H5N1

DRC Ebola: Armed attacks are the source of the increase in cases of the disease (Muyembe)

Via Actualite.cd: DRC Ebola: Armed attacks are the source of the increase in cases of the disease (Muyembe). The Google translation:

Recent armed attacks have caused an increase in cases of Ebola virus disease in the DRC. From November 29 to December 11, 2019, 34 cases were recorded. The supplies, for example, in the Biena health zone in North Kivu have been weakened. This area, which remained 85 days without cases of the disease, recorded a case on December 11, 2019 from the Aloya health area. These figures were given, this Saturday, December 14, by Dr. Jean Jacques Muyembe Ntamfum, technical secretary of the multisectoral committee of the response, in Kinshasa.

“It should be noted that after each armed attack, the necessary response activities to break the chain of transmission are interrupted, paralyzed or are idle for an indefinite period. Therefore, an increase in cases is observed for a few days after each attack," he said. 

He also announced the resumption of response activities, including vaccination at Biakato Mines where, as of December 11, 2019, 12 people have been vaccinated, including 8 high-risk contacts and 4 contact contacts. 

“There has been a slight improvement in the security situation in these areas. Threats to the response remain high, but there has been a reduction in incidents of community violence. The teams have resumed activities, despite the unstable and unpredictable security situation in the Biakato and Aloya districts and soon in Lwemba, which until then has been inaccessible to the response teams," he explained.  

Since the start of the epidemic, 239 health areas in 29 health zones across the provinces of North Kivu, South Kivu and Ituri have recorded at least one case of Ebola, he added.

DRC Ebola: CMRE update, December 12

CMRE has published Situation épidémiologique du 12 décembre 2019. It's pretty discouraging: no discussion of the 10 cases reported as a cluster yesterday, and a new case appearing out of nowhere in an Ebola-free area. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH AND SOUTH KIVU AND ITURI AT 11 DECEMBER 2019   

Thursday, December 12, 2019   

Since the beginning of the epidemic, the cumulative number of cases is 3,343, of which 3,225 are confirmed and 118 are probable. In total, there were 2,210 deaths (2092 confirmed and 118 probable) and 1088 people healed. 

• 432 suspected cases under investigation; 

• 3 new confirmed cases in North Kivu Mabalako and Biena; 

• No new deaths among confirmed cases;

• No one is cured out of ETC;  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 164 (5% of all confirmed / probable cases), including 41 deaths; 

• After 85 days without a case, the Biena health zone in North Kivu province again reported a confirmed case. The last case was notified on September 16, 2019.

The data presented in this table are subject to change after extensive investigation and after redistribution of cases and deaths in their respective health areas.

NEWS  

New Ebola case confirmed and reported to Biena after 85 days of silence   

• The Biena health zone in North Kivu province reported a new confirmed case #Ebola after 85 days without a case report since 16 September 2019;  

• This is a 28-year-old man, alive, unvaccinated and not listed as a contact in the Mandelya Health Area;  

• The date of onset of signs dates back to December 07, 2019 with exposure date from November 20 to December 03, 2019, by headache and musculo-articular pain;  

• This man arrived at Mandelya village on December 09, 2019 and went to the Health Center named after this village on December 10, 2019 following abdominal pain and melena (a symptom characterized by the evacuation through the anus of black blood, pasty and foul-smelling, with or without faeces. Stool is often referred to as tarry and can be seen by the patient or the doctor during digital rectal examination); 

• The alert was launched on December 11 by this health center and the patient was referred to the Mangina #Ebola Treatment Center after validation as a suspected case. It was confirmed #MVE case the same day;  

• This patient has reportedly been visiting the Afya Bora traditional center in the Mabalako Health Zone in North Kivu from 29 November to 06 December 2019, from which several confirmed cases have recently been released. 

