UNICEF DRC EBOLA SITUATION REPORT 24 September 2018

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UNICEF’s Response

Target Result

# of at-risk people reached through community engagement

and interpersonal communication approaches. (door-to-

door, church meetings, small-group training sessions, school

classes, briefings with leaders and journalists, other)

5,750,000

3,899,172

# of listed eligible people for ring vaccination informed of

the benefits of the vaccine and convinced to receive the

vaccine within required protocols.

11,904† 11,498

# of people with access to safe water in the affected health

zones

952,946 639,134

# of teachers briefed on Ebola prevention information 7,200 3,163

# of families with confirmed or probable cases who received

psycho-social support and/or material assistance 150* 150

† The target is dynamic as listing of eligible persons is defined * The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response mature

150 total reported cases (MoH, 23 September 2018)

118 confirmed cases (MoH, 23 September 2018)

100 deaths recorded (MoH, 23 September 2018)

1,836 contacts under surveillance (MoH, 23 September 2018)

UNICEF Ebola Response

Appeal

US$ 7.624M

Highlights

- 21 September, a confirmed case has been identified in Tchomia

Health Zone, Ituri province. UNICEF has deployed a mixed team

composed of WASH, C4D, and psychosocial to Tchomia to implement

the response.

- 21 September, a meeting was held with the Secretary General of

Ministry of health, UNICEF, WHO, and other partners to discuss

capacity building in fifteen priority provinces as part of the Ebola

emergency preparedness plan, which aims to control Ebola

outbreaks within the country.

- 22 September, increasing security incidents in Beni, Butembo, and

Tchomia Health Zone is hindering UNICEF’s operations in the

affected areas.

29 August, 2018 SITUATION IN NUMBER

Democratic Republic of the Congo

Ebola Situation Report

North Kivu and Ituri

24 September, 2018 SITUATION IN NUMBER

Total funding

available*64%

Funding Gap36%

Ebola Response Funding Status 2018

Ebola NK Funding

requirements : $ 7,624,546

*Funds available include Reprogrammed funds from Equateur Response

Photo Credit: Thomas Nybo

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018

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Epidemiological Overview

Summary Table (23.09.18):

Province Health Zone*1 Confirmed and Probable Cases Total Deaths Recorded

Suspect Cases under

investigation Confirmed Probable Total

Nord-Kivu Mabalako 69 21 90 65 4

Beni 29 4 33 24 4

Oicha 2 1 3 1 1

Butembo 6 2 8 4 2

Musienene 0 1 1 1 0

Masereka 1 0 1 1 0

Kalunguta 1 0 1 0 0

Ituri Mandima 9 2 11 3 0

Tchomia 2 0 1 1 0

TOTAL 119 31 150 100 11

Previous Total 17 September 2018 111 31 142 97 4

Humanitarian leadership and coordination

The Crisis Management Team continued to meet daily under the leadership of the Ministry of Health with all concerned

partners and with the chairs of the different working groups providing thematic updates. UNICEF continues to participate

1 With better access, the number of health zones with Ebola cases was review by the Surveillance commission and revised from 7 reported in the last update to 6 in this report.

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018

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actively in the coordination meetings at the national level and in Beni (operational headquarters) and co-leads the

commissions on communication, WASH and psychosocial care; and active in the working groups on logistics and

vaccination. A UNICEF security specialist is also deployed in the field to support security assessment and safety of the

operations.

Beni health zone is the most worrying area for the response due to the high number of reported confirmed and probable

cases. At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused

around three coordination hubs based in Beni, Butembo, and Mabalako Health Zone.

The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases in Makeke, Mandima Health

zone, Oicha Health Zone, Butembo, Masereka, and Tchomia Health Zone. UNICEF coordinates Makeke’s Ebola response

from the coordination team based in Mangina Health Area and the coordination response for Oicha Health Zone. A

coordination hub is put in place in Butembo Health Zone, which will also support the response in Masereka Health Zone.

A psychosocial and communication commissions have been set up in Butembo Health Zone, composed of five clinical

psychologists and communications specialists. Due to the security access in Oicha and Masereka Health Zone, UNICEF works

through local partners to implement its activities.

