The challenges of the response

The most constant obstacle: it appears in almost every bulletin since the first one, on 14 May, which notes the need to manage community rumours. The form changes, the substance does not. Household resistance to decontamination in Rwampara from 23 May; reluctance to swabbing in June; a positive body taken away to the family cemetery of Misebere, in Katwa zone, on 10 August; a safe and dignified burial refused “for religious convenience” in Bunia and three isolated alerts escaping overnight in Poko on 18 August. On 3 September, Ituri still records 21 refusals of isolation at the treatment centre, and a Kalunguta team is assaulted in the Mataba area.

From 14 May, the first bulletin notes the lack of proper isolation; on 31 May, capacity is judged insufficient “despite the opening of Rwampara”. Ituri saturates at 103% on 18 June, North Kivu at 160% on 9 July; on 15 July the Bambu centre shows 316% occupancy. The extensions requested for Bambu and Nizi are still to be completed in mid-August and still running late on 3 September. On 3 September, North Kivu remains above 100% and more than half of its patients are treated in non-standard facilities. The treatment-centre curve above shows the same thing in figures.

From the very first bulletin, on 14 May, infection prevention and control supplies and sampling kits are short; on 27 May, the bulletins note a “supply failure of referral hospitals” in generic essential medicines. From mid-June to mid-July, samples wait at the North Kivu laboratory. On 22 July, protective equipment and chlorine are short, and 175 triage units work out of 1,170. From 18 to 22 August, between 19 and 77 patients in Ituri, depending on the day, have “no food support”. On 3 September, Tshopo has had no safe blood for six days and its technical platform remains insufficient for biochemistry and haematology.

What the response does not measure, it cannot correct, and the site cannot show. On 17 July, North Kivu does not report its beds, and the occupancy rate is computed on the 15 July beds, carried over. On 6 August, “reporting completeness” is named as an obstacle to decision-making. On 26 August it stands at 83% nationally, 55% in Haut-Uélé and South Kivu. On 3 September, South Kivu “did not report” its alerts at all. On this site those days stay empty: when the source does not say, the site does not say.

On 31 May, 43% of contacts are seen, against a 95% target. On 19 June, 69%. On 17 July the bulletin speaks of “sharp deterioration”: 61.5% in Ituri, 54% in Haut-Uélé. Since 6 August the displayed threshold has been 85%, and on 3 September the national rate exceeds it; but Bas-Uélé stays under 70%, “linked to insufficient dedicated teams”, the 3 September bulletin still says. A contact not seen is an exposed person who can fall ill without being expected.

Fires at treatment centres in Rwampara and Mongbwalu are reported from 24 May, an ADF incursion on 2 June. “Insecurity and limited access (CODECO, ADF)” recurs verbatim from mid-June to 4 August. From 17 July the bulletins report the Muchanga bridge attack against burial teams and activities paralysed in Nyankunde. In mid-August, they explain incomplete decontaminations by “insecurity in some villages” and untraceable addresses. On 3 September, the Avakubi control point remains non-functional “for security reasons”.

The bulletins report this violence from 24 May, with the burning of treatment centres in Rwampara and Mongbwalu; from 17 July: “insecurity targeting EDS teams”, an attack at the Muchanga bridge, work paralysed in Nyankunde, the same sentence for seventeen bulletins. Then the facts sharpen. Workers and police assaulted at the Mukulia control point, according to the bulletins of 10 and 11 August. On the 19th, a team escorted by the army in Mungamba and the homes of two community relays targeted by an attempted arson. On the 20th, two Red Cross vehicles vandalised near Isiro, an ambulance attacked in Pawa. On the 24th, a burial team member killed in a road accident in Bambu, two others assaulted in Rwampara. On the 26th, the murder of a community animation cell chairman in North Kivu. On 4 September, residents threaten to burn the treatment centre under construction in Katwa.

A body that is not swabbed is a death that enters no count, and a burial without precautions is a chain of transmission. The bulletins say so from 25 May, with resistance to carrying out safe burials in Mongbwalu and Rwampara, then, on 27 May, “reluctance to post-mortem swabbing”. From 17 July they report an attack at the Muchanga bridge targeting burial teams, with activities paralysed in Nyankunde. On 10 August, ten failures in Mangala and four in Komanda. On 3 September, nine bodies go unswabbed in Bambu, Fataki and Mandima, “due to resistance”.

Payment enters the difficulties on 12 July. On the 17th, the Bunia and Rwampara zones are on strike, and work resumes only after the military governor steps in; the same text is repeated until 4 August. On 5 August, the psychosocial pillar in Beni, North Kivu, announces its own. On 15 August the strike deprives six Haut-Uélé control points of any reporting; on the 19th, five workers out of eighteen are paid in North Kivu. On 3 September, four Ituri control points are “on strike for lack of payment”.

Entry and control points are meant to spot travelling patients. On 5 August, 9 of Haut-Uélé's 38 priority points are active, and 4 of Tshopo's 19, just as two new zones are reached along the Nia-Nia axis. On 14 August, 26% are activated in Haut-Uélé, “for lack of training, supervision and support”. From 13 August to 4 September, only one of Ituri's eleven strategic sites works without interruption; in Haut-Uélé, the Magambe control point records 209 refusals of screening (5%) on 3 September.