VACCINATION  

• 1710 people were vaccinated with the 2nd Ad26.ZEBOV / MVA-BN-Filo vaccine (Johnson & Johnson) in the two Health Zones of Karisimbi in Goma; 

• Start of geographical vaccination in the Biakato Mines Health Area in Mandima, Ituri province, with 12 vaccinated people, including 8 high-risk contacts and 4 contact contacts;  

• Continuation of belt vaccination in Aloya health area in Mabalako, North Kivu province; 

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine, 256,899 people have been vaccinated; 

• Approved October 22, 2019 by the Ethics Committee of the School of Public Health of the University of Kinshasa and October 23, 2019 by the National Ethics Committee, the second vaccine, called Ad26.ZEBOV / MVA-BN -Filo, is produced by Janssen Pharmaceuticals for Johnson & Johnson; 

• This new vaccine complements the first, the rVSV-ZEBOV, vaccine used until then (since August 08, 2018) in this outbreak, manufactured by the pharmaceutical group Merck, after approval of the Ethics Committee on May 20, 2018. He was recently pre-qualified for certification. 

MONITORING AT ENTRY POINTS  

• Health control activities are disrupted in the Biakato Sub-Coordinations in Ituri; 

• Since the beginning of the epidemic, the total number of travelers checked (temperature measurement ) at the sanitary control points is 125,336,170 ;  

• To date, a total of 109 entry points (PoE) and sanitary control points (PoCs) have been set up in the provinces of North Kivu and Ituri to protect the country's major cities and prevent the spread of the epidemic in neighboring countries

DRC Ebola: CMRE update, December 11

CMRE has published Situation épidémiologique du 11 décembre 2019. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AT DECEMBER 10,  2019   

Wednesday, December 11, 2019 

Since the beginning of the epidemic, the cumulative number of cases is 3,340, of which 3,222 confirmed and 118 probable. In total, there were 2,210 deaths (2092 confirmed and 118 probable) and 1088 people healed. 

• 441 suspected cases under investigation; 

• 10 new confirmed cases in North Kivu Mabalako, all from the Aloya Health Area; 

• No new deaths among confirmed cases; 

• 1 person healed out of CTE in Ituri in Biakato; 

• No health workers are among the newly confirmed cases. The cumulative number of confirmed / probable cases among health workers is 164 (5% of all confirmed / probable cases), including 41 deaths; 

• Ebola response activities are paralyzed in Beni, Mangina and Biakato sub-coordination for security reasons;

 

The data presented in this table are subject to change after extensive investigation and after redistribution of cases and deaths in their respective health areas.

NEWS  

The Technical Secretary of the Multisectoral Ebola Epidemic Response Committee at the bedside of the Biakato wounded in Goma   

-   The Technical Secretary of the Multisectoral Committee for the Ebola Virus Disease Response (CMRE), Prof. Jean-Jacques Muyembe Ntamfum visited this Wednesday, December 11, 2019 at the bedside injured Biakato placed in a health center in Goma in North Kivu province; 

-   This is the second time since he arrived in Goma that the technical secretary went to visit these survivors of the attacks of the night from 27 to 28 November 2019 in Biakato in the province of Ituri, in order to follow their evolution health. He was accompanied by the general coordinator of the epidemic response to the Ebola Virus Disease, Prof. Steve Ahuka Mundeke and his two communications officers; 

-   A total of seven wounded have been hospitalized in this center since December 28, 2019, five of whom left the hospital on Wednesday, December 11, 2019; 

-   The technical secretary of the CMRE comforted and encouraged these seven wounded who later reiterated their desire to resume their work in the coming days to fight against Ebola Virus Disease;

-   " We thank Prof. Muyembe and all the staff of this hospital for the treatment and hospitality they have given us.We have not missed anything. Very soon we will resume our common fight against Ebola. to continue to save our brothers who are victims of this disease, "said the wounded, as one man; 

-  Prof. Muyembe did not fail to thank the medical director and all the staff of this health center for this hospitality shown towards the teams of the response; 

-   Among these agents there are two drivers and a communicator. 

