Congo has been battling an Ebola outbreak that has killed thousands of people for more than 18 months, and now it must also face a new scourge: the coronavirus pandemic.
Ebola has left those living in the country's east weary and fearful, and, just as they were preparing to declare an end to the outbreak, a new case popped up. Now, they will now have to manage both threats at once.
The new virus has overwhelmed some of the world's best hospital systems in Europe and ripped through communities in New York. In Congo, it could spread unchecked in a country that has endured decades of conflict, where corruption has left the the population largely impoverished despite mineral wealth, and where mistrust of authority is so entrenched that health workers have been killed during the Ebola outbreak. It's also unclear how forthcoming international support will be at a time when the whole world is battling the coronavirus.
"It all feels like one big storm," said Martine Milonde, a Congolese community mobilizer who works with the aid group World Vision in Beni, which has been the epicenter of the Ebola outbreak. "Truly, this is a crisis within a crisis within a crisis. The community suffers from insecurity, and suffered under Ebola, and now may have to face COVID-19."
In early March, an Ebola patient whom many hoped would be the last was discharged, and the outbreak was supposed to be officially declared over Sunday. But the World Health Organization on Friday announced a new case in Beni.
The outbreak has claimed more than 2,260 lives since August 2018 — the second largest the world has ever seen, after the 2014-2016 outbreak in West Africa.
Still, there is some hope: Many of the tools used to fight Ebola — hand-washing and social distancing chief among them — are also key to combating the coronavirus.
In Beni, which has reported two cases of the new coronavirus, "the communities here hold onto some hope that they are going to overcome this pandemic the way they had been working to overcome Ebola," said Milonde. "They are counting on the caution, vigilance and hygiene practices that they have been performing to save their families."
Community advocates in Beni — who walk around with megaphones to talk about Ebola — have started to include warnings about the coronavirus.
Messages explaining COVID-19, the disease caused by the virus, and where to go if sick are being spread on radio stations, through text message blasts and by religious leaders. Schools, churches and mosques are already armed with hand-washing kits.
Beni's mayor, Nyonyi Bwanakawa, says many of the measures will be familiar — but the recommendations to stay home are more stringent than what is required for Ebola, and officials are prepared to take "dramatic measures" if people resist.
Unlike Ebola, which kills about half of the people it infects, the new coronavirus causes mostly mild or moderate symptoms in about 80% of people. Spreading Ebola typically requires an exchange of bodily fluids, and people have often been infected when caring for loved ones or mourning in traditional funerals that involve close contact with the body. In contrast, the new coronavirus is far more contagious and mostly spread by people coughing or sneezing, including those with only mild flu-like symptoms.
That means the task of controlling the virus' spread in Congo will be massive: The government has only limited control in parts of the vast country, there are also some dense population centers with poor sanitation and infrastructure, and the country's mineral-rich east is beset by violence from various armed groups.
Dr. Michel Yao, program manager for emergency response at the WHO's Africa office, said implementing robust testing and contact tracing will be key. But getting the community fully involved in fighting the disease might be even more important.
That means not just speaking at communities, "but giving them responsibility and roles to play."
Initially, efforts to control Ebola were met with resistance, one of the major contributors to its spread. Amid the insecurity in the country's east, superstitions arose, and some clinics to treat Ebola patients were attacked and health workers killed.
The capital, Kinshasa, a tightly packed city of 14 million located on the country's western border, remains another major worry, said Yao, who is based at WHO's African headquarters in the neighboring Republic of Congo.
"If it reaches this place, it would be a big disaster," he said.
"Africa is only partly ready," said Yao. "If we stick to sporadic cases, this can be managed."
But many more developed countries have seen cases surge, and a sizable outbreak in Congo could easily overwhelm its hospital system. Advanced equipment to deal with severe respiratory illness, which the coronavirus can cause, is lacking: The Health Ministry says there are about 65 ventilators — all in Kinshasa — and 20 more on order for a country of more than 80 million people.
There have been 215 confirmed cases of the new coronavirus in Congo, with 20 deaths, the ministry said Friday.
And health workers will also need to find a way to continue to treat people infected with the many other diseases that regularly torment the population. Over the past year, for instance, a measles outbreak killed more than 6,000 people in Congo.
In addition, because donor countries are themselves dealing with outbreaks, help from abroad could be less forthcoming. The key, Yao said, is training more people locally to care for the ill.
