Photo: Why Ebola crisis in DRC is unlike anything before

It is the worst Ebola outbreak to have struck the Democratic Republic of Congo (DRC) - and the most complex one.

Since August, authorities in the country, together with a host of partners, have been trying to contain a new outbreak of the disease in the eastern North Kivu and Ituri provinces.

As of November 21, there have been 373 suspected cases of Ebola, including 347 confirmed cases. At least 217 people have already died.

There have been 10 outbreaks of Ebola since 1976 in the DRC, which is considered among the most experienced in dealing with the virus.

The situation this time, though, is different.

The North Kivu and Ituri provinces are among the most unstable and densely populated in the country, and subject to some of the highest levels of human mobility in it.

At the same time, there are warnings that a "perfect storm" of insecurity, community resistance about vaccinations and political manipulation threaten the efforts to contain the spread of the virus.
These factors collectively make the latest outbreak, unlike anything the DRC, which is scheduled to hold a crucial presidential election on December 23, has experienced before.

What is Ebola and how does it spread?

The Ebola Virus Disease (EVD) is introduced into the human population through close contact with the blood or other bodily fluids of infected animals. These include, but are not limited to, monkeys or fruit bats.

The virus is known to cause high fever, vomiting and diarrhoea, as well as internal and external bleeding; it puts the body into a state of shock and results in a decrease of the perfusion of blood to vital organs, ultimately inducing multi-system organ failure.

Once infected, patients have a very low chance of surviving.

When did the latest outbreak in the DRC begin?

In late July 2018, the provincial government of North Kivu reported 26 cases of acute haemorrhagic fever that had resulted in 20 deaths.

Six specimens of blood were sent to the Institut National de Recherche Biomedicale (INRB) in the capital, Kinshasa, where four samples tested positive for the Ebola virus.

"The result of the genetic analysis by INRB confirmed Ebola Zaire strain, but not linked to the Equateur outbreak strain, meaning that we are dealing with a new outbreak," Lianne Gutcher, a communications officer with the World Health Organization (WHO), told Al Jazeera.

The country's Ministry of Health officially declared an outbreak on August 1, 2018.
The centre of the outbreak is now Beni in North Kivu, though the medical charity Doctors Without Borders, also known by its French initials MSF, has warned that there is a possibility it could move to Butembo, a town close to neighbouring Uganda.

How does this outbreak compare with previous ones in the DRC?

Ebola is considered endemic in the DRC, with the first cases in 1976 appearing simultaneously in Yambuku - in the north of the country near the Ebola River, from which the disease takes its name - and Nzara, in what is now South Sudan.

While there is still no cure, the introduction of a vaccination programme earlier this year has been touted as the next step towards a more effective management of future outbreaks.
The DRC has been hit by two outbreaks this year.

The first one was declared in May after the deaths of 29 people in the city of Mbandaka in the Equateur province. Though there were concerns the town's proximity to the Congo River would see the virus moving to Kinshasa, the timely implementation of a vaccination drive saw the virus quickly contained.

That outbreak was announced over on July 24.

Both Uganda and the DRC have been able to prevent mammoth epidemics spreading as it did in West Africa between 2014 and 2016 that infected 28,000 people and caused 11,300 deaths. But given that the current outbreak in North Kivu is perhaps the first time the virus has spread into an area already home to a large-scale humanitarian crisis, containing the spread of Ebola this time around is proving to be a lot more difficult.

It is already the largest outbreak in the DRC and is on course to become the second largest Ebola outbreak ever.

"The difference is that we are now operating in a war zone," Axelle Ronsse, the emergency coordinator for MSF's Ebola response, told Al Jazeera, referring to the militia violence that has long plagued parts of the country's east.