i) the assessment of WASH materials in schools, jointly performed by IPC/WASH Commission and the educational authorities; ii) awareness-raising targeting education managers undertaken by the RCCE commission in collaboration with educational authorities; and (iii) teachers’ training on the Guidance Note for the Prevention and Control Ebola in schools led by Education teams and educational authorities. The RCCE Commission is currently validating the strategy.

In this perspective, on 26 August, the Division of Education of North Kivu 2 held a meeting which gathered the school’s managers of the Province. This meeting aimed at preparing the start of the school year and presenting the strategy. In turn, each Sub-Division will then hold the same meeting in its area of responsibility to inform about this strategy.

Following Bunia (09-11 August) and Butembo (16-18 August) and in the framework of this strategy, from 20 to 23 August, in Beni, the Ministry of Education together with UNICEF, organized a workshop to share experiences, best practices and lessons learned on the prevention and control of EVD in schools that can be spread in other health zones. The meeting gathered 26 participants, including 4 women, among which representatives from the Sub-Provincial Ministry of Education of Beni and Oicha, EPSP inspectors, WHO representatives and Alima and AVSI Education staff.

In line with the same strategy, on 23 August 2019, in Katwa health zone, the Educational Sub-Division of Butembo took advantage of the meeting organized in preparation of the start of the school year to raise awareness of 157 primary and secondary school directors, including 33 women, on prevention measures and the application of the Guidance Note for the prevention and control of Ebola in schools.

In the health zones of Lubero, Masereka and Musienene, UNICEF implementing partner AVSI together with the inspectors of the Educational division, assessed the need for hygiene kits in 80 schools. The result of the assessment revealed that 29 schools don’t have hygiene kits including WASH devices. WASH teams will make them available them before the start of the year. AVSI will continue this assessment in the other 83 schools in Beni, Mabalako and Oicha health zones.

Finally, in South Kivu, several preparedness and response activities have been carried out in schools. The EPSP and UNICEF team did the school mapping in Mwenga and organized a briefing session on Ebola and its prevention measures with five EPSP officials. In Chowe village the local NGO Enfants Solidaires Tujikaze and EPSP distributed 500 leaflets in French and Swahili to 500 pupils and their parents to inform about Ebola prevention measures, symptoms and the importance of prompt treatment in the isolation center.

DRC EBOLA SITUATION REPORT 26 August 2019 Key Results: Change since Total Result EDUCATION Target15 last report UNICEF ▲▼ # of students reached with Ebola prevention information in schools 1,458,000* 928,565 0 # of teachers briefed on Ebola prevention information in schools 47,000 32,436 183

Psychosocial Support and Child Protection16 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 strategy include the provision of (1) psychosocial support17 for EVD confirmed and suspected cases, including children, in the ETCs; (2) material18 and psychosocial assistance to affected families to better support children; (3) psychological support of contacts to support the Surveillance Commission in their listing and follow up; (4) psycho-social assistance, socio-culturally appropriate care19 and research for long-term solution to orphans and unaccompanied children; (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 SDB etc). Implementing Partners: Danish Refugee Council (DRC), Alliance for International Medical Action (Alima), Division Provinciale des Affaires Sociales (DIVAS), Division de l’Interieur (DIVInter)

Main activities during the reporting period Activities in ETC, TC and nurseries During the reporting period, UNICEF and its partners provided psychological support to 214 children, including 196 suspected cases (108 boys and 88 girls) and 18 confirmed cases (9 boys and 9 girls) admitted to the TCs/ETCs. In South Kivu, in the isolation center of Chowe, UNICEF and its partners distributed individual recreational kits to two children (suspected cases) and a radio to an adult confirmed case. In the ETC of Bukavu, the teams provided adequate psychological support to all the suspected cases (two men and one woman). In Beni (North Kivu), the psychosocial team organized a one-day session with 32 Ebola survivors including 27 women, employed in the ETC and nursery to take care of children. During the meeting, participants received psychological support and created a common space for sharing experiences and for a mutual emotional support. Activities in communities UNICEF and its partners provided psychosocial support and material assistance to 353 newly EVD affected families so that they continue to have the emotional and material capacity to care for their children. A total of 1,990 kits of material assistance (hygiene, funeral, NFI, new-born kits and food assistance) were distributed to discharged and recovered patients as well as affected families.

