Why the World Should Expect More Epidemics in the DR Congo

Democratic Republic of Congo (DRC) is on the spot again after the outbreak of the world’s largest and fastest moving measles epidemic with over 203,000 cases reported throughout the country. According to World Health Organisation (WHO), around 5,000 people have been killed after the disease spread to all the 26 regions in the country.

The number of deaths caused by measles now surpasses that of people killed by Ebola in the last 15 months. Relief Web states that so far, children under the age of five have accounted for 74 per cent of the infections and nearly 90 per cent of deaths.

It is not the first time that deadly epidemics have occurred in DRC. On 12th October this year, the country’s government officially declared a cholera epidemic, after over 20,000 cases were reported in nearly all the provinces. A report by the Centers for Disease Control and Prevention (CDC), reveals that the DRC alone accounts for an estimated “189,000 (5% – 14%) of the 1.34 – 4.01 million cholera cases worldwide annually.”

These are all happening at a time when the country continues to battle with its tenth outbreak of Ebola in 40 years. It is that largest Ebola outbreak in the country’s history and the second biggest in the world after the one that occurred in West Africa during 2014/2016. The epidemic has been mainly in the North Kivu and Ituri provinces in the North-Eastern part of the country where a multinational team of medics have been trying to combat the spread of the virus.

More than 1000 Ebola cases were reported in the first eight months of the epidemic but between April and June this year, the number had doubled to 2000. According to Medicine San Frontiers, the number of new cases are still being reported at an average rate of 50 per week, although it is a significant drop from the initial rate of 100 cases per week.

DRC is also known as the country where HIV/AIDS virus originated from after it was transmitted to human beings from chimpanzees. Research published in Science, notes that the capital Kinshasa was the epicentre of the virus that later went pandemic. With time, the number of infections grew and the virus spread across the vast Congo Basin, and to other continents. Researchers mainly blame Congo’s rapidly expanding colonial transportation for playing a great role in the spread of the virus.

So why is the DRC  so susceptible to major outbreaks of diseases?

It is as a result of many years of war that led to mass poverty and a dysfunctional healthcare system. DR Congo is a failed state which means that it cannot address these problems by providing basic human services such as access to clean water, good houses, security and medical care which are key in preventing outbreak and the spread of diseases.

For example, the UN estimates that 51 million or three-quarters of the DRC’s population have no access to clean safe drinking water despite the country holding half of Africa’s water reserves. And according to UNICEF, 70 million residents do not have access to improved toilets, latrines or sewerages.  This may explain why there are repeated outbreaks of water-borne diseases such as cholera.

DRC’s budget is only $6 billion and only 1.2% of it is allocated to healthcare by the government. That is a drop in the ocean considering that it has a population of 85 million whose average life expectancy is estimated to be around 35 to 45 years. Before the civil war, the country had a stable economy and was known all over Africa for its extensive network of clinics, quality of physicians, and excellent primary health care system.

However, the political and economic turmoil of the last 30 years has impacted negatively on this system. Medical facilities don’t have enough workforce and equipment, and often run out of critical medicine and supplies. It is estimated that almost 70 per cent of DRC citizens have little or no access to health care.

Hygienic and sanitary conditions of medical facilities are deplorable and do not meet the standards set by WHO. A report published in the Journal of Nursing and Palliative Care Services states that “The presence of filthy conditions observed in some hospitals and national health centres is a delicate issue” and that some hospitals that cannot afford to hire professional cleaners have resorted to using mentally ill men to collect garbage and to clean public toilets and morgues .

Furthermore, some hospital buildings are dilapidated and in an utter state of neglect. In some instances, patients are forced to sleep on the floor because of the lack of mattresses and beds. Most hospitals depend on the electric energy supplied by the national electricity company to carry out key medical procedures such as surgeries. But frequent power outages have left many of them unable to offer diagnoses and treatments. Reports reveal that some childbirth and surgical procedures are executed with the spotlight because of frequent power blackouts.

The country’s infrastructure such as road systems, transportation services and telecommunication are also in a poor state after decades of civil war. Poor roads have made it difficult for those in emergencies to access medical facilities and for medical personnel to reach out to those in need of medical services. Statistics indicate that over 70% of deaths are reported before patients reach hospitals.

Although the richest country in Africa in terms of natural resources, DRC remains one of the poorest countries in the world with most of its population surviving on a wage of under one dollar per day. In 2015 it was ranked as the poorest country in the world by the Global Finance Magazine based on its GDP Per Capita over the year 2009-2013. This means that the government cannot afford to run a national health insurance scheme to insure the population against costs of healthcare.

Therefore those who require medical treatment have to pay from their own pockets. In a country where only 20% are in employment earning an average of $394.25 a year, those who cannot afford hospital fees have resorted to unconventional methods of treatment whenever they fall sick. But even those who manage to go to hospitals are charged high fees and are forced to buy their products such as syringes and gloves before they are treated.

Another factor playing a great role in the spread and outbreak of diseases is the country’s extensive forest cover. The swathes of forests are home to different species of animals such as baboons, gorillas, chimpanzees and bats that are known to harbour deadly viruses. Because of human activities, people living in areas near the forests do come in regular contact with infected animals, thus setting in motion the transmission cycle.

For instance, scientists believe that HIV viruses had crossed into humans early in the 20th century, as a result of people hunting and eating infected primates such as chimpanzees. “This happened not once but many times, putting into circulation in the local human population a host of different HIV viruses, including both the HIV-1 and HIV-2 types,” said Oliver Pybus, an evolutionary biologist and infectious disease specialist at the University of Oxford.

Apart from hunting and eating game meat, deforestation is another human activity that has put people into direct contact with infected wild animals.

The only solution out of these regular epidemics is finding peace and stability, strengthening the healthcare system, and the reduction of human activities such as deforestation and hunting that put human beings in direct contact with infected wild animals.