The challenge will be rallying again after many months of trying to contain Ebola.
"The job wasn't yet finished, and we have to deal with another emergency," Yao said.
Katungo Methya, 53, who volunteers for the Red Cross in Beni, expressed a weariness many feel.
"It's so upsetting to have this second disease. We lost so many people through Ebola, a lot of deaths, now corona," she said. "Everyone is really afraid."
Weeks before the coronavirus spread through much of the world, parts of Africa were already threatened by another kind of plague, the biggest locust outbreak some countries had seen in 70 years.
Now the second wave of the voracious insects, some 20 times the size of the first, is arriving. Billions of the young desert locusts are winging in from breeding grounds in Somalia in search of fresh vegetation springing up with seasonal rains.
Millions of already vulnerable people are at risk. And as they gather to try to combat the locusts, often in vain, they risk spreading the virus — a topic that comes a distant second for many in rural areas.
It is the locusts that "everyone is talking about," said Yoweri Aboket, a farmer in Uganda. "Once they land in your garden they do total destruction. Some people will even tell you that the locusts are more destructive than the coronavirus. There are even some who don't believe that the virus will reach here."
Some farmers in Abokat's village near the Kenyan border bang metal pans, whistle or throw stones to try to drive the locusts away. But mostly they watch in frustration, largely barred by a coronavirus lockdown from gathering outside their homes.
A failed garden of cassava, a local staple, means hunger. Such worries in the village of some 600 people are reflected across a large part of East Africa, including Kenya, Ethiopia and South Sudan. The locust swarms also have been sighted in Djibouti, Eritrea, Tanzania and Congo.
The U.N. Food and Agriculture Organization has called the locust outbreak, caused in part by climate change, "an unprecedented threat" to food security and livelihoods. Its officials have called this new wave some 20 times the size of the first.
"The current situation in East Africa remains extremely alarming as ... an increasing number of new swarms are forming in Kenya, southern Ethiopia and Somalia," a new FAO assessment said.
Favorable breeding conditions through May mean there likely will be another new round of swarms in late June and July, coinciding with the start of the harvest season, the agency said.
The U.N. has raised its aid appeal from $76 million to $153 million, saying immediate action is needed before more rainfall fuels further growth in locust numbers. So far the FAO has collected $111 million in cash or pledges.
The locusts are "invading the Eastern Africa region in exceptionally large swarms like never seen before," the Nairobi-based Climate Prediction and Application Center said.
The new swarms include "young adults," voracious bugs "that eat more than the adult ones," said Kenneth Mwangi, a satellite information analyst at the center.
Mwangi and other officials in Kenya cited difficulties in fighting the infestation as coronavirus-related travel restrictions slow cross-border travel and delay the delivery of pesticides.
The verification work of field officers has been curtailed, making it harder for the center to update regional prediction models, Mwangi said.
In rural Laikipia county, among the worst affected in Kenya, some are calling attention to the threat to commercial farms.
"I think, unfortunately, because of other things going on around the world, people are forgetting about the problem with the locusts. But it's a very, very real problem," farmer George Dodds told the FAO.
Aerial spraying is the only effective way to control the locust outbreak. After the locusts crossed into Uganda for the first time since the 1960s, soldiers resorted to using hand-held spray pumps because of difficulties in obtaining the needed aircraft.
Uganda's agriculture minister said authorities are unable to import enough pesticides from Japan, citing disruptions to international cargo shipments.
The government is yet to meet an additional budget of over $4 million requested for locust control, the minister said.
The sum is substantial in a country where the president has been fundraising from wealthy people to help respond to the virus and its economic disruption. Health workers are threatening to strike over lack of protective gear.
Other countries face similar challenges.
In Ethiopia, where some 6 million people live in areas affected by the locust outbreak, the infestation if unchecked "will cause large-scale crop, pasture and forest-cover loss, worsening food and feed insecurity," the FAO says.
Bands of immature locusts are forming in areas that include the country's breadbasket, the Rift Valley region, it said.
Ethiopia's agriculture minister has said efforts are underway to deploy six helicopters against the infestation that could last until late August.
But ministry spokesman Moges Hailu spoke of an ominous sign: The locust swarms are now appearing in locations where they had not been previously sighted.
The U.S. military said Tuesday it has killed a high-ranking leader of the al-Qaida-linked al-Shabab extremist group with an airstrike in Somalia.