The identification of a confirmed case in Tchomia Health Zone, Ituri, is important in the evolution of the Ebola epidemic as

the confirmed Ebola case is located near Lake Albert, which is in close proximity to Uganda. This increases the risk of disease

spill over to Uganda due to high movements of population across the lake and in the vicinity. Furthermore, the identification

of a new case near Lake Albert places Bunia city at risk, which is located about 30km from Tchomia Health Zone. Due to

security reasons, UNICEF’s response will be coordinated from Bunia. A mixed team composed of WASH, C4D, and

psychosocial are currently underway to implement the response.

Response Strategy

The joint response plan of the government and partners has been finalised based on the recent experience from the

Equateur Ebola response. In support of the joint response plan, the UNICEF response strategy will focus on communication,

WASH, and Psycho-social care, nutrition and cross-cutting education sector response.

• Risk communication, social mobilization and community engagement with the aim to (1) proactively engage with

affected and at risk communities, (2) provide timely and accurate health advice to encourage positive health

seeking behaviors and (3) address community concerns and rumors. The strategy is implemented through 5 pillars

that include (i) community engagement; (ii) promotion of preventive behaviors; (iii) responding to resistance; (iv)

advocacy and capacity building of actors and (v) communication in support of ring vaccination.

• The WASH strategy, as part of the Infection Prevention and Control (IPC), aims to stop the spread of the disease

through the availability of 1) WASH in health care facilities, which includes providing water and WASH kits, 2)

hygiene promotion and the provision of WASH kits in schools, including handwashing station and

soap/temperature check points, and 3) WASH in communities, through mass outreach on hygiene promotion to

vulnerable communities and the setup of handwashing stations/temperature control in strategic transit locations,

as well as the disinfection of households/neighborhoods of confirmed cases.

• The child protection and psycho-social support to EVD survivors and family members of EVD cases as well as contact

families seeks to (1) provide psycho-social support; (2) establish or re-establish social and community networks and

support systems; (3) provide social kits to EVD affected families (4) identify and provide appropriate care to orphans

and unaccompanied children due to the Ebola epidemic. The key element of the strategy will include (i)

psychosocial support activities for children and their families; (ii) material assistance to affected families to better

support children; (iii) facilitation of professions help to children and families with more severe psychological or

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018

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social problems / needs; (iv) coordinate mental health and psychosocial support (MHPSS); (vi) psycho-social

assistance, appropriate care and research of long-term solution to orphans and unaccompanied children.

• The nutrition component will focus on provision and pre-positioning of Ready for Use Therapeutic Food (RUTF),

therapeutic milk and other drugs for systematic treatment of severe acute malnutrition (SAM) cases to the 6 health

zones affected by Ebola or in situation of nutritional alert in North Kivu province. In addition, address young child

and infant feeding practice that is impacted by the increasing number of women affected by the Ebola epidemic

• The cross-cutting education sector strategy involve key EVD prevention measures on the school premises, include:

(i) mapping of schools to identify its proximity with a confirmed case and the identification of schools in the affected

health areas (ii) training of educational actors (students, teachers, inspectors, school administration agents, head

of educational provinces) on Ebola including WASH in school, psychosocial support and against discrimination, (iii)

provision of infrared thermometers and handwashing facilities, clean water, soap, and capacity reinforcement on

hygiene behaviours in schools (iv) construction of isolation rooms for suspected cases at school (v) provision of

specific documentation and protocol for prevention, guidance and management of suspected cases in school (vi)

provide key messages on Ebola prevention to families.

Summary Analysis of Programme Response

The targets for the response indicators was revised to accommodate for Masereka and Butembo Health zone with new

confirmed cases of Ebola, in addition to Beni and Mabalako Health zone. UNICEF staff and implementing partners are

currently operational in Beni, Mandima, Mabalako, Musienene, Butembo, Tchomia, Oicha, and Masereka to support WASH,

C4D, and psychosocial activities. Furthermore, the response indicators were adjusted to evolve with the epidemiological

trend. Overview of the key elements in the response with a special emphasis on UNICEF’s response in the affected health

zones.

