UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 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

4,634,907

# of listed eligible people for ring vaccination informed of the

benefits of the vaccine and convinced to receive the vaccine

within required protocols.

17,405† 16,973

# of people with access to safe water in the affected health zones 952,946 740,991

# of teachers briefed on Ebola prevention information 7,200 3,629

# of affected families with confirmed, suspects, probable cases

who received one or several kits of assistance to support their

children

214* 214

† 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 matures

214 total reported cases (MoH, 14 October 2018)

179 confirmed cases (MoH, 14 October 2018)

139 deaths recorded (MoH, 12 October 2018)

4,195 contacts under surveillance (MoH, 14 October 2018)

UNICEF Ebola Response

Appeal

US$ 7.624M

Highlights

• Insecurity in Beni city remains challenging, however, UNICEF operations in the affected areas have resumed. UNICEF continues to break down reluctance on Ebola vaccination, treatment in Ebola Treatment Centers, or refusal of secure and dignified burials through scaled up community engagement approaches

• The Joint Response plan is currently being reviewed by a team comprised of representative from the Ministry of Health, WHO, UNICEF and World Bank to encompass newly affected health zones.

• Since the last reporting period, 30 new Ebola cases have been identified, particularly in the epicentre of the epidemic, Beni Health Zone. Of the new cases identified, there has been an increase in the number of deaths and confirmed cases of children

• Community resistance and insecurity has increased in Butembo Health Zone, leading to ville morte over a couple of days

• Tchomia Health Zone has stabilized as no new cases have been identified during the reporting period

SITUATION IN NUMBER

Democratic Republic of the Congo

Ebola Situation Report

North Kivu and Ituri

15 October, 2018 SITUATION IN NUMBER

Photo Credit: Mark Naftalin

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

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Epidemiological Overview

Summary Table (14.10.18):

Province Health Zone Confirmed and Probable Cases Total Deaths Recorded

Suspect Cases under

investigation Confirmed Probable Total

Nord-Kivu Mabalako

71 21 92 67 0

Beni 76 8 84 55 19

Oicha 2 1 3 1 0

Butembo 12 2 14 8 3

Musienene 0 1 1 1 0

Masereka 4 0 4 1 1

Kalunguta 2 0 2 1 1

Ituri Mandima 9 2 11 3 1

Komanda 1 0 1 0 0

Tchomia 2 0 2 2 0

TOTAL 179 35 214 139 25

Previous Total 8 October 2018 146 35 181 115 9

During the reporting period, a UN staff was confirmed with Ebola

in Beni Health Zone.

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

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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

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 five coordination hubs based in Beni, Butembo, Tchomia, and Mabalako Health Zone. And one sub-coordination

hub is operational in Bunia city.

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.

Due to the security access in Oicha and Masereka Health Zone, UNICEF works through local partners to implement its

activities.

The stabilisation of the epidemiological situation in Tchomia Health Zone, Ituri, has been important in the evolution of the

Ebola epidemic as the previously confirmed Ebola case was 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. Due to security reasons, UNICEF’s response will be coordinated from Bunia, of which a coordination hub is currently

being established.

Response Strategy

The joint response plan of the government and partners is currently under review, to identify key progress, challenges and

modifications to upscale the response and respond to the current epidemiology. In addition, the MoH out in pace a team

that include MoH WHO, UNICEF and World Bank to review the joint response plan based on the field level review.

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.

• 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

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

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and unaccompanied children due to the Ebola epidemic. The key element of the strategy includes (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 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 six

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

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

is detailed below.

Communication and social mobilization (C4D)

The Risk Communications and Community Engagement (RCCE) teams set out to intensify discussions with leaders and civil

society groups in all of Beni’s 15 affected districts due to the increasing insecurity. Meetings with 124 community chiefs

were conducted to inform and encourage collective action and bring back the calm and regain confidence in the institutions

and partners involved in the response. Following discussions, community leaders agreed on the importance of local

leadership and ownership of the recommended process, which includes the oversight of local alerts and surveillance

committees, managed by the community chief themselves. ‘We must first protect ourselves, so we can protect our

community, and by protecting our communities, we also protect ourselves’, said the deputy Mayor of Beni during a visit to

a local Safe and Dignified Burial (SDB) ceremony in his district. He added that ‘Creating multi-disciplinary teams is key, by

involving women, youth and representatives from all influential groups’. Since the beginning of the response, 7,684 (100%

coverage) influential members and groups were reached through community engagement and discussions in order to

promote Ebola prevention messages, reaching 289 influential leaders during the reporting period.

