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Ebola Virus Disease (EVD) - Regional Emergency Health Response Plan 2020-2022

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IOM Vision

The current Ebola outbreak in the Democratic Republic of the Congo (DRC) has been declared a public health emergency of international concern (PHEIC) under the International Health Regulations (IHR, 2005), whereby a PHEIC 'represents an extraordinary event that poses a public health risk to other countries through international spread'. In the context of the IHR 2005 and Global Health Security Agenda (GHSA), IOM – the United Nations Migration Agency – is working to prevent, detect and respond to the ongoing 2018 Ebola Virus Disease (EVD) outbreak from a human mobility-centred perspective.

IOM’s Health, Border and Mobility Management (HBMM) framework aims to empower governments and communities to prevent, detect and respond to potential health threats along the mobility continuum (at points of origin, transit, destination and return). Therefore, in line with priorities outlined in the regional Strategic Response Plan 4 (SRP4), the HBMM, GHSA, IHR 2005 and national roadmaps and preparedness plans, IOM seeks to contribute to containing the epidemic by prioritising disease surveillance and prevention, by responding to current regional needs to enhance screening and active surveillance efforts and capacity, whilst also providing direct service provision, health screening and risk communication at points of entry and points of control (POE/POC) to save lives and halt the spread of the virus. IOM aligns its priorities with Sustainable Development Goal (SDG) 3d, namely strengthening the capacity of all countries, for early warning, risk reduction and management of national and global health risks. IOM facilitates this through enhancing the overall capacity of countries to prevent, coordinate, and manage infectious disease outbreaks, continually assessing and accounting for priorities within the humanitarian-development-peace nexus, fostering overall health system strengthening and contributing to achieving universal health care (UHC) through enhancing capacity at POCs/POEs in the DRC and Priority 1 border countries, whilst also planning for transition and recovery activities.

Context Analysis

The situation within the Democratic Republic of the Congo is one of the most complex and protracted crises and humanitarian situations in the world and has been further impacted by the most recent EVD outbreak that began in August 2018. This outbreak is the second-largest and deadliest in history, adding to an already enormous humanitarian situation. As of 7 January 2020, a total of 3,392 EVD cases have been reported, including 3,274 confirmed and 118 probable cases (case fatality ratio 66%). According to the Ministry of Health (MoH)/World Health Organization (WHO), the number of deaths rose to 2,235 since 1 August 2018, when the outbreak was officially declared. Due to the security situation in the country, cases have recently spiked, where week 50 in 2019 saw 22 new cases, a sharp increase from the preceding week 7. The uptick in new cases was predicted by the WHO following the attacks on Ebola treatment centres at the end of 2019 and consequent interruptions of treatment, serving to further emphasise the ongoing fragility of the situation.

More than half of all cases have been female (56%) and children under 18 years of age constitute close to a third of all cases. The WHO has assessed the risk of the current DRC EVD outbreak at national and regional levels as very high as a result of the transportation and trade links between the affected areas, the rest of the country and neighbouring countries, internal displacement and the movement of refugees from DRC to neighbouring countries. Uganda declared an outbreak from June-August 2019 due to cases coming across the border from the DRC. While there are signs the number of cases is slowly reducing, the outbreak remains a critical global, regional and national public health concern, and entering into 2020, it still remains unclear when it will end. The DRC EVD outbreak has been characterised by continuous shifts in disease hot-spots and their locations, challenges in contact identification, and recurring security incidents that impact response activities - which are further compounded by a lack of resources.

Looking at 2020 and beyond, population movement, both within the DRC and across borders to the neighbouring countries, continue to increase the risk of disease spread. Significant additional resources are required in the years ahead to facilitate both the ongoing response and preparedness efforts, namely through strengthening the International Health Regulations' (IHR 2005) core capacities, specifically the reinforcing of public health surveillance at points of entry and control (POE/POC). Focusing on improving the quality of health screenings, the responsiveness to epidemiological trends, on improving cross border surveillance, and in supporting contact tracing to implement surveillance activities that aim at reducing disease transmission within the country and across the borders, will assist in the fight to end the latest EVD epidemic. This will also aid in preparing for and mitigating the threat of future epidemics due to enhanced capacity and health system strengthening at the national level, and in the neighbouring border countries, whilst working in synergy with key partners. Target beneficiary figures are an estimate of total direct beneficiaries, that is, an aggregate of the two DRC Ebola-affected province populations, in addition to the populations of South Sudan, Burundi, Uganda, Rwanda and Tanzania.