Since August 2018, an outbreak of Ebola has been spreading in the provinces of Ituri and North Kivu, north-eastern Democratic Republic of the Congo. Amid mounting insecurity the number of infections has expanded rapidly since the beginning of the year. The outbreak is looking increasingly likely to have global implications. A2 Global assesses the impact on travel and tourism.
- The marked increase in the number of Ebola infections in north-eastern Democratic Republic of the Congo (DRC) since March is cause for international alarm. While it took nearly seven months for the outbreak to reach 1,000 cases, it took less than two months for this number to double.
- The exponential growth is due to rising insecurity and lack of public awareness about the disease. These factors are hampering efforts to control the outbreak.
- This situation looks very likely to become a public health emergency of international concern, potentially graver than the Ebola outbreak in West Africa in 2014.
- This has serious implications for business operations and travel in this immediate region and potentially beyond Africa.
- The current Ebola outbreak was first confirmed in the north-eastern province of North Kivu in August 2018. It quickly spread to neighbouring Ituri province. In early June, the total number of cases (confirmed and suspected) surpassed 2,000, of whom over 67 per cent have died.
- While the epidemic appeared to have been largely contained in the first four months, the rate of infection has increased rapidly since the beginning of the year. While it took nearly seven months to exceed 1,000 cases, the number of infected people has more than doubled since the end of March.
- It now looks increasingly likely that Ebola will spread across the border into Uganda, and other countries in the region, such as Burundi, Rwanda, and the more distant Kenya, and become a public health emergency of international concern (PHEIC). According to the World Health Organization (WHO), a global PHEIC ‘implies a situation that: is serious, unusual or unexpected; carries implications for public health beyond the affected state’s national border; and may require immediate international action.
- The main factor for this growth has been mounting insecurity. Since the outbreak began, there have been scores of armed attacks targeting health workers and the treatment and screening centres where they work. The Safeguarding Health in Conflict Coalition, an alliance of non-governmental organisations and health-promoting organisations, recorded 28 such attacks in 2018 alone.
- According to WHO figures, 85 health workers were killed and 42 health facilities targeted between January and the end of April 2019. There have also been incidents of violent protest and looting at healthcare centres. This marks a clear escalation of insecurity.
- In response, aid organisations have had to close units. Both Médecins sans frontiers (MSF), a French humanitarian NGO, and the WHO have repeatedly suspended operations after armed attacks. This has disrupted screening efforts, allowing the virus to spread.
- Compounding the risk of contagion is poor risk awareness and sensitisation among local communities, as well as communities’ mistrust of foreign intervention.
IMPACT ON TRAVEL AND LOGISTICS
- Between 2014 and 2016, an outbreak of Ebola in the Mano River region of West Africa – which includes Guinea, Liberia, and Sierra Leone – killed 11,310 of the 15,261 people confirmed with the infection.
- The WHO’s decision to classify that outbreak as a PHEIC had serious implications not only for local economies, but also for African economies far from the outbreak.
Major international airlines suspended all flights to affected countries, and neighbouring states closed their borders. Mandatory health checks, including temperature checks, were put in place at airports around the world.
- According to the World Travel and Tourism Council (WTTC), arrivals in Sierra Leone 35 months after the outbreak was confirmed were at 50 per cent of pre-outbreak arrivals. The country is estimated to have lost USD67 million in direct travel and tourism-related GDP.
- The WTTC also estimates that the rest of West Africa (excluding Nigeria) saw a drop in arrivals by 7.7 per cent. Kenya, which is located thousands of kilometres away, saw arrivals drop by nearly 15 per cent in 2014 – although the widespread violence that followed the 2013 general elections there was likely also a factor.
- A 2015 survey by the United Nations Economic Commission for Africa indicated that safari tour operators had seen a drop of 20-70 per cent in bookings since that Ebola outbreak.
FORECAST & RECOMMENDATIONS
- Mandatory screening is already in place at Entebbe International Airport (EBB), which serves Uganda’s capital Kampala. Should the outbreak become a PHEIC, such checks are likely to be implemented at other regional airports, but potentially also at global air hubs. These include Istanbul Airport, Dubai International Airport, Addis Ababa, Nairobi, and Casablanca. Other global airports including in London, Madrid, and Paris could also be affected.
- Travellers exhibiting Ebola symptoms, which include severe headaches, muscle pain, vomiting, and diarrhoea, are likely to be quarantined until cleared by health authorities. Even those who are not showing symptoms but may have travelled to Ebola areas could be quarantined. These periods could last several weeks.
- Border closures are also probable, although they will likely be harder to enforce, as many borders in the Great Lakes sub-region are extremely porous, including those of Burundi, Central African Republic, and South Sudan.
- Humanitarian workers in eastern DRC and neighbouring countries should receive training on how to identify cases of Ebola, and how to mitigate the risk of infection. After training, routine checks on lessons learned should be carried out to avoid complacency.