In South Kivu, funeral kits have been distributed to two affected families, whose members died of EVD. Two orphans (boys) of the same family were identified and received appropriate care including material assistance for the extended family who is taking care of them. School fees were paid for the child in age to go to school. In addition, the psychosocial team provided psychosocial support to 1,901 contacts, 149 new separated children (67 boys and 82 girls) and 78 new orphans (35 boys and 43 girls) in the three provinces. In the socio-cultural context of the DRC, orphans are generally placed with their extended families. In case of resistances, UNICEF and its partners engage in family mediation to find solution in the best interest of the child. Placement in foster families is also possible and required if the extended family cannot welcome an orphan. UNICEF is currently working with the Ministry of Social Affairs for reinforcing the number and capacity of foster families in EVD

15 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 IV (July to 31 December 2019), covering all health zones in Ituri and North Kivu province. 16 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), Alima and DIVAS. All results, unless otherwise stated, are UNICEF results with implementing partners. 17 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. 18 Material assistance is assessed on a case by case basis, according to the specific needs of children and their families. 19 According to the local context and socio-cultural norms. 11

DRC EBOLA SITUATION REPORT 26 August 2019 affected communities. Specific nutritional and psychosocial monitoring protocols are set up for the follow-up of orphans, with a focus on those under 23 months both at ETC and community level. In addition, the Psychosocial Commission started to work on the preparation for the new school year and, in particular, on a supply plan for school kits and payments of school fees for EVD-related orphans and survivor children. UNICEF Child Protection and Education teams together with implementing partners have already purchased 100 school kits and uniforms ready to be distributed to these children. Key Results Change since Total Result CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT Target20 last report UNICEF ▲▼ # of children as confirmed or suspect case receiving psychosocial support inside the 10,312* 6,642 214 transit centres and ETCs # of affected families with confirmed, suspects, probable cases who received 22,939* 9,626 353 psychosocial assistance and/or material assistance # of contact persons, including children, who receive psycho-social support 17,086** 14,966 1,435 # of separated children identified who received appropriate care and psycho-social 2,950 2,782 149 support as well as material assistance # of orphans identified who received appropriate care and psycho-social support as well 1,960 1,502 78 as material assistance # of psychologists and psychosocial agents trained and deployed to respond to the needs 1,300 918 0 of affected children and families * This figure has been adjusted in regard to the high number of persons being admitted daily to the transit centers and ETCs as suspect cases. It includes support provided to families with suspect, probable or confirmed EVD members. ** The target number has been changed in relation to the evolution of the epidemic.

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. Implementing Partners: ALIMA, Adventist Development and Relief Agency (ADRA), Programme National de Nutrition (PRONANUT) Main activities during the reporting period UNICEF and its implementing partners provided adequate nutritional care for 420 new suspected and confirmed cases admitted in the ETCs, including seven children under six months, 56 children aged from 6 to 59 months and three pregnant women. Among these, 60 per cent were admitted in the ETC of Butembo (154 cases) and Katwa (101) following the resumption of positive cases in these zones. At communities and household level, the nutritionists and psychosocial agents of the ETCs, supported by UNICEF, provided nutritional support (Ready-to-Use Infant Formula - RUIF) to 107 separated infants non-breastfeed, 13 more than the previous week (29 in Butembo, 27 in Katwa, 26 in Beni, 15 in Mabalako, three in Komanda and seven in Bunia). Among these, 26 were children under six months and 81 children aged from six to 23 months. Twenty-two children under five suffering of Severe Acute Malnutrition were admitted for treatment in the Outpatients Therapeutic Programme (OTPs) under the supervision of health zone nutritionists. In addition, UNICEF and its partners such as communication agents, health promotion workers and nutritionists sensitized 1,621 women caregivers on adequate Infant and Young Child Feeding practices (IYCF) in the Ebola context

20 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 IV (July to 31 December 2019), covering all health zones in Ituri, North Kivu and South Kivu provinces. 12

