Kampala, Uganda – The Ugandan government is under pressure to bring an escalating Ebola outbreak under control, after the health minister announced that six schoolchildren in the capital city, Kampala, have tested positive for the virus.
At least 15 people in Kampala are now confirmed to have been infected with Ebola, according to a statement by Health Minister Jane Ruth Aceng on Wednesday – just days after the government insisted there were no infections in the capital.
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Aceng said that the children were likely infected by a man who travelled from one Ebola-hit district to Kampala and died there.
“We were able to get this cluster, plus one other, because of the ministry’s vigilance in contact tracing and field case management,” she said.
However, health experts have criticised the government’s response to the outbreak as slow and inept due to logistical failures, distrust towards the state, and reluctance to impose restrictions after Uganda endured one of the longest COVID-19 lockdowns in the world.
The government first confirmed an outbreak of the Sudan strain of the Ebola virus on September 20 in Mubende District, 145km (90 miles) from Kampala. As of Wednesday, the virus had spread to seven Ugandan districts in total, infecting 109 people and leading to 30 deaths, according to Aceng.
However, Ugandan President Yoweri Museveni only announced a three-week lockdown on October 15 in two of the most-affected districts and put Kampala, the capital city, on high alert in a bid to contain the virus.
It is the fifth time Uganda has experienced an Ebola outbreak since the turn of the century. An outbreak in the year 2000 killed more than 200 people.
Samuel Etajak, an epidemiology researcher at Makerere University School of Public Health, told Al Jazeera that the government has struggled to contain this outbreak in part due to a failure to quickly trace contacts and keep them under observation.
“For an epidemic response, you need a lot of logistical support. For example, you need vehicles to transport field teams doing case investigations, who are doing contact tracing, who are doing evacuations of suspected cases,” he said.
In an address to the nation on October 12, Museveni said a patient had escaped from an isolation centre in Mubende to seek medication from a traditional healer in a neighbouring district. He later ended up in Kampala and was hidden by relatives.
Museveni said that, when the condition of the patient worsened, he was taken to hospital in Kampala and registered under a false name. After he died hours later, his body was given to family members for transportation back to the village for burial. That is when the patient’s true identity was discovered.
Herbert Luswata, secretary general of the Uganda Medical Association, says a lockdown in the community where the virus was first reported and tight security should have been a top priority from the start.
“[With an earlier lockdown] we would not have been having cases of patients and suspected cases escaping,” Luswata said. “You need [to use] the army when you’re managing this kind of epidemic.”
Museveni has ordered witch doctors, traditional healers and herbalists to desist from accepting any sick person.
Yonas Tegegn Woldemariam, the World Health Organization’s representative in Uganda, said that as traditional healers are part of communities, it’s important to engage them to support the response teams and enlighten them on the risks they pose if they continue handling people infected with Ebola, which is spread through contact with infected blood and other bodily fluids.
Woldemariam said traditional healers can help with early detection within communities and directing patients to trained health teams handling Ebola.
“It is important for the country and us partners to educate them on the risk of Ebola disease,” he said.
Distrust of the state is prevalent in many communities.
Etajak says a team of health workers who were going to bury a person who had died of Ebola were hijacked by relatives who confiscated the body. The relatives claimed they wanted to check whether the body’s organs had been removed and sold, as claims of organ theft have been on the rise in Uganda.
Hope Grania Nakazibwe, a legislator representing Mubende district, said that in some Ebola-affected communities, residents believed the deaths were punishment for moral failings.
“People are believing in witchcraft. It’s hard to believe but that’s what is happening,” she told Al Jazeera. “It is the reality even when the ministry of health is educating them”.
Cases rise in Kampala
The government had insisted that there were no active Ebola cases in the capital until Sunday.
Luswata said the delay in admitting the presence of Ebola in Kampala or taking preventive action could have meant that many people in the city failed to take precautions.
“That is a danger because when people are reluctant [to take precautions], it increases chances of them getting infected,” Luswata said.
On Wednesday, Aceng said all people suspected of coming into contact with Ebola in Kampala would be put into quarantine for 21 days in a government facility to prevent transmission.
“I appeal to all Ugandans to understand and appreciate the rationale behind this and cooperate to ensure that we bring this outbreak to a speedy end so that we return to our normal way of life,” she said.
“The penetration of Ebola in heavily populated areas creates a situation of rapid spread and is associated with sustained and protracted person-to-person transmission. Urban Ebola transmission is complex, and the government will do all it takes to ensure control of transmission in the urban settings.”
While the Sudan strain of the Ebola virus has no proven vaccine, Aceng added that the health ministry will be evaluating the efficacy of three candidate vaccines in the coming weeks.
Meanwhile, Nakazibwe says people in locked-down areas are already complaining that the restrictions such as nighttime curfews are too harsh, having only been fully released early this year from a two-year-long COVID-19 lockdown that devastated businesses.
“A number of people believe that if this outbreak doesn’t end soon, businesses will collapse completely,” she said.