DRC EBOLA SITUATION REPORT 12 May 2019 Democratic Republic of the Congo Ebola Situation Report North Kivu and Ituri PhotoPhoto Credit: Credit: UNICEF UNICEF DRC DRC Tremeau Thomas Nybo 12 May 2019 SITUATION IN NUMBERS Highlights 1,705 total reported cases (MoH, 12 May 2019) SITUATION IN NUMBERS • Insecurity persists in Katwa and Butembo health zones, resulting in 1,617 confirmed cases temporary suspension of activities. On 3 May, a Safe and Dignified (MoH, 12 May 2019) Burial team was violently attacked by community members after the burial of a confirmed Ebola case. On 8 May, 50-armed militia entered 484 children <18 among confirmed Butembo and opened fire in the city. This led to the temporary cases (MoH/ WHO, 12 May 2019) suspension of activities for five days 20 January 2019 deaths among confirmed cases 1,036 (MoH, 12 May 2019) • As of 7 May, women and children continue to be disproportionally affected by the virus, of the total cases with recorded sex and age, 12,320 contacts under surveillance 57% (907) were female and 30% (475) were children aged less than (MoH, 12 May 2019) 18 years. UNICEF Ebola Response Appeal US$ 50.15 million Ebola Response Funding Status 2018 - 2019 UNICEF’s Response Funding Gap Indicator Target Result US$7.93M 16% # of at-risk people reached through community engagement and interpersonal communication approaches (door-to-door, church 19,500,000 15,339,003 meetings, small-group training sessions, school classes, briefings with leaders and journalists, other) Ebola NK and Ituri Phases # of listed eligible people for ring vaccination informed of the I, II & III benefits of the vaccine and convinced to receive the vaccine within 116,473 * 114,553 Funding requirements* : required protocols. $ 50,149,121 # of households of confirmed cases, contacts and neighbours of confirmed cases who received a hygiene and prevention kits with 15,000 2,476 Total funding adequate messaging available** US$42.21M # of teachers briefed on Ebola prevention information 32,296 21,650 84% # of affected families with confirmed, suspects, probable cases who 5000** 4,727 * Funding requirement includes budget for phase I ($ 8,798,899), received one or several kits of assistance to support their children phase II ($ 13,031,305), phase II.I ($ 3,933,000) and phase III ($ 24,385,917) * The target is dynamic as listing of eligible persons is defined **Funds available include Reprogrammed funds from Equateur **The target is estimated based on both the number of confirmed, probable and suspected case, and is adjusted according to the Response and funds received since August 2018 response 1 DRC EBOLA SITUATION REPORT 12 May 2019 Guy Epidemiological Overview1 Summary Table (12/05/19) Confirmed and Probable Cases Deaths Suspect Cases under Province Health Zone Deaths among Confirmed Probable Total Total Deaths investigation confirmed cases Beni 279 9 288 151 160 49 Butembo 167 0 167 183 183 10 Kalanguta 85 15 100 40 55 18 Kyondo 19 2 21 13 15 16 Mabalako 142 16 158 97 113 7 Masereka 36 3 39 14 17 1 Musienene 38 1 39 19 20 11 Mutwanga 5 0 5 3 3 11 Nord-Kivu Oicha 41 0 41 20 20 13 Katwa 541 14 555 362 376 13 Vuhovi 79 12 91 28 40 3 Biena 7 1 8 8 9 30 Goma 0 0 0 0 0 4 Kayna 8 0 8 4 4 4 Mangurujipa 10 0 10 4 4 15 Lubero 8 2 10 2 4 16 Mambassa 0 0 0 0 0 5 Mandima 119 4 123 73 77 14 Komanda 28 9 37 10 19 3 Ituri Nyakunde 1 0 1 1 1 0 Tchomia 2 0 2 2 2 0 Bunia 2 0 2 2 2 8 Total 1617 88 1705 1036 1124 251 Previous Total 29 April 2019 1400 66 1466 891 957 239 1 Data source: Epidemiological table based on daily numbers by the National Coordination Committee (Comité National de Coordination, CNC) 2 DRC EBOLA SITUATION REPORT 12 May 2019 Key Epidemiological Developments The Ebola outbreak in the Democratic Republic of the Congo (DRC) continues to take place in the provinces North Kivu and Ituri, both affected by conflict and armed violence. According to latest risk assessments by the World Health Organization (WHO), the national and regional risk levels remain very high, while global risk levels remain low. Since late February, recorded cases of Ebola have increased per weekly basis. A general deterioration of the security situation, and the persistence of community mistrust exacerbated by political tensions, have resulted in temporary suspension of activities and delays in case investigations. The high proportion of community deaths reported among confirmed cases, relatively low proportion of new cases who were known contacts under surveillance, existence of transmission chains linked to nosocomial infection, persistent delays in detection and isolation in ETCs, and challenges in the timely reporting and response to probable cases, are all factors increasing the likelihood of further chains of transmission in affected communities and increasing the risk of geographical spread both within the DRC. This