Communication and social mobilization (C4D)

The communication team focused on strengthening coordination between the three communications commissions (in

Butembo, Beni and Mangina), in order to learn from each other’s lessons learned and experiences and better coordinate

the actions for increased efficiency. An additional effort was made to better position communication in each of the

surveillance, Dignified and Safe Burials (SBD) and vaccination commissions, so that to ameliorate and adjust the

communication on technical aspects of the response. The analysis of rumors, resistance and refusals was deepened and

the insights serve to design appropriate communication responses to each situation, including by strengthening radio

programs to be more reactive to present changes and needs. An investigation team was sent to Tchomia Health Zone, 20km

from Bunia City to investigate the identification of a new confirmed Ebola case. This week’s situation report is dedicated to

sharing few best-practices.

Organizing a public welcome in their communities for survivors has become common practice for RCCE teams, thus creating

opportunities for community dialogue on the efficiency of the treatment and reducing the reluctance. On Sept 20, a hero’s

welcome in her community was organized for Ebola survivor Madsika Janine (30), released from the ETU. The members of

the by the communications and Psycho-Social teams accompanied her to her home in Beni, where over 200 people were

waiting to welcome her back. Clearly touched by the event, she took time to thank everyone and publicly acknowledged

the professional care and treatment she received in the ETU and pleaded with everyone present to cooperate with the

response teams and not be affected by false rumors. She credited her survival to an early detection and treatment in the

Ebola Treatment Units (ETUs). This important event sent a critical message to the surrounding communities that Ebola

survivors should not be stigmatized, Ebola is fully treatable if diagnosed early, and that Ebola Treatment Centers (ETCs) are

both safe and can save lives. During the reporting period, 378 influential leaders, like Janine, were reached through

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advocacy, community engagement and interpersonal communication activities to highlight the importance of treatment

and reducing reluctance, reaching a total of 6,446 (91% coverage) since the beginning of the response.

The week was marked by an important reduction in the tension created by youth groups in Butembo. Previously, detecting

an increase in young people’s resistance in Butembo, the Communications Commission identified four youth groups to

collaborate with. The communication team met with its leaders of Vernda Muchanga, the largest of these four groups,

including over 2,000 members, to listen to their concerns, share with them the facts about Ebola, and discuss the roles and

responsibilities of young people and how this can influence the evolution of epidemic in their communities. Following these

open discussions, the group leaders accepted the need to collaborate for the benefit of their communities and engaged to

identify 10 youth trainers and facilitate a large Ebola workshop for 700 youth, which was organized on September 19. The

leaders of other three groups have been contacted in the same manner to assure their positive engagement and support to

surveillance teams. The team believes that these interventions were instrumental in reducing the resistance and tensions

from youth groups. Mass communication, such as the approach implemented in Butembo, reached 301,000 at-risk

population during the reporting period through community engagement, advocacy, interpersonal communications, public

animations, radio, door-to-door, church meetings, schools, adolescent groups, administrative employees, armed forces.

Since the beginning of the response, the communication team has reached a total of 3,899,172 (68% coverage) persons.

The coordination of activities in the urban district of Ndindi (Beni), where growing resistance was reported previously, had

visibly improved. The chiefs of all its three districts (along with the sub-chiefs of all 107 avenues), were visited in person and

briefed on Ebola prevention, surveillance, and community engagement. From these encounters, a central Ndindi committee

was established and that united all three districts, and which also included representation from all the Chiefs of Avenues.

Other sub-committees were created to address specific audiences such as young people, authorities, teachers, and special

groups. This central committee is now responsible for coordinating and facilitating all Ndindi activities, including

surveillance, SDB and prevention of resistance. The creation of this structure has already shown a positive impact in the

coordination of community interventions. The mobilization of 347 frontline workers (RECOs) enabled to break down

reluctance and collaborate with the community in the affected areas. Overall, 3,102 (67% coverage) RECOs have been

working since the beginning of the response.

