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Ebola Outbreak In Five Graphics
More than 1,800 people have died and more than 2,700 have been infected in the latest outbreak of Ebola in central Africa.
The World Health Organization (WHO) has declared the crisis a public health emergency of international concern.
The outbreak is the second-largest in the history of the virus. It follows the 2013-16 epidemic in West Africa that killed more than 11,300 people.
1. Ebola cases are on the rise
So far, more than 1,800 people have died in the Democratic Republic of Congo in the latest outbreak, which began in August last year.
The death of a priest from the disease in the eastern city of Goma, a major transport hub on the DR Congo-Rwanda border, could be a "game-changer" given the city has a large population, the WHO said.
He had travelled 200km (125 miles) by bus from Butembo - one of the towns hardest hit by Ebola - where he had mixed with worshippers sick with the disease.
The DR Congo health ministry said the driver of the bus he was travelling on and the other 18 passengers were being vaccinated.
However, the case has heightened concerns the outbreak could spread to Rwanda.
The country's authorities have ruled out closing the border saying the priest's death was not sufficient reason to shut the frontier.
2. North Kivu and Ituri provinces are affected
The current 12-month epidemic began in the eastern region of Kivu in the DR Congo and cases have since been reported in neighbouring Ituri.
The latest case in the border transport hub of Goma is of particular concern to health authorities, as it is far harder to isolate patients and trace contacts in major cities, where highly-mobile, large populations are living in close proximity.
Goma adjoins the city of Gisenyi on the Rwandan side, and people travel between the two places every day.
Rwanda has stepped up border monitoring and has urged its citizens to avoid "unnecessary" travel to DR Congo. Some 2,600 health workers had also been vaccinated.
Ugandan health officials are also screening travellers at the border to check their temperature and disinfect their hands.
Three Ebola cases that originated in DR Congo were confirmed in the country last month, but no new cases have been registered there.
The country's health minister, Jane Ruth Aceng, said the challenge was to stop people crossing at "unofficial entry points" between the two countries.
3. The virus can spread quickly
Ebola infects humans through close contact with infected animals, including chimpanzees, fruit bats and forest antelope.
It can then spread rapidly, through contact with even small amounts of bodily fluid of those infected - or indirectly through contact with contaminated environments.
Even funerals of Ebola victims can be a risk, if mourners have direct contact with the body of the deceased.
Subsequent stages can bring vomiting, diarrhoea and - in some cases - both internal and external bleeding.
Patients tend to die from dehydration and multiple organ failure.
There are normally fewer than 500 cases reported each year, and no cases were reported at all between 1979 and 1994.
The current outbreak is the worst on record after an epidemic that struck Liberia, Guinea and Sierra Leone between 2013-16, leaving more than 11,300 people dead.
It killed five times more than all other known Ebola outbreaks combined.
4. The virus can be fatal, but there are treatments
The fatality rate from Ebola is high - up to 90%, according to the WHO, and there is no proven cure as yet.
However, rehydration with oral or intravenous fluids and the treatment of specific symptoms can improve survival - especially if the virus is caught early.
Ebola patients are channelled into specialist treatment centres, where those of high-risk are separated from those of low-risk.
Although medics currently treat Ebola's symptoms rather than offer a cure, a range of new drugs, blood products and immune therapies are currently being tested.
A multiple drug trial is currently under way in DR Congo to fully evaluate effectiveness, according to the WHO.
An experimental vaccine, which proved highly protective in a major trial in Guinea in 2015, has now been given to more than 130,000 people in DR Congo.
Thousands of health workers across the region have also been vaccinated.
5. With the right action, the spread can be stopped
The key to containing and controlling an outbreak is good communication with affected communities, the WHO says.
It is crucial to trace those who may have been in contact with infected people, ensuring they get tested and receive treatment, but people also need to know how to reduce the risk of passing on the virus.
The WHO and its partners are communicating advice to affected communities. Recommendations include:
In Uganda, mass gatherings including market days and prayers have been cancelled.
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The Ebola Death Toll Exceeds 1,600. This Is What It's Like On The Front Lines
Health workers carry an Ebola victim's coffin on May 16 in Butembo, a city at the epicenter of the outbreak in the Democratic Republic of Congo.
Two weeks ago a mother buried her two sons. This week she was buried in the same cemetery.
After her burial, a family member was trying to walk away but couldn't bring himself to leave.
"He eventually went and stood, arms folded, in front of the victim's son's grave, stared at his picture on the cross and looked up four graves over to her grave," photographer John Wessels said. "He did this for at least 10 minutes. It was heartbreaking."
The mother and her children are among the more than 1,600 people who have died as a result of the ongoing Ebola outbreak in the Democratic Republic of Congo, according to estimates from the World Health Organization.
A health worker puts on protective gear before entering the red zone of an Ebola treatment center in Bunia on November 6.
Community members along the road from Beni to Mangina watch from a distance as health workers collect the body of a suspected Ebola victim on August 23. They also watched the workers disinfect the house and burn mattresses, "a very confusing and shocking scene to watch," photographer John Wessels said.
The current Ebola outbreak began last summer in the country's North Kivu province and now constitutes a public health emergency of international concern, WHO announced on Wednesday, July 17. This is only the fifth declaration of its kind in the organization's history.
The region is also grappling with a long-term conflict and dozens of armed groups causing intermittent violence. WHO has received additional support from the United Nations and local police to protect treatment centers.
"The displacement of people due to these attacks makes it harder for the (Ebola) response to be effective," Wessels said. "It also means that some days the response is shut down due to insecurity and fighting in the area. All of this adds up to make it a highly complex and stressful environment for community members and doctors alike."
