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Updated July 22, 2019
Ebola Outbreak: Democratic Republic of Congo
Through annual appropriations, Congress provides funds to
Organization Stabilization Mission in the Democratic
control infectious disease threats, including those with
Republic of Congo (MONUSCO).
pandemic potential like Ebola. In FY2019, Congress
provided $100 million to the U.S. Agency for International
As of July 20, 2019, WHO reported 2,578 Ebola cases,
Development (USAID) and $108.2 million to the U.S.
including 1,737 deaths. Concerns about the outbreak
Centers for Disease Control and Prevention (CDC) to
spreading to neighboring countries without experience in
global health security and pandemic preparedness. The
Ebola control (Rwanda, Burundi, and South Sudan) are
Trump Administration’s FY2020 budget request included
heightening. Confirmed Ebola cases are being treated with
$90 million and $100 million for USAID and CDC global
experimental drugs in Ebola Treatment Centers (ETCs). As
health security programs, respectively. Congress also
of June 9, 2019, 564 people had been treated and
provided over $5 billion in emergency funds in FY2015 for
discharged from ETCs. As of July 15, 2019, more than
domestic and global efforts to contain the West Africa
161,000 people had been vaccinated, including more than
Ebola outbreak (P.L. 113-235). Some unspent funds are
31,000 health workers (HWs) and front-line workers
being used to fight the Ebola outbreaks in the Democratic
(FLWs) in the outbreak zone and over 8,000 HWs and
Republic of Congo (DRC).
FLWs in South Sudan, Uganda, and Rwanda. Plans are
underway to vaccinate HWs and FLWs in Burundi.
On August 1, 2018, the World Health Organization (WHO)
reported a new Ebola outbreak in eastern DRC, about a
International and U.S. Responses
week after declaring that a separate outbreak had ended in
DRC Government and Nationals. Underscoring the
western DRC. The ongoing Ebola outbreak—the 10th to be
Congolese role in the international Ebola response, Dr.
documented in DRC—is the largest in the country’s history
Michael Ryan, WHO Executive Director for Health
(Figure 1). It is occurring in North Kivu and Ituri provinces
Emergencies, stated at a June 6, 2019, press briefing that
where a protracted conflict has caused a long-running
“there may be non-governmental organization (NGO) or
humanitarian crisis. In addition to classic public health
WHO badges on the tents but the doctors and nurses are
responses (surveillance, contact tracing, isolation, and safe
Congolese; surveillance officers are Congolese; 80% of the
burials), health workers (HWs) are using an investigational
vaccinators in this response are Congolese.” The DRC
vaccine to prevent the spread of disease. Armed conflict
government response is led by the Ministry of Health
and intermittent community resistance to these efforts are
(MoH) and includes providing government personnel,
hindering all aspects of outbreak control.
hiring local first line workers, organizing volunteers, and
conducting information awareness campaigns. The
Figure 1. Ebola Virus Outbreaks in DRC: 1976-2019
government has also begun offering certain health services
free of charge in selected government health facilities.
U.N. Emergency Ebola Response Coordinator. On May
23, 2019, the U.N. Secretary-General appointed
MONUSCO Deputy Special Representative David Gressly,
a U.S. citizen, to serve as a new U.N. Emergency Ebola
Response Coordinator to strengthen coordination. While the
WHO will continue to lead all health operations and
technical support activities to the government, Gressly is
expected to lead a broader UN-wide effort to strengthen
political engagement, financial tracking, humanitarian
coordination, and preparedness and readiness planning for
the DRC and surrounding countries. Gressly will continue
to report to the head of MONUSCO and indicates his new
Source: CRS graphic, based on WHO data.
role reflects the need for “more than just a public health
response.”
In July 2019, the WHO announced the Ebola outbreak had
become a Public Health Emergency of International
World Health Organization. The WHO is coordinating
Concern (PHEIC) and called for donors to address delays in
international Ebola control efforts with some 700 personnel
funding. The declaration followed the identification of three
deployed to the DRC. The WHO has also conducted
Ebola cases in Uganda in June 2019 and another one in the
readiness assessments in neighboring countries. In February
capital of North Kivu, Goma in July 2019. Goma has over 1
2019, WHO called for $148 million to contain the outbreak
million people and is an operational hub for the U.N.
within six months. As of July 7, 2019, $109.3 million had
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Ebola Outbreak: Democratic Republic of Congo
been pledged. At a July 15 meeting on Ebola in Geneva,
than concern for locals’ well-being, appear to be fueling
WHO and other U.N. officials urged donors to provide
conspiracy theories and community resistance. WHO
additional support for Ebola control efforts. At the
Director-General Dr. Tedros Adhanom Ghabreyesusi said
conference, the United Kingdom pledged up to £50 million
that Congolese in the outbreak zone had asked him whether
($62 million) and Italy pledged €300,000 ($338,000).
international organizations were there to help the Congolese
or to prevent Ebola from spreading to their countries. Dr.