The urgent necessity to upscale activities in Beni town and put into practice community surveillance systems also required

establishing local partnerships with 8 new civil society groups, who pledged stronger engagement of women and youth. In

all, 66 associations were engaged in the response this week in Beni health zone, Butembo health zone and Mangina health

area.

Since the beginning of the response, 4,637 (99% coverage) frontline workers in the affected zones were mobilized on Ebola

response and participatory community engagement approaches. Building capacities and widening the terms of reference

(to include improved Interpersonal Communications, addressing rumors and surveillance of suspects) of 820 front line

workers in Beni, is ‘key to community engagement in such emergencies and require our full investment and attention’ said

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

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Astrid Muzita, a UNICEF C4D specialist. Astrid accompanied the Deputy Mayor of Beni in visiting three prominent churches

and influential religious leaders that have expressed some concerns over local procedures of sending suspects to Ebola

Treatment Units (ETUs). Following these meetings, four influential community leaders were accompanied to visit the ETU

for the first time. The local radio station also interviewed participants of the visit and broadcasted their testimonies the

same day. As a result, the communications team successfully negotiated with managers to announce open-house visits to

ETU each Wednesday and Saturday, of which Ebola flyers were distributed announcing this service.

During the reporting period, 16 radio stations in Beni have signed Ebola-engagement contracts, of which all have

successfully broadcasted 2,232 Ebola songs (7 songs were recorded by popular artists), 5,239 peer-to-peer testimonials (in

2 languages), 1,736 mini-programs (8-10 min each), and 196 positive community activities. A radio survey in Beni showing

the impact of these broadcasts and other listening habits was conducted this week. Results will be shared in next week’s

report. Through mass communication approaches, 4,634,907 (81% coverage) at risk population were reached with Ebola

prevention messages, of which 186,555 were reached during the reporting period.

The Deputy in Butembo Health Zone was recently classified as an Ebola contact and following to prior resistance to receiving

treatment, he has accepted to receive the preventive Ebola vaccine and since then, has also expressed periodic

commitment and respect for the recommended Ebola protocols. The Communications Commission aims to break down

further community resistance through his support.

Challenges faced by the Communication Commissions this week is the growing interest of families to seek private and

home-based health-care providers (instead of going to Ebola Treatment Units), delays in communicating test results to

respective families, perception of ETUs as a place where their loved ones go to die, conviction that the new Ebola vaccine

is only for elites, and the perception of strong political association of response teams. This analysis is reported by Oxfam

field staff, engaged with communities in Beni on a daily basis.

In response, continuous meetings with leaders and local structures are planned to address such barriers and strengthen

linkages between positive deviance groups and other resistant groups. During the reporting period, 67 households

presenting reluctance on Ebola vaccination, treatment in ETCs or refusal of secure and dignified burials were reached,

adding to a total of 437 (100% coverage) households since the beginning of the response. The Communication commission

acknowledge the need to reinforce working with health authorities in reaching out to private health care providers who

are seeking economic opportunities. Following the mobilization of local leaders and social committees, reluctance to Ebola

treatment and vaccination has significantly decreased in the hotspot of Ndindi neighborhood, Beni town. 16,973 (98%

coverage) eligible persons out of the 17,405 targeted were informed of the benefits of the vaccine and convinced to receive

the vaccine within required protocols. Questions and concerns by community members are mapped out and fed back to

the coordination commission to include in daily activities with partners.

Water, Hygiene and Sanitation (WASH)

During the reporting period, an evaluation of 45 health centers and schools was completed in the four areas with the most

confirmed Ebola cases in Beni health zone. UNICEF and implementing partner OXFAM are finalizing the plan of intervention

and the locations where activities will start this week.

As of 12 October, 18 new health facilities in the affected health zones in North Kivu and Ituri 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 154 (48% coverage) out of the 320 targeted since

the beginning of the response.

In Tchomia Health Zone, UNICEF continued the distribution of WASH package in 7 health centers and WASH kits in 16

schools. In addition, 89 handwashing stations were installed in public areas, reaching a total of 125 since the beginning of

the response.

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

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This week, a collaborative workshop between WASH/PCI and Communications commission’s took place in Beni health zone

to do a mapping of actors working in public health and communities, and scale up community engagement activities.

Following the workshop, trainings have continued for all WASH partners in scaling up of community engagement and

dialogue activities.