DRC EBOLA SITUATION REPORT 26 August 2019 (411 in Butembo, 279 in Katwa, 94 in Beni, 478 in Mabalako, 213 in Komanda, 130 in Bunia and 16 in Goma) both at ETCs and contact households level. During the reporting period, UNICEF Nutrition team organized a series of trainings for 17 nutritionists of the ETCs in Beni, Mangina and Komanda on the collection methodology for nutritional data in the Ebola context with tablets. Key Results Change since Total Result NUTRITION Target21 last report UNICEF ▲▼ # of < 23 months children caregivers who received appropriate counselling on IYCF in 51,865 50,910 1,621 emergency # Ebola patients who received nutrition support during treatment according to guidance 8,750 8,410 420 note # of less than 6 months children who cannot be breastfed and who receive ready-to-use 600 783 26 infant formula in ETCs, nursery’s, orphanages and in the communities

Social Science Analysis Cell (CASS) The formative, social sciences analysis section seeks to increase the accountability to affected populations through the provision of social sciences analysis to inform response interventions. Social sciences research agenda and themes are primary developed from epidemiological and context analysis as well as directly from response interventions and via requests from the Commissions. Social sciences analysis supports UNICEF programme teams and the overall response to better understand and engage the communities with which we work. UNICEF’s Social Sciences team contributes to the integrated Analysis Cell which includes Epi and Social Sciences work. UNICEF’s Social Sciences teams includes local, national and international researchers specializing in epidemiology, health demography, anthropology and social sciences health studies. The team involves the exploration of behavioural determinants of health and uses multiple methods to collect data such as questionnaires, structured and guided interviews, focus groups, informal discussions and observation. Data are triangulated and mapped by area and group to ensure saturation and representation. Research results are presented at Commissions and weekly in Sub-Coordinations (or in ad hoc requests) to facilitate access. The UNICEF’s Social Sciences team have ensured that all raw data, presentations and reports as well as workshop tools and training modules are available openly for everyone in the response. Main results during the reporting period General activities & programmes The teams continue to work in Butembo, Katwa, Vuhovi, Lubero and Kyondo in partnership and via the MoH Epi Cell and together with WHO, Centers for Disease Control and Prevention (CDC), Africa CDC, IFRC and MSF. General activities & programmes In coordination with the Epidemiology Cell, a study on Ebola and children under five years old was presented on 21 August at EOC. The objective of the analysis was to better understand parents’ perceptions, knowledge, attitudes and practices towards children in the context of the Ebola outbreak. Epidemiological data showed that fewer children under 5 years old are recorded and followed as contacts compared to adults and children under 18. This partly contributes to a higher mortality rate among young children. The social sciences analysis looked at treatment seeking behaviors of mothers and indicated that: • Mothers are afraid of their children being admitted to the ETC; • Parents don’t believe they have the capacity to protect their children from EVD; • Knowledge of less severe or dry symptoms related to Ebola is limited among parents; • Parents perceive ETCs as places where people die. Key recommendations included improving communication on: • Ways to protect children under 5 specifically; • Identification of dry symptoms among children under 5;

21 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 IV (July to 31 December 2019), covering all health zones in Ituri and North Kivu province. 13

DRC EBOLA SITUATION REPORT 26 August 2019 • Potential positive impact of prompt treatment in the ETC by focusing on children that have survived following EVD treatment. Ongoing social sciences analysis In Beni, teams collected data on perceptions of WASH hygiene kits and are currently analysing them along with data collected on health seeking behaviours in Beni, Mabalako and Mandima. Key findings and recommendations from a study on traditional healers was presented on 24 August in Beni and Mangina sub-coordinations. Findings suggest that several traditional healers have been involved in the response but would like more support in terms of personal protective equipment. Those who are not currently engaged expressed interest in activities related to community engagement, surveillance and safe and dignified burials. Recruiting traditional practitioners to participate in community engagement activities was one of the main recommendation taken and referred to the RCCE commission as it could have a positive impact on community resistance. In Butembo and Katwa, a preliminary analysis of treatment seeking practices in areas with long and short delays22 suggests that key barriers which prevent people from seeking treatment are grounded in fear of the ETC. As a result, people prefer to self-medicate, receive home care or consult traditional healers or private facilities that do not collaborate with the EVD response. The high visibility of Ebola response teams and the stigma this brings to affected households and the surrounding community also deter people from seeking treatment. Motivators in areas where the delay between onset of symptoms and admission to the ETC is shorter (1-3 days) include: • Increased involvement of local, community-based organizations in the response; • Engaging youth and survivors in response activities; • Visibility of more and more survivors in communities and; • Organization of regular visits to ETC for the community leaders.