In Ndindi, a total of 124 mobile telephones (with credit) were distributed to all the Chiefs of Avenues and a calling protocol

was put in place for chiefs to dial to report suspected cases and for other communication needs. In the last three days, six

serious cases were reported by seven Chiefs of Avenues. In partnership with Oxfam’s community teams, a reporting system

is being put in place to record and analyze all suspected cases, deaths, and resistance cases.

The temporary crisis in the education sector in Oicha health zone, north of Beni, provoked by a rumor, was successfully

solved. It started with and rumor launched by a program visitor on a local radio station, claiming that the Ebola vaccine is

now available for children in schools. Despite the political agenda of the messenger, the consequences were immediately

observed in communities. The following day, 20% of the schools had to shut down due to parents fearing their children will

be vaccinated without their permission. In response, the RCCE commission quickly recorded radio messages from both the

national Ebola coordinator and the director of education, focusing on the eligibility for Ebola vaccine. The messages were

immediately broadcast on all 16 neighboring radio stations, including the one in Oicha Health Zone. In parallel, and with

help from local leaders, the RCCE commission and education team also sponsored community sessions with parent

associations to address their concerns. One week after the incident, it is reported that 100% of schools are open and that

all students are back in their normal routine, however the issue remains sensitive.

In Mangina Health Area, the impact of the different commissions working together was apparent in the village of Kiavisimi.

A couple confirmed with Ebola escaped from Beni to come and hide here due to fear of ETUs. Aware of this, the surveillance

teams tried to intervene, but they were threatened and not allowed to made contact with the couple. The Mangina

coordination team quickly sent a mixed team that included members of surveillance, RCCE, PS, a local survivor and a leader

from the neighboring community of Kanzaba. Upon arrival, they were finally able to have a truthful dialogue with the village

chief, as well as with other leaders and close family members. The team remained in the community and continued the

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018

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dialogue until everyone understood the consequences if they did not cooperate. With additional help of the catholic nuns

from the local convent, they were finally able to convince the community to allow the couple to be treated in the ETU. With

204 people now identified as contacts, the team also convinced them to receive the vaccine. Of the couple, the wife passed

away while the husband has shown improvement in his condition. A few days later, the community leader excused himself

for the behavior of the community, and acknowledged that if they acted sooner, they may have saved the life of their sister.

A total of 41 households were reached with communication to break down reluctance to Ebola vaccination, treatment or

refusals of secure and dignified burials practices benefited from personalized house visits to address general concerns,

reaching a total of 247 (67% coverage) households since the beginning of the response.

Water, Hygiene and Sanitation (WASH)

During the reporting period, 28 new health facilities in the affected health zones in North Kivu provinces benefitted from

essential WASH activities; these include the provision of handwashing points, briefing of staff on hygiene promotion, and

disinfection, and the installation of chlorination points, reaching a total of 116 (36% coverage) out of the 320 targeted since

the beginning of the response.

UNICEF with the support of its partners OXFAM, CEPROSSAN and Mercy Corps completed the installation of a WASH

package in 10 health structures in Butembo Health Zone. While 126 health facilities have been fully covered so far, WASH

response in additional 16 health facilities is on-going.

As of 21 September, 438 (49% coverage) community sites (ports, market places, local restaurants, churches) out of the

targeted 900 were provided with handwashing facilities for Ebola infection control in Beni, Mandima, Mabalako and

Butembu Health zones in partnership with Oxfam and PPSSP and CEPROSSAN.

61,182 persons gained access to safe water in the affected health zones, reaching a total of 639,134 (67% coverage) out of

the targeted 952,946 since the beginning of the response.

Key activities in the last seven days:

• Distribution of family hygiene kits to 100 households in the village of Kiavisimi in the health zone of Mabalako after

a suspected case was identified. The village showed maximum community commitment to the response against

Ebola after some resistance showed previously.

• After a confirmed case in Bunia, a member of WASH team joined the Rapid Response team deployed to support

the Bunia office. More WASH staff from Kinshasa office will join soon for additional support.