As of 12 October, 575 (68% 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, Butembo

and Tchomia Health zones in partnership with Oxfam, Programme de Promotion des Soins de Sante Primaire (PPSSP) and

Centre de Promotion Socio-Sanitaire (CEPROSSAN).

Since the beginning of the response, a total of 740,991 (78% coverage) persons have gained access to safe water in the

affected health zones, out of the targeted 952,946.

Key activities in the last seven days:

- In Beni Health Zone, 11 community sites and 47 schools were followed up1 for water supply for handwashing

stations in the health areas of Butsuli, Ndindi and Kasanga. In addition, 200 teachers and 300 community leaders

were briefed on WASH messages this week.

- During the reporting period, 35 community engagement and public health teams from Medair, Mercy Corps, PPSSP

received WASH training, which includes specific scale up activities in health centres and schools, to set up

community dialogue sessions on Ebola, responding to barriers to treatment seeking.

Education

During the reporting period, UNICEF and the Ministry of Health continued the monitoring of 35 schools for the

implementation of prevention measures. In all visited schools, children provided correct answers to the questions regarding

the main prevention measures such (1) handwashing practices and key moments for handwashing (2) probable signs of

Ebola Virus Disease (EVD) and means of contaminations and (3) good behavior that need to be adopted during the epidemic

period.

Insecurity remains a challenge for school functioning in Beni town, which led to the closing of schools from the 8-13th of

October. Students and teachers from two districts, Beu and Rwenzori in Beni, decided to boycott classes in all other schools

as a result of the insecurity. Students and teachers from relatively secured districts, such as Mulekera and Bungulu in Beni,

also supported the initiative, further affecting the school system.

As of 15 October, 71,363 (24% coverage) school children, of which 34,250 girls, were reached with Ebola prevention

messages. 2,025 school children were reached during the reporting period. In addition, 3,629 (50% coverage) teachers, of

which 1,270 women, were briefed on Ebola prevention measures.

During the reporting period, 25 schools in high risk areas were provided with handwashing facilities, reaching a total of 390

(65% coverage) schools since the beginning of the response. UNICEF Education team is working with the Ministry of

Education authorities to come-up with adequate statistics regarding students, teachers in all schools from highly affected

areas as well as neighboring zones.

Psychosocial and Child Protection

During the reporting period, 55 children affected by Ebola (17 confirmed, 38 suspects cases) went through Ebola Treatment

Centers and received specific psychological assistance. Among them, 45 children (15 confirmed, 30 suspects cases) were in

the Ebola Treatment Centers (ETC) of Beni Health Zone. Their families also received a psycho-social assistance.

1 Follow up visits were conducted to ensure the utilization of the handwashing station, their status, and if enough soap was available, it not more soap was provided.

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

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130 affected families by EVD received psychosocial support and 77 affected families received material assistance in 9 health

zones. 63 hygiene kits have been distributed to discharged and cured patients, 6 families received funeral kits, 65 families

received food assistance and 5 families received Non Food Items (NFIs) kits.

For all community reintegration of discharged and cured patients, a psycho-education is systematically conducted with the

neighborhood and communities to avoid stigmatization of the affected families.

11 new separated/orphan children due to the Ebola epidemic has been identified and received appropriate care, reaching

a total of 184 out of the targeted 300. 10 children are from Beni health zone. 29 separated/orphan children (new and

former identified) received material assistance which includes: 17 NFI kits, 9 school kits, 3 newborn kits.

A total of 519 contacts families; 424 in Beni health zone, 14 in Mangina health area, and 81 in Butembo health zone,

received a psycho-social support.

In Beni and Tchomia health zone, 84 psychosocial agents have been trained on the nutritional care of separated/orphan

children as well as on detection and referral of children with acute malnutrition.

Several teams of psychosocial agents are deployed within the different commissions (vaccination, prevention, surveillance,

communication) to include a psychosocial component in the interventions. The role of psychologists/psychosocial agents

is particularly key to convince suspect cases to join the ETC and families to organize safe and dignified burial (SDB).

Nutrition

During the reporting period, 165 pregnant and lactating women were sensitized on the infant feeding and young children

in emergency (IYCF-E) keys practices by nutritionists in three ETCs, Mangina, Beni and Butembo, reaching a total of 885 (9%

coverage) persons since the beginning of the response. In collaboration with psycho social community workers, 16 orphan

children received nutritional support, of which 4 orphans under 6 months old received Powdered Infant Formula (PIF) and

12 received milk as a complement.