VACCINATION  

- 1532 people were vaccinated with the 2 nd Ad26.ZEBOV / MVA-BN-Filo vaccine (Johnson & Johnson) in the two Health Zones of Karisimbi in Goma; 

-  Preparation of the geographical vaccination with the teams of premises in the Biakato Mines and Lwemba health areas in Mabalako; 

-  Continuation of ring vaccination activities around the confirmed ones from 08 to 09 December 2019 in the Aloya Health Zone in Mabalako, North Kivu. 53 people were vaccinated. 

-  Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine, 256,751 people have been vaccinated; 

-  Approved October 22, 2019 by the Ethics Committee of the School of Public Health of the University of Kinshasa and October 23, 2019 by the National Ethics Committee, the second vaccine, called Ad26.ZEBOV / MVA-BN- Filo, is produced by Janssen Pharmaceuticals for Johnson & Johnson; 

-   This new vaccine comes in addition to the first, the rVSV-ZEBOV, vaccine used until then (since August 08, 2018) in this epidemic manufactured by the pharmaceutical group Merck, after approval of the Ethics Committee on May 20, 2018. It has recently been pre-qualified for registration. 

MONITORING AT ENTRY POINTS  

-  Sanitary control activities have been resumed in the different points of entry and control of the Beni and Mangina sub-coordinations in North Kivu; 

-  Sanitary control activities are disrupted in the Biakato sub-coordination in Ituri; 

-  Since the beginning of the epidemic, the cumulative number of checked travelers (taking temperature) at the sanitary control points is 124,980,269 ; 

-  To date, a total of 109 entry points (PoE) and sanitary control points (PoC) have been set up in the provinces of North Kivu and Ituri to protect the country's major cities and prevent the spread of the epidemic in neighboring countries.

DRC Ebola: 10 new cases on December 10, 16 this week, 3,340 total

The MoH/WHO AFRO Ebola DRC KIVU 2018 Dashboard reports 10 new cases on December 10. As Helen Branswell notes in a tweet, this is clearly the result of the pause in the response effort because of local violence. That brings this week's cases to 16, 42 in the last 21 days, and 3,340 since the outbreak was declared. Out of 3,000 contacts, 600 are going untraced. 

Venezuela refugee crisis to become the largest and most underfunded in modern history

Via ReliefWeb, a report by the Brookings Institution: Venezuela refugee crisis to become the largest and most underfunded in modern history. Excerpt:

The Venezuelan refugee crisis is just about to surpass the scale of the Syrian crisis.  

As 2019 comes to a close, four years since the start of the Venezuelan humanitarian crisis, 4.6 million Venezuelans have fled the country, about 16 percent of the population. The figure is strikingly similar to the 4.8 million people that had fled Syria by 2015, four years into the massive forced displacement crisis there. 

As Figure 1 shows, the Venezuelan refugee crisis is one of the largest in modern history, and, if current trends continue, there could be as many as 6.5 million Venezuelans living outside of the country by 2020 (based on estimates from the U.N. Refugee Agency, UNHCR)—far outpacing the speed of displacement seen in Syria. In prior work, we show that the numbers could be significantly higher if the humanitarian crisis in Venezuela continues to worsen, reaching over 8 million.  

Unlike other refugee crises, the Venezuelan one is not the result of conventional war or conflict. But the conditions Venezuelans face daily are not much different than those in an active war zone. Since 2013 the Venezuelan economy has contracted by 65 percent, the largest contraction outside of war in 45 years. 

The only close comparators are countries in active conflict, such as Liberia, which lost 90 percent of its GDP during its bloody civil war. But the Venezuelan economic collapse, which preceded international sanctions, stands out because it was not triggered by external forces or internal unrest: It was manufactured by those in power, and thus, was totally avoidable. 

This has resulted in one of the worst humanitarian crises this hemisphere has ever seen. The U.N. Food and Agriculture Organization estimates that the undernourishment rate has quadrupled since 2012, and the U.N. estimates that 300,000 people’s lives are at risk due to limited access to medical treatment and lifesaving medications. 

