The DRC government and its international partners successfully controlled the tenth outbreak of Ebola after 22 months. This was later than originally expected and only after significant, and belated, corrections to the response’s leadership, the coordination model, and the response strategy. ODI’s report finds that this was in part due to lessons from the 2014–2016 West Africa Ebola outbreak not being effectively applied from the start.

It is clear that international leadership from the World Health Organisation (WHO), United Nations (UN) agencies, the UN Organization Stabilization Mission in the DRC (MONUSCO), international non-governmental organisations (INGOs), the World Bank and other actors was slow to organise effectively. A more inclusive and coordinated approach is needed for greater success in responding to future emergencies, particularly when they occur in complex contexts, such as conflict regions or areas with pre-existing humanitarian needs.

ODI’s independent report, The Democratic Republic of Congo's 10th Ebola response: International leadership and coordination support, that draws together over 120 interviews with a range of key stakeholders involved in the response, puts forward the following recommendations:

There is no room for 'go it alone' approach

As the Ebola outbreak in the DRC progressed and was unable to be controlled, it was clear that a more inclusive and coordinated response was needed; yet attempts to get the UN Country Team and humanitarian operations in country to work more closely with the government and WHO led to the creation of parallel coordination systems. In a complex context, the UN Resident and Humanitarian Coordinator should assume responsibility for the international response in order to lead a coordinated and united approach to tackling the crisis. A broad range of international expertise and assets, from logistical and security capacity to political analysis and humanitarian delivery capacity are needed to complement public health interventions in such settings.

Nicholas Crawford, ODI Senior Research Associate and lead author of the report, says:

“In future outbreaks in complex and conflict settings, there's no room for a 'go-it-alone' approach. Leadership and coordination structures on the health and humanitarian sides must work together from the outset of the response to avoid parallel structures and dual-leadership models.”

Responses must adapt to work in conflict settings

The 10th Ebola outbreak in eastern Democratic Republic of Congo was the first Ebola outbreak in a conflict area – a factor that was not fully appreciated in the response model imported from previous outbreaks. Context-specific approaches were missed, including around community engagement, security and financial management.

The response in the DRC also failed to build on existing health and community structures already in place in country. In the future, international responders must think more about the context in which they are going into and how to engage more effectively with longstanding and trusted health and community structures already in place.

Community engagement and acceptance is key to successful future responses

The initial focus on disease eradication above all else in the 10th Ebola outbreak in eastern Democratic Republic of Congo left little attention or resources for other acute health and humanitarian needs of affected populations and contributed to distrust among affected communities. Community resistance, armed violence and the proliferation of 'Ebola business' – or attempts to profit from or manipulate aid resources – hampered the response. High payments made to outside doctors, security personnel and others in the response, as well as questionable procurement actions such as renting fleets of cars at higher than market value, all added to a sense in communities that Government and international responders did not have their interests at heart.

Kerrie Holloway, ODI Senior Research Officer, says:

“Future responses to health emergencies in fragile states must build community acceptance by engaging with recognised community structures. In doing so international efforts will be better received and more effective in dealing with the spread of disease.”

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For further information or to interview the researchers please contact Charlotte Howes at ODI on +44 7808 791 265 or at [email protected].