Report – Ebola in the DRC: The Perverse Effects of a Parallel Health System

The international humanitarian response to the tenth Ebola epidemic in the Democratic Republic of the Congo (DRC) had a deep impact on  social, political, and economic life in the east of the country. Today, the Congo Research Group (CRG) is releasing the first of a series of three reports on the outbreak and the humanitarian response. The report, titled “Ebola in the DRC: The Perverse Effects of a Parallel Health System” shows how, instead of helping the dilapidated Congolese health system cope with Ebola, the Responsea coalition of the Congolese government and international partnersdeveloped a massive parallel health system through which Ebola was managed in North Kivu.

Although it was temporary, the parallel health system set up by the Ebola Response in North Kivu contributed to undermining efforts to stem the spread of the virus. The Response concealed certain nuances about the virus during public awareness campaigns, excluded community health workers during contact tracing, and delayed implementing protocols for “dignified and safe burials.” It also began vaccinations with an opaque consent process before reversing course.

The Response thus operated as a structure external to the local community. It did not systematically solicit the local community’s opinion, since “getting to zero (cases)” was its primary objective, rather than the well-being of a population that has been plagued by other forms of violence, particularly due to armed conflict, for more than two decades.

In particular, the report reveals how the strategy put in place by the Response tried to bypass the Congolese health system at all costs. It set up infrastructure and put in place practices not directly linked to existing health structures. A triage system was introduced into all the health structures in the region; active surveillance teams, composed of non-medical staff, were imposed on local health structures; transit centers and Ebola treatment centers (ETCs) were created. Thus, while the Response saved lives, it also generated fear and mistrust, building on a racist history of negating African systems of knowledge and practice that considered the Congolese health system as fundamentally incapable of fighting Ebola. In order to better control epidemics in the DRC today and tomorrow, it will be essential to rebuild the Congolese health system.

This report, which principally covers the six health zones of North Kivu that registered more than 100 cases of Ebola (Beni, Butembo, Katwa, Vuhovi, Kalunguta, and Mabalako), is the result of a survey on the impact of Ebola and the Response on the local community, conducted among more than 3,630 households between January and March 2020. Our field researchers also reviewed retrospective hospital data from 56 health facilities and six health zones in the region, examined more than 200 documents (presentations, publications, and reports) from the Response, and reviewed practices initiated by Congolese people themselves to treat Ebola outside the official health system.

For more information, read the report “Ebola in the DRC: The Perverse Effects of a Parallel Health System