In fact, Venezuela is quickly becoming a failed state, if it hasn’t become one already. Extended shortages of water and electricity have become the norm, and generalized violence—often carried out with the complicity of government security forces—makes the country one of the most violent in the world. 

Thus, those fleeing Venezuela are refugees and should be entitled to the protections that come with that status. So far, the bulk of the hosting responsibilities, and hence integration challenges, have fallen on regional neighbors. 

Yet, despite the massive scale of displacement and humanitarian need, host nations—the three largest being Colombia, Ecuador, and Peru—have received very little support from the international community compared with other historical displacement episodes. 

In response to the Syrian crisis, for example, the international community mobilized large capital inflows, spending a cumulative $7.4 billion on refugee response efforts in the first four years. Funding for the Venezuelan crisis has not kept pace; four years into the crisis, the international community has spent just $580 million. On a per capita basis, this translates into $1,500 per Syrian refugee and $125 per Venezuelan refugee.

DRC Ebola: CMRE update, December 8

CMRE has published Situation épidémiologique du 08 décembre 2019. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AT 07 DECEMBER  2019    

Sunday, December 08, 2019     

Since the beginning of the epidemic, the cumulative number of cases is 3,320, of which 3,202 are confirmed and 118 are probable. In total, there were 2,209 deaths (2091 confirmed and 118 probable) and 1084 people healed. 

• 391 suspected cases under investigation; 

• 4 suspected cases were notified on 05 December 2019 in the Osso health area in Lubutu, Maniema province. 1 case was invalidated. Among the 3 remaining suspects, the first samples of 2 suspects are negative and their clinical evolution is good. They are in agreement of the second levy. One suspect died and the oral sample was not taken and the body was secured and returned to the family. 

• 1 new confirmed cases in North Kivu in Mabalako; 

• No new deaths among confirmed cases; 

• No cured person has emerged from CTEs;  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 164 (5% of all confirmed / probable cases), including 41 deaths; 

• Ebola response activities are paralyzed in Beni, Mangina and Biakato sub-coordination for security reasons;

 

The data presented in this table are subject to change after extensive investigation and after redistribution of cases and deaths in their respective health areas.

NEWS  

Joint DRC-Rwanda launch of the second Johnson and Johnson vaccine in Rubavu, Rwanda 

• The official launch of the second Ebola vaccine took place on Sunday, 08 December 2019 in Rubavu, Rwanda, precisely on the border between the Democratic Republic of Congo and the Republic of Rwanda; 

• Launched jointly by the two countries as part of regional protection against Ebola Virus Disease, the International Health Regulations make cross-border relations one of its priorities;  

• WHO declared on July 17, 2019 in Geneva, this tenth outbreak of Ebola Virus Disease as a health emergency of international concern; 

• For the Technical Secretary of the CMRE, Prof. Jean-Jacques Muyembe Ntamfum, this joint launch will help strengthen regional and international health security in the immunization component; 

• The DRC has already started vaccinating its Majengo and Kahembe populations in the health zone of Karisimbi in the city of Goma and since November 14, 2019 more than 1300 people have been vaccinated; 

• The launch of the second J & J vaccine was made in front of the Deputy Governor of North Kivu Province accompanied by his provincial Minister of Health, the General Coordinator of the Epidemic Response to Ebola Virus Disease and various partners including a representative of the World Health Organization (WHO) and a representative of Johnson and Johnson; 

• For this launch in Rwanda, the first person to receive the second vaccine, is a Congolese, a collaborator of Prof. Muyembe, who welcomed this dose that protects him against the Ebola virus. To this end, he invited other persons from Rwanda and the Democratic Republic of the Congo to follow his example; 

• For the Rwandan Minister of Health, Dr. Diane Gashumba, it is very important to seize this opportunity during this time when the epidemic continues to make victims in the DRC to vaccinate their population in order to save them from possible epidemics. This vaccination, for Rwanda, is conducted by the Organization "Umurinzi", which means "the guardian"; 

• The J & J launch ceremony was closed with a press conference hosted by the Technical Secretary of the Multisectoral Ebola Virus Epidemic Committee and the Minister of Health of the Republic of Rwanda; 

• As soon as the Technical Secretary of the CMRE left Rwanda, he went directly to the health center, where are hospitalized the wounded returned from Biakato following the attacks by armed incivists on the night of 27 to 28 November 2019 ;  

• There are a total of 7, including 6 men and 1 woman, who have said they are ready to resume their life-saving work, especially saving lives, especially those who are sick with Ebola. 