During this week, 22 psychosocial community workers were trained on nutrition care for orphaned children in Tchomia

health zone. Medical care committee also organized a meeting chaired by the national coordinator to validate keys

nutrition indicators to monitor nutrition activities in the ETCs. Those indicators include (i) number of under 6 months old

children orphans and/or separated from mothers and whom are under adequate BMS, (ii) number of pregnant and lactating

women sensitized on IYCF-E and (iii) number of hypoglycemia patients corrected with diet prescribed by nutritionists in

ETC.

Finally, with the support of UNICEF this week, the North Kivu provincial Nutrition coordinator has arrived in Beni to support

the team in coordinating interventions.

Supply & Logistics

Since the beginning of the response, $2,251,026 worth of items composed of WASH, C4D, Child Protection, Health and

Education supplies have been procured for the Ebola response in Ituri and North Kivu province.

Offshore procurement represents a total value of $824,527 (37%) and local procurement represents a total value of

$1,426,500 (63%).

During the reported week, Supply & Logistics section in Goma is finalizing local solicitations process for a total value of

$216,344 related to local procurement of wash items (Ebola response). Supplies being procured are composed of:

Calcium Hypochlorite (HTH), drum 45kg, buckets 20 liters, boot rubber, soap, water tanks, sprayers 16 liters, etc.

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

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Human Resources

As of 15 October, 62 UNICEF staff members have been deployed to the affected health zones in North Kivu and Ituri

provinces. In addition, UNICEF is reviewing the HR strategy for a sustained response to the epidemic.

External Communication

One month after the start of the school year in the DRC, the CO issued a press release focused on the status of education

in the Ebola affected regions. The press release was supported with new video and photo material posted on WeShare.

The issue of education was covered at the UN press briefing in Geneva.

Since the beginning of the outbreak, CO published in total 35 articles on its blog www.ponabana.com, as well as 31

Facebook posts, 23 Instagram posts and almost 200 tweets.

Funding

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

actors, has an estimated need of US$ 43.837 million. Based on the joint response plan, UNICEF estimated amount required

for immediate response is US$ 7.624 million. A revision of the plan is currently on-going under the leadership of MoH.

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$503,147), World Bank (US$ 3,947,688) have been allocated to support the

Ebola response in North Kivu and Ituri province.

Funding for education ensures UNICEF’s visibility for safe running of schools during the Ebola epidemic, reaching Ebola

affected out of school children, and highlighting the important role of education to fight Ebola.

The Strategic Response Plan is currently being revised and will be validated during the upcoming week.

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

$

Reprogrammed funds from Equateur

Response $

Funds Received for North Kivu

$

Funds available $

WASH 2,346,521 723,295 2,238,874 2,962,169

Communication for Development (C4D)

2,602,340 371,558 2,961,857 3,333,415

Psychosocial Support 433,321 100,000 548,800 648,800

Management of Severe Acute Malnutrition

500,000 0 549,800 549,800

Operations support and Coordination costs + ICT

1,742,364 132,761 1,171,414 1,304,175

Total 7,624,546 1,327,614 7,470,745 8,798,359

UNICEF DR CONGO EBOLA SITUATION REPORT 15 October 2018

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Next Sitrep: October 22, 2018

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 DR CONGO EBOLA SITUATION REPORT 15 October 2018

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Ebola Response Tracking Indicators (15 October 2018) Target Total results

Change since last report ▲▼

RESPONSE COORDINATION

# of affected localities with functioning partner coordination mechanism 5 5 0

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.

7,684 7,684 289

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

4,650 4,637 211

# 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 4,634,907 186355

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

437 437 67

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

17,405† 16,973 1859

% 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. 320 154 18

# of target schools in high risk areas provided with handwashing facilities 600 390 25

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

900 575 98

# of people with access to safe water source in the affected areas 952,946 740,991 96,908

EDUCATION

# of students reached with Ebola prevention information in schools 297,000 71,363 2025

# of teachers briefed on Ebola prevention information in schools 7,200 3,629 63

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT

# of affected families with confirmed, suspects, probable cases who received one or several kits of assistance to support their children

214* 214 0

# of affected families, including children, with confirmed, suspects and probable cases who received continuous psycho-social support in their community

214* 214 34

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

4,195** 3,348 1387

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

300 200 11

NUTRITION

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

9,756 885 165

† 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 matures ** The target is dynamic and 100% of listed contacts is the identified target