Soldiers of the Armed Forces of the Democratic Republic of the Congo (FARDC) prepare to escort health workers attached to Ebola response programs in Butembo on May 18.
A police officer stands guard in front of a window riddled with bullet holes at an Ebola treatment center in Butembo that was attacked in the early morning hours on March 9.
An injured suspected Mai-Mai rebel fighter is thrown into the back of a truck outside an Ebola treatment center in Butembo after the March 9 attack. He was shot in the leg by government forces, Wessels said.
Wessels, a South African photojournalist based in Congo, has been on the ground documenting the crisis since it started in August.
He has witnessed families gutted by the virus and seen entire communities ravaged. "There is a lot of stigma around the disease, and we could not imagine what people affected by it are going through," he said. "The stress must be overwhelming."
"The fact that it is now declared a global health emergency really doesn't change anything on the ground. It is still at the same intensity and is still as dangerous as it was before."
Health workers burn medical waste generated during the care of Ebola patients in Mangina on August 21.
A worker helps an unconfirmed Ebola patient into her bed inside a treatment center in Butembo on November 3. "Health workers and doctors take shifts to watch over the patients," Wessels said. "Wearing full (protective gear) like that can be very taxing, so sometimes shifts are only up to an hour long or less."
Family members watch an Ebola victim's burial on May 16 in Butembo. "Burials in the context of Ebola can be complicated as the family can't touch the body and can only view it very quickly," Wessels said. "This goes against some cultural practices and so there is a lot of anger surrounding how safe burials are performed."
The Ebola virus first appeared in 1976 in two simultaneous outbreaks, one in what is now Nzara, South Sudan, and the other in Yambuku, Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name.
Ebola is a severe, often fatal illness with an average death rate of 50%. It spreads between humans through direct contact with an infected person's bodily fluids, including infected blood, feces or vomit, or direct contact with contaminated objects, such as needles and syringes.
Despite the danger, Wessels said he doesn't need to wear protective gear while covering the outbreak. He does, however, follow strict protocols and take precautions to avoid exposure to the virus, like keeping a safe distance from possibly infected zones and washing his hands as often as possible.
Young girls look at a poster explaining the symptoms of Ebola in Mangina on August 19.
A family member reacts during an Ebola victim's burial in Butembo on May 16.
A family member visits an Ebola patient inside a Biosecure Emergency Care Unit (CUBE) in Beni on August 15.
Wessels said he plans to continue covering the deadly disease to get the word out about the human toll on the country he has called home for the past two years.
"I'm hoping the world sees how shocking, stressful and heartbreaking this crisis is for the people of North Kivu," he said.
A woman gets her temperature checked on July 16 at an Ebola screening station in Goma as she enters Congo from Rwanda. The first case of Ebola in Goma was recently confirmed, raising fears that the virus could make its way across the border into Rwanda.
Three people ride a motorcycle and carry a cross for a grave along the road linking Mangina to Beni on August 23. "This scene is something we see often," Wessels said. "Unfortunately it has become 'normal' to see pick-ups with multiple coffins and people carrying crosses to burials in and around the towns."
John Wessels is a South African photographer based in the Democratic Republic of Congo. He is a regular contributor to Agence France-Presse. Follow him on Facebook, Instagram and Twitter.
DR Congo's Deadliest Ebola Outbreak Declared Over
The largest-ever Ebola vaccine campaign was a key factor in containing its spread
The worst-ever outbreak of Ebola in the Democratic Republic of Congo has officially been declared over, almost two years after it began.
No new cases of the disease have been reported in the north-east of the country, where dozens of armed groups operate, since 27 April.
Some 2,280 people died since the outbreak began in August 2018.
The deadliest outbreak on record was in West Africa between 2014 and 2016 with more than 11,000 deaths.
However, DR Congo, which is the size of mainland western Europe, is dealing a fresh Ebola outbreak in the north-west of the country.
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The case in Mbandaka was announced on 1 June where 13 people have since died. Genetic analysis shows it is a different strain of the virus to that found in the east.
The WHO in DR Congo has told the BBC the situation in Mbandaka - the country's 11th outbreak - is nearly under control.
But new Ebola outbreaks are to be expected given the existence of the virus in animals in many parts of DR Congo, the WHO says.
For an outbreak to be declared over, there has to be a 42-day period since the last positive case was tested negative and discharged from hospital.
Why did it take so long to end?
The outbreak in eastern DR Congo was the 10th to have hit the country since 1976, when the virus was first discovered by a group of scientists who decided to call it Ebola after a local river.
Health Minister Eteni Longondo described it as "the longest, most complex and deadliest" in the DR Congo's history.
Decades of conflict in the east have led to widespread mistrust of the authorities, which has made it harder for health workers to treat sick and at-risk people.
BBC health reporter Rhoda Odhiambo says there had been more than 420 attacks on health facilities in the region by armed groups since 2018, which greatly hampered efforts to contain the spread of the disease.
Another challenge in tackling the eastern outbreak was its geographical span across 1200km (475 miles) and three provinces - North Kivu, Ituri and South Kivu, she says.
Fear of the deadly Ebola virus - which sees patients suffer gruesome symptoms and rules out customary burial rites - has been another challenge.
How was it achieved?
WHO's regional director to Africa says the end of the outbreak was only possible because of collaboration.
Ending the epidemic required an enormous effort involving different arms of government amongst others
"This is a sign of hope that with solidarity and science epidemics can be controlled," Dr Matshidiso Moeti said.
The largest-ever Ebola vaccine campaign was a key factor in containing its spread.
The introduction of two experimental vaccines saw more than 320,000 people inoculated.
Health workers and Congolese authorities have mostly succeeded in preventing the spread to neighbouring countries.
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A quick guide to DR Congo
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