VACCINATION  

• 1300 people were vaccinated, until 06 December 2019, with the 2nd Ad26.ZEBOV / MVA-BN-Filo vaccine (Johnson & Johnson) in the two health zones of Karisimbi in Goma; 

• Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine, 256,229 people have been vaccinated; 

• Approved October 22, 2019 by the Ethics Committee of the School of Public Health of the University of Kinshasa and October 23, 2019 by the National Ethics Committee, the second vaccine, called Ad26.ZEBOV / MVA-BN -Filo, is produced by Janssen Pharmaceuticals for Johnson & Johnson; 

• This new vaccine complements the first, the rVSV-ZEBOV, vaccine used until then (since August 08, 2018) in this epidemic manufactured by the pharmaceutical group Merck, after approval of the Ethics Committee on May 20, 2018. It has recently been pre-qualified for registration.

MONITORING AT ENTRY POINTS

• Sanitary control activities were resumed in the various entry and control points of the Beni and Mangina sub-coordinations in North Kivu;

• Health control activities are disrupted in the Biakato Sub-Coordinations in Ituri;

• Since the beginning of the epidemic, the total number of travelers checked (temperature increase) at the sanitary control points, until Wednesday 05 December 2019, is 123,984,301 ;

• To date, a total of 109 entry points (PoE) and sanitary control points (PoCs) have been set up in the provinces of North Kivu and Ituri to protect the country's major cities and prevent the spread of the epidemic in neighboring countries.

DRC Ebola: CMRE update, December 7

CMRE has published Situation épidémiologique du 07 décembre 2019. I've bolded some items of particular interest. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AT 06 DECEMBER  2019   

Saturday, December 07, 2019 

Since the beginning of the epidemic, the cumulative number of cases is 3,319, of which 3,201 are confirmed and 118 are probable. In total, there were 2,209 deaths (2091 confirmed and 118 probable) and 1084 people healed. 

• 439 suspected cases under investigation; 

• 4 suspected cases were notified on 05 December 2019 in the Osso health area in Lubutu, Maniema province. The first 2 samples analyzed in the Goma laboratory returned negative to the Ebola virus and 1 case was invalidated. The sample is still being sent to the Goma laboratory for the remaining 1 case; 

• 1 case of reinfection of Mabalako was not counted; 

• No new confirmed cases; 

• No new deaths among confirmed cases; 

• No cured person has emerged from CTEs;  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 164 (5% of all confirmed / probable cases), including 41 deaths; 

• Ebola response activities are paralyzed in Beni, Mangina and Biakato sub-coordination for security reasons;

 

The data presented in this table are subject to change after extensive investigation and after redistribution of cases and deaths in their respective health areas.

NEWS  

Arrival on Saturday of the Technical Secretary for Ebola Response to the Ebola Virus Disease in Goma, North Kivu  

• The Technical Secretary of the Multisectoral Committee on the Ebola Virus Epidemic Response, Prof. Jean-Jacques Muyembe Ntamfum, arrived in the afternoon of Saturday, December 07, 2019 in Goma in the province of North Kivu; 

• A mission as part of a supervisory visit to the response activities in the North Kivu provinces and the consolation and comfort of the response teams, victims of attacks on the night of 27-28 November. November 2019 in Biakato, Ituri, by unidentified gunmen, causing injury, death and loss of property in Ebola response sites; 

• In this context, it has exchanged with the various actors of the response to eventually put in place field strategies to end this tenth epidemic of # Ebola that has already lasted more than a year in the DRC. 

