The Democratic Republic of the Congo (DRC) is reeling from an outbreak of Ebola that is estimated to have killed nearly 5,400 people.
asserted
that → reel → people
The World Health Organization (WHO) has described it as “the largest Ebola outbreak ever reported” in the country.
asserted
Organization → describe → country
The outbreak was first detected in Mongbwalu, a gold-mining town of around 130,000 people in Ituri province in northeastern Congo, after the WHO was alerted on May 5 about an unusual cluster of illness and deaths.
uncertain
WHO → detect → illness
The earliest known suspected case was a healthcare worker who developed symptoms on Apr. 24 and later died at a medical facility in Bunia, the provincial capital.
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who → know → Bunia
On May 15, laboratory tests confirmed that the outbreak was caused by the Bundibugyo virus.
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outbreak → confirm → virus
Since then, the epidemic has spread to the eight provinces, with about 65% of new cases occurring in the community, suggesting widespread undetected transmission.
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% → spread → transmission
The virus spreads primarily through direct contact with an infected person’s blood or other bodily fluids, or through contact with contaminated materials and surfaces.
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virus → spread → materials
As a zoonotic disease, Ebola can also pass from infected wildlife to humans.
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Ebola → pass → humans
The epidemic is now spreading fast and far beyond the borders of Congo, reaching Uganda, Kenya, and Nigeria.
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epidemic → spread → Uganda
The WHO, the Africa Centers for Disease Control and Prevention (Africa CDC), and other public health experts have identified several obstacles to containing the outbreak: the lack of an effective vaccine against the Bundibugyo virus, armed conflict in eastern Congo, inadequate healthcare infrastructure, and cuts to international health assistance.
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WHO → identify → assistance
What this list leaves out is a deeper problem: a decades-long crisis of governance.
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leaves → leave → governance
Ebola is particularly difficult to control in Congo because its ruling class has done little to care for the health and well-being of most Congolese.
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class → control → Congolese
The Trump Administration has compounded the problem by weakening the American and international institutions.
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Administration → compound → institutions
Dismantling the United States Agency for International Aid (USAID), ending foreign assistance programs, cutting staff at the U.S. Centers for Disease Control and Prevention (CDC), and withdrawing from the WHO have undermined disease surveillance, outbreak preparedness, and emergency response.
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Dismantling → dismantle → surveillance
Funding cuts have also weakened support for disease detection, community surveillance, medical supplies, and frontline health systems in Congo.
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cuts → weaken → Congo
The roots of endemic corruption and weak governance in Congo reach back decades.
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roots → reach → Congo
In 1965, five years after the country’s independence from Belgium, Mobutu Sese Seko, the army chief, seized power in a coup.
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Seko → seize → coup
He aligned himself with the U.S. during the Cold War and ruled with absolute power, using the machinery of government to enrich himself and his most senior officials while neglecting the basic functions of the state.
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He → align → state
During the final decades of Mobutu’s rule, civil servants across the country—soldiers, police officers, doctors and teachers—were paid a pittance.
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servants → pay → pittance
Even their meager salaries were routinely stolen by officials a rung or two above them.
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salaries → steal → them
This was the system Mobutu bequeathed to his successors.
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Mobutu → bequeath → successors
It endures today.
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It → endure → ?
Ebola is killing people not only in remote, rural communities but also in cities such as Kisangani, home to more than 1.5 million people and far from the conflict in eastern Congo.
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Ebola → kill → Congo
A substantial proportion of Ebola deaths have occurred outside healthcare facilities.
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proportion → occur → facilities
During a recent two-week reporting period, the WHO found that approximately 65% of deaths occurred in communities rather than treatment centers.
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% → find → centers
These deaths expose the failures in early detection, timely referral, and access to appropriate medical care.
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deaths → expose → care
The deaths in Kisangani suggest a near-total breakdown of the public health system in Congo beyond the conflict zone.
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deaths → suggest → zone
Congo’s health care system has been deteriorating since the 1990s, when economic collapse, political instability, and crumbling state institutions eroded the government’s ability to finance and deliver basic public services.
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collapse → deteriorate → services
The two successive Congo wars, which began in 1996 and 1998, destroyed health facilities, displaced communities, and disrupted essential services.
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which → begin → services
Dependence on foreign aid grew.
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Dependence → grow → aid
Meager government investment, weak accountability, fragmented donor support, and high cost of treatment continued to put access to essential services beyond the reach of most Congolese.
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investment → continue → Congolese
Successive governments have done little to repair it.
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governments → do → it
Health care workers go unpaid, and morale is low.
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morale → go → ?
In August, Roger Kamba, the health minister, acknowledged that 15% to 20% of the names added to payrolls for Ebola response belonged to “ghost workers,” fictitious employees invented by poorly paid officials to siphon off funds.
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Kamba → acknowledge → funds
Many frontline health workers fighting Ebola have not been paid for most of this year; in August, many of those workers went on strike while the epidemic surged.
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epidemic → fight → strike
It does not have to be this way.
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It → have → ?
Earlier this year, Ebola spread rapidly from Congo into neighboring Uganda.
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Ebola → spread → Uganda
While the epidemic raged on in Congo, Uganda contained it.
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Uganda → rag → it
According to The Lancet, Uganda’s Ministry of Health “announced the end of the outbreak on July 28, after 42 days without a new confirmed locally transmitted case.”
uncertain
Ministry → accord → case
Congo is among the most corrupt and poorly governed countries in the world, according to Transparency International and Freedom House.
uncertain
Congo → govern → International
…and 28 more, not listed.
The Aporia