Supply and Logistics UNICEF regularly monitors the supply chain and discusses with the different involved actors to ever improve efficiency of the supply and services facilitation for the Ebola response in Ituri and North Kivu provinces. During the reporting UNICEF distributed WASH, C4D, Child Protection, Health, Education and ICT items and supplies for a total value of US$ 290,096. The total value of procurement orders was US$ 3,660, cent per cent offshore procurement.

Human Resources UNICEF continue to strengthen its presence on the ground to better respond to the expanding outbreak in North Kivu and Ituri provinces. The number of staff dedicated to the Ebola response scaled up to 205 persons already working in the affected areas23, with an additional 43 persons under recruitment. In addition, excluding Ebola staff, UNICEF has a capacity of 35 staffs in Goma sub-office (North Kivu) and 22 in Bunia sub-office (Ituri) to support the overall UNICEF operations in the region.

External Communication The external communication team continued work to spotlight UNICEF’s Ebola response. In this reporting period, UNICEF Country Representative Edouard Beigbeder is quoted by The Times on the role of survivors at UNICEF-run nurseries. UNICEF is interviewed by Australia Radio on the importance of community engagement and mentioned in a UN News photo essay. After confirmation of the first Ebola cases of in South Kivu, the CO issued a press statement recalling the particular vulnerability of children to this disease. The statement was picked up by Vatican News and Europa Press and shared on social media. A professional videographer and photographer also travelled with UNICEF in affected areas to gather new material on key issues and UNICEF’s response.

22 This study took place in Butembo from 14 to 18 August and was reported in the Situation Report 38, page 14. 23 UNICEF staff on ground includes 35 staff in Goma (EOC), 10 staff in Goma sub-coordination, 35 staff in Beni, 68 staff in Butembo/Katwa, 15 staff in Mangina, 9 staff in Bunia, 9 staff in Komanda, 6 staff in Mambasa, 6 staff in Bukavu and 12 staff in Kinshasa. 14

DRC EBOLA SITUATION REPORT 26 August 2019 Since the beginning of the outbreak, the CO published 99 content pieces on its website https://www.unicef.org/drcongo/. The Ebola landing page is updated weekly, linking to key figures, press releases, situation reports and stories. The CO has also posted nearly 890 messages on Facebook, Instagram and Twitter.

Funding The SRP4 provisional funding requirement for the public health response is US$ 287.6 million for activities until end December 2019. The DRC grand total budget for the Ebola response in North Kivu and Ituri provinces from August 2018 to December 2019 is estimated at US$ 563.8 million. As part of this joint response plan, the UNICEF estimated public health response requirements stands at US$75.9 million, out of a total of US$ 126 million. To date, the UNICEF response is 39 per cent funded. UNICEF expresses its sincere gratitude to all current donors for their substantial contributions to UNICEF's actions in favour of the Ebola response: The World Bank Group’s Pandemic Emergency Financing Facility (PEF), The European Commission (European Civil Protection and Humanitarian Aid Operations (ECHO), Gavi - the Vaccine Alliance, The Central Emergency Response Fund (CERF), the Government of Japan, the German Committee for UNICEF, the Government United Kingdom and the Paul G. Allen Family Foundation.

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response Plan 2018 - 2019) Reprogrammed Funds Funds Funding gap funds from Received for Requirements* available Appeal Sector Equateur North Kivu $ ** Response Phase I & II $ % $ $ $ Water, Hygiene and 47,951,276 723,295 17,879,794 18,603,089 29,348,187 61% Sanitation - WASH / IPC Communication for Development (C4D) - Community engagement and 51,440,240 371,558 13,356,698 13,728,256 37,711,984 73% Communication for Campaigns Child protection and 9,402,390 100,000 7,344,617 7,444,617 1,957,773 0% Psychosocial Support *** Nutritional Care and Counselling in Ebola 4,336,536 0 2,136,118 2,136,118 2,200,418 0% Treatment Center / Community **** Operations support, Security and Coordination costs and 11,067,320 132,761 6,619,369 6,752,130 4,315,189 39% Information and Communications Technology Surveillance 1,520,000 720,000 720,000 800,000 53%

Preparedness Plan 322,000 0 322,000 322,000 0 0%

Total 126,039,762 1,327,614 48,378,597 49,706,211 76,333,551 61%

DRC EBOLA SITUATION REPORT 26 August 2019 Next Situation Report: 01 September 2019