A statement by the U.S. Africa Command said Yusuf Jiis was one of three extremists killed in Thursday's airstrike near Bush Madina in the Bay region.
The U.S. called Jiis a "foundational member" of al-Shabab, which controls parts of central and southern Somalia and frequently carries out attacks in the capital, Mogadishu.
"While we might like to pause our operations in Somalia because of the coronavirus, the leaders of al-Qaida, al-Shabaab and ISIS have announced that they see this crisis as an opportunity to further their terrorist agenda so we will continue to stand with and support our African partners," AFRICOM commander Gen. Stephen Townsend said.
The U.S. in a separate statement said an airstrike on Monday killed five al-Shabab members near Jilib.
The statement said the U.S. was aware of reports alleging that the airstrike killed civilians but that AFRICOM assesses none were killed.
This isn't the first time the U.S. been accused of killing civilians with airstrikes in Somalia. AFRICOM last week announced it would publish a quarterly report addressing allegations, the same day Amnesty International released its latest investigation into airstrikes and said two strikes in February had killed two civilians and injured three others.
Armed men attacked an army camp in Mali's north, killing at least 25 soldiers, the army said Tuesday.
"Yesterday, our camp in the town of Bamba in the Gao region was attacked" and six others were wounded, said army spokesman Col. Maj. Diarran Kone.
The army was in control of Bamba as of Tuesday, he added.
The attack has not been claimed but bore the mark of armed groups linked to al-Qaida or the Islamic State group that are present in the Gao region.
This is the second major attack since the beginning of the year against army positions in the Gao region. More than 30 soldiers were killed near the end of March in an attack on the village of Tarkint.
The attacks come at a time when the government has announced its intention to open dialogue with armed groups linked to al-Qaida.
At least 17 medics in Egypt's main cancer hospital have been quarantined after testing positive for the coronavirus, officials said Saturday, raising fears the pandemic could prey on health facilities in the Arab world's most populous country.
Egypt has reported around 1,000 confirmed cases and 66 fatalities from the global pandemic. Authorities have closed schools and mosques, banned public gatherings and imposed a nighttime curfew to prevent the virus from spreading among the population of 100 million, a fifth of whom live in the densely-populated capital, Cairo.
Dr. Hatem Abu el-Kassem, the director of the National Cancer Institute, said three doctors and 12 nurses tested positive for the virus. He said all other health workers at the facility, which is affiliated with Cairo University and treats hundreds of cancer patients every day, would be tested. The university later said a total of 17 health workers tested positive.
The institute will be partly closed for three days to be sterilized, with only the emergency ward remaining open.
Several doctors took to social media to criticize the institute's leadership for not taking restrictive measures earlier.
Maggie Mousa, an anesthesiologist at the institute, tweeted that one of her close friends was infected. She accused top officials of mismanagement and negligence for not imposing restrictions after the first case was detected more than a week ago.
"They refused to take any measures to protect her and isolate the institute," she said.
Cairo University said it has established a fact-finding mission to investigate the measures taken by the institute to prevent the virus from spreading.
The virus causes mild to moderate symptoms in most patients, who recover within a few weeks. But it is highly contagious and can cause severe illness or death, particularly in older patients or those with underlying health problems, including cancer patients.
As the number of infections has grown to more than 1.1 million worldwide, the exposure of personnel at health facilities is of growing concern.
More than a million people have been infected worldwide and more than 50,000 have died from the COVID-19 illness caused by the virus. More than 200,000 have recovered, according to data gathered by Johns Hopkins University.
Egypt's Health Ministry reported a spike in cases on Friday, with 120 new infections and eight fatalities, its highest one-day tally since the first case was reported in February.
The government has not yet imposed the kind of total lockdown seen in other countries in the region, but officials have said there are plans for stricter measures if needed.
Egypt's President Abdel Fattah el-Sissi said in a statement Saturday that many projects the government was planning to open this year would be postponed until 2021 because of the pandemic. They include the Grand Egyptian Museum that's been under construction for over a decade and intended to showcase Egypt's ancient treasures as well as the country's new administrative capital in the desert outside of Cairo.
The worst coronavirus outbreak in the Middle East is in Iran, where the Health Ministry on Saturday reported another 158 deaths. That brings the overall number of fatalities there to 3,452, amid 55,743 confirmed cases. Health Ministry spokesman Kianoush Jahanpour said more than 4,000 patients are in serious condition.