• WASH and C4D teams continued their ongoing community WASH activities to identify capacity building needs for

partner staff in Community Engagement. A workshop is scheduled to take place on 24 September 2018 in Butembo.

A mapping of regular community feedback and rumours is ongoing on use and perceptions of WASH services, more

specifically the use of chlorinated water.

Education

As 24 September, 48,125 (16% coverage) school children were reached with Ebola prevention messages, of which 14,300

were reached during the reporting period. In addition, 933 teachers were briefed on Ebola prevention, reaching a total of

3,163 (44% coverage) teachers since the beginning of the response.

Since the beginning of the response, 309 (52% coverage) schools in high risk were provided with handwashing facilities,

reaching 15 during the reporting period.

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018

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Psychosocial and Child Protection

During the reporting period, nine affected families by EVD received psycho-social support and material assistance including

food assistance in eight health zones, reaching a total of 150 (100% coverage) out of the targeted 150 families.

12 families of discharged patients previously identified received a material assistance during the reporting period. In

Mangina Health Area and since the beginning of the response, 126 discharged patients - among which 36 cured persons

and 90 non-case patients, received a psychosocial support and material assistance. In addition, a total of 58 families who

lost one member from EVD received a specific assistance.

19 new separated/orphan children due to the Ebola epidemic has been identified, of which 11 from the Butembo health

zones, reaching a total of 154 (57% coverage) out of the targeted 300. All of them received appropriate care and support.

27 separated/orphan children - previously identified - received NFI kits, which also support their extended families and/or

caregivers.

A total of 112 of school age children who became orphans due to the Ebola virus received UNICEF assistance to return to

school.

350 contacts families received a psycho-social support, reaching a total of 1,351 (74% coverage) out of the targeted 1,836.

In Beni Health Zone, some psychosocial agents were jointly deployed with World Food Programme (WFP) to provide

psychosocial support to 41 contacts persons who also received food assistance.

A new training for psychosocial assistants was organized for the Butembo Health Zone for 35 people. 15 new agents are

now acting in the field.

Nutrition

During the reporting period, 21 Ebola patients, of which two lactating women and one child (three months), have benefited

from specific nutrition treatment and counseling in Beni and Mangina Ebola Treatment center (CTE).

In collaboration with UNICEF, this treatment is ensured by four governmental nutritionists trained on Ebola patient care

and biosecurity. Nutrition care consists of providing support through the four phases: intensive, maintenance, transition

and stimulation phases.

A package of nutrition supplies including therapeutic milk, anthropometric equipment (electronic scales, MUAC) have been

donated to Butembo Health Zone to facilitate the therapeutic treatment in Butembo ETC.

UNICEF Nutrition team and governmental representative has drafted a reporting template to be validated and codified to

facilitate the rapid SMS reporting of nutrition interventions.

Supply & Logistics

Since the beginning of the 10th Ebola Emergency Response, the total value of supplies procured is US$1.5 million.

Human Resources

As of 24 September, 60 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri

provinces.

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018

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External Communication

The CO ended a content gathering mission in the affected region leading to new videos and photos on WeShare. A new

press release focused on children that have become orphan or are unaccompanied following Ebola was issued during the

reporting period. UNICEF highlighted the issue during the press briefing at the Palais des nations in Geneva. During the

reporting period media coverage of UNICEF’s response to the Ebola outbreak included Radio Okapi, Radio Okapi Magazine

des Nations Unies, XinhuaNews Agency, All Africa, Actualites.cd, Reliefweb, Les depeches de Brazzaville .

New digital publications on the Ebola epidemic and UNICEF’s response include a photo essay and human interest stories.

The CO has published 25 articles on its blog since the announcement of the epidemic, as well as more than 130 tweets, 20

Facebook posts and 14 pictures on Instagram.

Funding

The Response Plan developed jointly with the Ministry of Health, United Nations Agencies and in coordination with other

actors is estimated at US$ 43.837 million. Based on the joint response plan, UNICEF estimated amount required for

immediate response is US$ 7.624 million.