U.S. Responses. The United States is the top bilateral
Tedros expressed his embarrassment and urged donors to
humanitarian donor to DRC and the top financial
consider broader support for the Congo to counter this
contributor to MONUSCO. As of July 2, the United States
perception. DRC’s Health Minister also asserted that
had allocated more than $98 million to Ebola control in the
perceptions of the response bringing cash into the region
DRC. The Administration has placed strict constraints on
had fueled threats to health workers, including kidnappings.
U.S. personnel movement due to security threats. U.S.
Health System Constraints. Perceptions among some
personnel are providing technical support from Kinshasa,
Congolese that the infusion of Ebola resources are to
Goma, and neighboring Rwanda and Uganda, while
protect the donors rather than to help the people of the DRC
implementing partners (U.N. agencies and NGOs) are using
are also rooted in long-standing and ongoing health
U.S. resources for Ebola control activities.
challenges. Since January, for example, a measles outbreak
Selected Challenges
has killed almost 2,000 people in Ituri province. There has
been little press discussion of this or other health issues,
U.S. Aid Restrictions Related to Trafficking in Persons.
DRC is currently ranked as “Tier III” (worst) under the
such as high maternal and infant mortality, that have
regularly killed more people than the Ebola outbreak within
Trafficking Victims Protection Act (TVPA, P.L. 106-386,
the same time frame. Further contributing to local
as amended), which triggers prohibitions on certain U.S. aid
frustrations, resource constraints have demanded that health
absent a full or partial presidential waiver. President Trump
resources in some areas be diverted to Ebola control.
partially waived these restrictions for DRC for FY2018, but
not for FY2019. Thus, pursuant to the TVPA, no “non-
Public health care shortfalls have also hindered Ebola
humanitarian, non-trade-related” assistance could be
control efforts. The WHO has reported that Ebola
provided “to the government” of DRC. USAID’s IDA
transmission is likely occurring in ill-equipped and
account, the core source of funding for U.S. Ebola response
understaffed health facilities. Inconsistent adherence to
support to date, is exempt from the restriction.
infection prevention and control, periodic disruptions in
supply chain systems, and limited access to water for
Although the TVPA indicates that support to NGOs is to be
handwashing in some health facilities have complicated
generally excluded from restrictions, in practice, the
Ebola control efforts. In addition, some health workers have
Administration has applied the prohibition to various
refused to wear personal protective equipment in health
programs funded through the Development Assistance
facilities or perform rudimentary infection prevention and
(DA) and Economic Support Fund (ESF) accounts,
control measures due to threats of violence by some
including some implemented by NGOs. Two bills
members of the community. As of July 9, 2019, 132 health
introduced in the 116th Congress (S. 1340 and H.R. 3085)
workers had contracted Ebola, 34 of whom had died. The
would authorize the USAID Administrator to provide
assistance for Ebola control efforts, “notwithstanding any
MoH, WHO, and other partners have identified health
other provision of law.”
facilities of concern and are addressing lapses around
triage, case detection, and infection prevention and control.
Insecurity. Security threats have hampered response efforts
Outlook
by forcing temporary cessation of Ebola case management,
One year later, the Ebola outbreak in the DRC continues to
interrupting contact tracing, and frustrating surveillance
spread, with several new cases occurring outside known
efforts in high transmission areas. Dozens of armed groups
transmission chains. The 2015 Ebola emergency
are active in the areas most affected by the outbreak. Road
appropriations that are being used to fund U.S. Ebola
travel is often dangerous, with frequent reports of militia
control efforts are expected to be mostly expended by the
attacks, armed robbery, and kidnappings. State security
end of FY2019. The Trump Administration has requested
force personnel reportedly maintain ties with armed groups
$90 million under the USAID Global Health Programs
and have been implicated in abuses, including a series of
(GHP) account and sought $100 million through CDC for
civilian massacres in Beni since 2014.
global pandemic preparedness efforts in FY2020.
Communities in Beni and Butembo have long opposed
H.R. 2166, the Global Health Security Act of 2019, would
DRC’s central government and complained of neglect and
codify an Obama-era executive order setting out agency
persecution. WHO officials have urged broader
roles in promoting global health security. Also, H.R. 826
international support for political mediation, engagement
would seek to facilitate research and treatment of neglected
with opposition, and negotiated solutions, asserting that
tropical diseases, including Ebola. Members may continue
focusing exclusively on community engagement will not
to debate what role, if any, the United States should play to
address deep-seated political issues that need to be
bolster global health security and whether to adjust funding
addressed at a higher level.
levels to address infectious disease threats.
Ideas that outsiders are profiting from the outbreak and that
Tiaji Salaam-Blyther, Specialist in Global Health
international concern is driven more by fear of contagion
Alexis Arieff, Specialist in African Affairs
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Ebola Outbreak: Democratic Republic of Congo
IF11100
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