Assessing the risks faced by the city of Goma in the Democratic Republic of Congo (DRC) would go well beyond the norms of the insurance industry. On January 17, 2002, a large part of the city center was destroyed by an eruption of Mount Nyiragongo, about 20 kilometers (12.4 miles) to the north. Volcano hazard is not a significant risk factor for many towns and cities – and nor is Ebola. Goma is exceptional in being at risk from both.
Outbreaks of Ebola have occurred in the DRC sporadically in 1976, 1994, 2003, 2007 and 2012. The most recent outbreak started on August 1, 2018, and even with the infection of 2,500 and the deaths of more than 1,700, the Ebola virus is still not contained. Endemic hostilities in the DRC make it hard for health organizations to track contacts of those infected, and to operate treatment centers without fear of military attack. Health workers expose themselves daily to lethal infection – and should not be exposed also to armed assault. But they are – two health workers were killed in mid-July.
The city of Goma, DRC and Mount Nyiragongo in the background. Image credit: Flickr/MONUSCO
Goma is more than 350 kilometers (217 miles) south of where the Ebola outbreak was first detected and lies outside the main conflict regions. So, it has taken almost a year for Ebola to reach Goma. With a population of about a million, Goma is the largest city to have an infection. The risk of urban spreading is obvious. But Goma has been preparing for the arrival of Ebola for a year, setting up hand-washing stations and discouraging moto-taxi drivers from sharing helmets. An Ebola Treatment Center in Goma has been operational since February.
The transmission vector was a pastor from the town of Butembo, a long 18-hour bus ride to Goma. Pandemic risk modelers seek to identify contagion super-spreaders, who come into contact with many infected people through their daily activities. This pastor was such a super-spreader. While in Butembo, the pastor held regular services in seven churches, during which he laid his hands onto worshipers, including people who were ill. The pastor has since died. This tragic tale is a reminder that ignorance is a major transmission factor in the spread of contagion. Ever since the Black Death, congregating in places of worship has been known as an infectious risk escalator.
According to the World Health Organization (WHO), health officials have identified 60 people who came into contact with the pastor since he became ill and half of them have been vaccinated. Concerned still about the spread of Ebola in Goma, WHO has now classified the Ebola outbreak as a public health emergency of international concern.
Since the 2014-2015 Ebola crisis in West Africa, RMS has emphasized the cost-effectiveness of early control of emerging infectious diseases, and sought to encourage financial preparedness for control measures. Hundreds of millions of dollars are still needed to control the Ebola epidemic, and this WHO emergency classification may encourage reluctant donors to provide funds they have promised but not delivered. More bluntly, the UN Under-Secretary-General for Humanitarian Affairs, Mark Lowcock told Reuters: “The need is for money, not next week, or next month or later in the year. The need is for money now.”