Exchange between the CMRE Technical Secretary and the United Nations Under-Secretary-General for Security  

• The Technical Secretary of the Multisectoral Committee for Ebola Virus Epidemic Response (CMRE), Prof. Jean-Jacques Muyembe Ntamfum, as soon as he arrived in Goma, North Kivu province, exchanged at a meeting with the Assistant Secretary-General for Safety and Security, Gilles Michaud; 

• The highlight of this meeting was the safety of sites, living quarters and field response teams in areas of high insecurity for the response; 

• The meeting was held at the general coordination of the response to Goma in front of various personalities, including the Congolese Armed Forces (FARDC), the Congolese National Police, MONUSCO and the UN Security in the DRC 

VACCINATION  

• 1300 people were vaccinated with the 2nd Ad26.ZEBOV / MVA-BN-Filo vaccine (Johnson & Johnson) in the two health zones of Karisimbi in Goma; • Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine, 256,100 people have been vaccinated; 

• Approved October 22, 2019 by the Ethics Committee of the School of Public Health of the University of Kinshasa and October 23, 2019 by the National Ethics Committee, the second vaccine, called Ad26.ZEBOV / MVA-BN -Filo, is produced by Janssen Pharmaceuticals for Johnson & Johnson; 

• This new vaccine complements the first, the rVSV-ZEBOV, vaccine used until then (since August 08, 2018) in this epidemic manufactured by the pharmaceutical group Merck, after approval of the Ethics Committee on May 20, 2018. It has recently been pre-qualified for registration. 

MONITORING AT ENTRY POINTS  

• Sanitary control activities were resumed in the various entry and control points of the Beni and Mangina sub-coordinations in North Kivu; 

• A lifeless body of a 44-year-old man was intercepted at Makeke Checkpoint, coming from Lwemba for Makeke, whose result came back positive.  

• Health control activities are disrupted in the Biakato Sub-Coordinations in Ituri; 

• Since the beginning of the epidemic, the total number of travelers checked (temperature measurement ) at the sanitary control points, until Wednesday 05 December 2019, is 123,641,729 ;  

• To date, a total of 109 entry points (PoE) and sanitary control points (PoCs) have been set up in the provinces of North Kivu and Ituri to protect the country's major cities and prevent the spread of the epidemic in neighboring countries.

MSF withdraws staff as security in Ebola-affected Biakato deteriorates

A statement from MSF.org: MSF withdraws staff as security in Ebola-affected Biakato deteriorates.

On 4 December 2019, Medecins Sans Frontières (MSF) took the painful decision to temporarily withdraw our staff from the Biakato region of Ituri province, Democratic Republic of Congo. After months of working extremely closely with the community to address the health needs in the region, MSF is saddened to have made this decision.  

In the early morning of 3 December, a group of people armed with sticks and machetes entered Biakato health centre. They didn’t reach the Ebola Treatment Centre which is located within the health centre, and no one was injured.  

During the same night, a group of people also armed with sticks and machetes attempted to enter the MSF compound in Biakato Mines. Rocks were thrown at the compound for a brief period, but no one was injured.  

These events follow the deadly attack against Ebola responders in Biakato during the night of 27/28 November. In the days after the attack, MSF remained in the area to provide medical care in local health centres, as well as in the Biakato Mines Ebola Treatment Centre, in collaboration with the Ministry of Health. As many Ebola responders and organisations had evacuated the area, and access to healthcare was extremely limited for people, the situation became challenging over a couple of days. 

MSF has been providing healthcare in the Biakato region since 2016. During the current Ebola outbreak, we have worked closely with the Biakato community to identify and help respond to the Ebola and non-Ebola health priorities in the region, including the rehabilitation of wells and the construction of a paediatric ward.  

In support to the Ministry of Health, we have also provided access to free primary healthcare and inpatient paediatric care. In November 2019, still in cooperation with the Ministry of Health, MSF built and managed an Ebola Treatment Centre in Biakato. 