Funds available include funds reprogrammed from Equateur Response in consultation with World Bank (PEF), USAID, ECHO

and Japan. At present, funds from Gavi (US$ 120,000), CERF (US$ 900,000), USAID (US$ 2 million), and UNICEF National

Committee in Germany -German Natcom (US$503,147) have been allocated to support the Ebola response in North Kivu

and Ituri province.

Agreement was approved and signed with the DRC Government through the World Bank‘s funded project “DRC Health

System Project” for a total amount of US$ 3,947,688

Next Sitrep: October 1, 2018

Funding Requirements (as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018)

Appeal Sector Requirements

Funds available Funding gap

Funds Received Current Year*

$ %

WASH 2,346,521 2,297,364 49,157 2%

Communication for Development (C4D)

2,602,340 1,595,536 1,006,804 39%

Psychosocial Support 433,321 400,000 33,321 8%

Management of Severe Acute Malnutrition

500,000 50,000 450,000 90%

Operations support and Coordination costs + ICT

1,742,364 504,861 1,237,503 71%

Total 7,624,546 4,847,761 2,776,785** 36%

*Funds available include proposed funds to be reprogrammed from Equateur Response ** Does not include funds in the pipeline

Who to contact

for further

information:

Pierre Bry Chief Field Operations UNICEF DRC Tel: + (243) 817 045 473 E-mail: pbry@unicef.org

Gianfranco Rotigliano Representative a.i. UNICEF DRC Tel: + (243) 996 050 399 E-mail: grotigliano@unicef.org

Tajudeen Oyewale Deputy Representative UNICEF DRC Tel : +(243) 996 050 200 E-mail : toyewale@unicef.org

UNICEF DRC EBOLA SITUATION REPORT 24 September 2018

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Ebola Response Tracking Indicators (24 September 2018) Target Total results

Change since last report ▲▼

RESPONSE COORDINATION

# of affected localities with functioning partner coordination mechanism 4 4 1

COMMUNICATION FOR DEVELOPMENT

# of members of influential leaders and groups reached through advocacy, community engagement and interpersonal communication activities. (CAC, religious /traditional leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders, special populations, and adolescents.

7,100 6,446 378

#of frontline workers (RECO) in affected zones mobilized on Ebola response and participatory community engagement approaches.

4,650 3,102 347

# of at-risk population reached through community engagement, advocacy, interpersonal communications, public animations, radio, door-to-door, church meetings, schools, adolescent groups, administrative employees, armed forces.

5,750,000 3,899,172 301,000

# of households for which personalized house visits was undertaken to address serious misperception about Ebola, refusals to secure burials or resistance to vaccination.

368 247 41

# of listed eligible people for ring vaccination informed of the benefits of the vaccine and convinced to receive the vaccine within required protocols.

11,904† 11,498 1,842

% of respondents who know at least 3 ways to prevent Ebola infection in the affected communities (from Rapid KAP studies)

80% 74% 0

WATER, SANITATION & HYGIENE

# of health facilities in affected health zones provided with essential WASH services. 320 116 28

# of target schools in high risk areas provided with handwashing facilities 600 309 15

# of community sites (port, market places, local restaurant, churches) with hand washing facilities in the affected areas

900 438 8

# of people with access to safe water source in the affected areas 952,946 639,134 61,182

EDUCATION

# of school children reached with Ebola prevention information 297,000 48,125 14,300

# of teachers briefed on Ebola prevention information 7,200 3,163 933

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT

# of families with confirmed or probable cases who received psycho-social support and/or material assistance

150* 150 8

# of contact family members, including children, who receive psycho-social support and/or material assistance

1,836** 1351 350

# of unaccompanied children and orphans* identified who received appropriate care and psycho-social support

300†† 170 35

NUTRITION

# of < 23 months children caregivers who received appropriate counseling on IYCF in emergency

9,756 571 21

* The target is estimated based on both the number of confirmed, probable and suspect case, and would be adjustment as the response mature † The target is dynamic as listing of eligible persons is defined ** The target is dynamic and 100% of listed contacts is the identified target †† The target is an estimation and dynamic based on field experience