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Friday, 22 March 2024
NOTE TO JOURNALISTS
Health situation in the Democratic Republic of the Congo (including mpox updates)
Dr Boureima Hama Sambo, WHO Representative to the Democratic Republic of the Congo and Dr Rosamund Lewis, WHO Technical Lead for Mpox updated the UN Geneva press corps at the biweekly Palais press briefing held earlier today, 22 March (access the recording [https://www.unognewsroom.org/story/en/2111/un-geneva-press-briefing-22-march-2024]).
In the Democratic Republic of the Congo (DRC), the overall health situation is worsening. The challenges faced by the people of DRC have reached alarming levels, exacerbated by a combination of violence (wars and intercommunal fighting), climate shocks and epidemics.
In many parts of the country, particularly in eastern DRC, civilians are tragically caught in renewed fighting, and hospitals are overwhelmed with injured people.
DRC is the second largest displacement crisis globally after Sudan, with more people forced to flee the violence since the start of the year. Close to 10 million people are on the move.
Poverty and hunger affect a quarter of the population or 25.4 million people. The spread of cholera and other infectious diseases poses significant threats to the population’s health. Combined with malnutrition, the diseases are increasing the risk of mortality, especially in children, and putting even more pressure on the health system.
Women and girls are paying the high price of armed conflict and displacement. 30,000 cases of gender-based violence were reported in DRC in 2023. These numbers are among the highest in the world?.
In addition to conflict-related challenges, severe flooding has recently ravaged communities, exacerbating the risk of diarrhoeal and water-borne diseases and compounding the strain on the already fragile health system.
The humanitarian needs are soaring, with women and children particularly vulnerable. Close to 20 million people require health assistance in 2024, yet the crisis, as the health response, remains severely underfunded.
On disease outbreaks:
DRC is facing its worst cholera outbreak since 2017, with 50,000 suspected cases and 470 deaths recorded in 2023. The risk is particularly high in internally displaced people (IDP) sites where living conditions are dire, with water supply, hygiene and sanitation services inadequate – conditions that favour the spread of cholera.
DRC is also battling the largest epidemic of measles recorded since 2019, with close to 28,000 cases with 750 deaths so far in 2024. The combination of measles and malnutrition has a severe health impact on children under 5 years of age and the lack of access to vaccines and vaccination services further exacerbates the situation.
Anthrax and plague have been also affecting the communities in Eastern DRC in the last months.
In addition, the still-emerging outbreak of mpox has been on the rise across the country over the last year. Close to 4,000 suspected cases and 271 deaths have been recorded so far in 2024, which represents a higher case fatality than what was seen during the global outbreak. Over two-thirds of the cases are reported in children. Young children are particularly at risk of death. There is the geographic expansion to previously unaffected provinces such that almost all provinces, including Kinshasa, are now reporting cases; this also represents a threat of expansion to neighbouring countries and beyond.
Since 2023, there is newly documented sexual transmission of mpox due to the more virulent clade I of the virus, with outbreaks among sex workers and among men who have sex with men. WHO is supporting the health authorities to respond to mpox hotspots in the country and to implement the national mpox response plan, including through integration and collaboration with the national HIV/AIDS control and immunization programmes.
Despite all these compounding challenges, WHO continues to support the government and the health partners in responding to this complex crisis. WHO scaled up its health response in eastern part of DRC since last year through:
Delivering supplies to prevent and respond to disease outbreaks and supporting patient management, including through the setup of treatment centers.
Vaccinating almost 5 million people against cholera in November 2023, in the most affected provinces, including North Kivu.
Strengthening routine immunization activities in eastern provinces
Supporting partners to provide health services to survivors of sexual and gender-based violence and scale up mental health and psychological support in North and South Kivu provinces.
WHO calls on all parties to ensure access to lifesaving health services to civilians and to protect health facilities. The world should not turn a blind eye to a situation that could have severe knock-on effects for security and health in the region.
Background information
Attacks on health care:
Attacks on health persist, impeding access to essential health services for those in need. Over 55 health facilities documented on the WHO SSA platform have been damaged or robbed since 2022.
Disease outbreaks:
Cholera: Already 9 465 suspected cases including 174 deaths (CFR 1.8%) have been reported this year.
Measles: 27 683 cases with 750 deaths (CFR 2.7%) recorded since the beginning of this year 2024. There were 311 500 cases/5 799 deaths (CFR 1.3%) in 2023.
Anthrax: DRC is facing reported cases of anthrax in the province of Nord Kivu, affecting 6 health zones. 76 suspected cases (1 confirmed) have been reported including 11 deaths from December 2023 to February 2024.
Plague: DRC is also battling plague in 2 health zones (Rethy and Logo) in the province of Ituri. Already 205 cases have been reported including 7 deaths (CFR 3.4%) since the beginning of this year.
Mpox outbreak in DRC:
There is a high number of reported cases in historically endemic areas for which over two thirds are reported in children with a high associated number of deaths due to mpox especially in infants and young children; The proportion of deaths among cases is rising.
Emergence of gene deletions that may affect the ability of countries to detect importations of the virus has been seen in some strains.
The geographic expansion (23/26 provinces, including Kinshasa) and accelerating transmission of the mpox outbreak in the DRC (clade I) represent a risk for the people of DRC, neighbouring countries in the sub-region and the world.
Cases are on the rise over the last year. 3941 suspected cases and 271 deaths (CFR 7%) recorded so far in 2024. This compares to the < 0.2% CFR globally. Just 389 cases were laboratory-confirmed, illustrating the challenges in securing access to diagnostics across the country.
During this period, more than 65% of suspected cases and around 85% of suspected deaths in the country are among children under 15 years of age.
New modes of transmission including sexual contact between same-sex and different-sex partners have been documented. This is the first reported sexual transmission of clade I mpox.
In 2023, 14 659 cases were recorded and 688 deaths, CFR 4,6% – substantially higher than the global mpox CFR of