MSF cannot work if the security of our staff and patients is not ensured. It is not clear yet who was responsible for the attempted intrusion on the compound or into the health centre, nor are the motivations behind those actions clear.  

As we are not currently able to guarantee that the necessary security conditions to work have been met, MSF decided to temporarily withdraw our staff from the Biakato region. The decision to leave this community, with whom we have worked very closely over the past few years, was extremely hard to take. 

Prior to departure, we ensured that the necessary materials were given to the Ministry of Health, to enable them to continue the activities we had been undertaking in collaboration, to ensure the community continues to have access to the medical care they need. MSF will re-assess the situation and we hope to be able to return to Biakato soon.

Ebola doctor in DR Congo says 'There is no good security plan'

Via NPR's Goats and Soda blog: Ebola Doctor In Congo Says 'There Is No Good Security Plan'. Click or tap through for the full interview.

Dr. Marie-Roseline Bélizaire had just gathered the members of her Ebola response team for a morning meeting when they heard the rat-a-tat of gunfire. 

"It was just in front of our door – very close," she recalls. "We all got on the floor to protect ourselves." They lay there for the next 20 minutes, listening as police fired into the surrounding jungle to drive off a group of armed men who had been spotted trying to make their way toward the compound – an encampment of tents and low-rise buildings near the town of Mangina that serves as living quarters for the team.  

The Nov. 28 attack was merely the latest in a series of violent incidents that Bélizaire, who is originally from Haiti and is 40 years old, has survived while working as a field coordinator for the World Health Organization over this 16-month long outbreak. Indeed, Bélizaire had called that morning meeting to plan next steps in the wake of two even more serious attacks hours earlier: The first was an hour-long, midnight assault by gunmen on her team's offices a mile away. The second was more devastating: Four Congolese Ebola responders were killed in a nearly simultaneous attack on the living quarters of another team located a 2-hour drive away.

In total this year, WHO has documented about 390 attacks on health facilities involved with the Ebola response, with 11 Ebola responders killed and more than 80 injured. Globally, according to a United Nations report released this week, so far in 2019 there have been 825 attacks on health-care workers and their facilities, resulting in 171 deaths.  

That makes this Ebola episode the most violent on record. NPR reached Bélizaire by phone to find out what it's like to be – quite literally — on the front lines.

Hong Kong: Counting the health cost

An editorial in The Lancet: Hong Kong: counting the health cost. And Hong Kong isn't the only city dealing with such issues.

Civil unrest in Hong Kong, stemming from the introduction of a controversial extradition bill, has been marked by fierce conflict between protestors and law enforcement, along with extensive use of weapons, including tear gas and water cannons. As the unrest continues, the effects of ongoing violence on the health of the population of Hong Kong should be urgently examined. 

Violent clashes with police have resulted in a wave of physical injuries. Some injured police have alleged bias and poor treatment from public hospitals. Among the civilian population, doctors are concerned about the number of head injuries from batons and rubber bullets. In The Lancet, Darren Mann has described the fear of being arrested while receiving first aid. A World Report this week describes growing tensions between doctors and police, including in hospitals. The combination of violence and the breakdown of trust in the public medical-care service has led to a surge in undocumented and untreated injuries, particularly in Hong Kong's youth. 

Concerns are also growing about exposure to chemical hazards in Hong Kong's densely populated urban landscape. Tear gas, a chemical weapon with respiratory and ophthalmic effects, has been used extensively, and is reported to have seeped into public and residential buildings, including at least one hospital. Potentially toxic by-products from petrol bombs or burning tyres and unknown irritants in water cannons have unknown health effects. Without understanding a weapon's composition or the risks, doctors are unsure how to manage exposure or whether to recommend any public health measures. 

Exposure of the population to violence on this scale is also likely to have mental health effects. The harms from the conflict could do long-term damage to the health of the people of Hong Kong, and stoke further unrest. A systematic, transparent, and robust documentation of the health impacts of these events is necessary not only to calculate and manage the currently unknown health effects, but also to rebuild trust.