past week saw a continued increase in the number of new Ebola virus disease (EVD) cases reported in the North Kivu and Ituri provinces of the Democratic Republic of the Congo, with a total of 106 new confirmed cases reported. The outbreak remains contained to a geographical area, with hotspot areas within Katwa, Mandima, Butembo, Mabalako and Musienene health zones. In the 21 days between 15 April – 5 May 2019, 76 health areas within 14 health zones reported new cases, representing 47% of the 163 health areas affected to date (Table 1 and Figure 2). During this period, a total of 298 confirmed cases were reported, the majority of which were from the health zones of Katwa (40%, n=120), Mandima (13%, n=40), Butembo (13%, n=38), Musienene (8%, n=25), Mabalako (8%, n=24), and Beni (6%, n=19). As of 12 May 20192, a total of 1705 EVD cases, including 1617 confirmed and 88 probable cases, were reported. A total of 1,124 deaths were reported (overall case fatality ratio 66%), including 1036 deaths among confirmed cases. Of the 1705 confirmed and probable cases with known age and sex, 56% (951) were female, and 29% (502) were children aged less than 18 years. The number of healthcare workers affected has risen to 101 (6% of total cases). Humanitarian Leadership and Coordination UNICEF continues to support coordination in all locations with functional strategic or operational commissions, and co-leads the commissions on communication and community engagement, WASH - IPC, and psychosocial care. UNICEF is also active in the working groups on logistics, vaccination and nutrition. The strategic Ebola response coordination based in Goma maintains a strong support to active operational coordination (Butembo / Katwa, Mangina, Mandima , Vuhovi, Beni and all active health zones). One sub- coordination hub is operational in Bunia city. The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases and the geographical extension of the epidemic to newly affected health zones. A multi-sectoral UNICEF Rapid response team is in place and deployed to new hotspots as required. The past week showed a continued deterioration of the security situation in Butembo city. 3 May 2019, a safe and dignified burial (SDB) team in Katwa was also attacked after conducting a SDB of a confirmed case. Response activities were temporarily suspended in Butembo and neighbouring health zones from 4-5 May 2019 following a civil demonstration by members of a local moto-taxi drivers union. Response operations later resumed following negotiations with community leaders, threats of attacks persisted against some healthcare facilities and healthcare providers. On 8 May, Butembo centre was at the heart of a coordinated attack apparently targeting some local institutions. Despite no response actors were affected, activities were suspended for 48 hours. In Butembo, current 2 Source: World Health Organisation 12 May 2019 3 DRC EBOLA SITUATION REPORT 12 May 2019 coordination efforts aim to enhance security measures collectively through the UN Security Management System. Coordination efforts included updating security risk management processes by addressing procedural, operational and physical security measures. Response Strategy The Ebola response is based on the joint National Strategic Response Plan (SRP) III against the Ebola Virus Disease (EVD) in North Kivu and Ituri provinces, which covers a six-months period until 31 July 2019. SRP III aims at containing the transmission of EVD in the provinces of North Kivu and Ituri and to avoid the spread of the disease to new health zones as well as neighbouring provinces and countries. Through the broadening of the scope of the response to all 70 health zones in North Kivu and Ituri provinces to eradicate Ebola and due to the longer six-month time frame, in comparison with previous planning, SRP III allows for greater flexibility in adopting rapid, effective and needs-based response measures. The strategy further provides for a strong anchoring of the response in the local health system, the strengthening of the information management system, and a strong accountability framework. In support of SRP III, the UNICEF Ebola response strategy continues to focus on communication and community engagement, WASH, and psychosocial care, nutrition, and a cross-cutting education sector response. Summary Analysis of Programme Response An overview of the key elements in the Ebola response, with a special emphasis on UNICEF’s interventions in the affected health zones, is detailed below. Communication and Social Mobilization The risk communication, social mobilization and community engagement aims to (1) proactively engage with affected and at-risk communities, (2) provide timely and accurate health advice to encourage positive health seeking behaviours, and (3) address community concerns and rumors.