The long awaited presidential elections of DR Congo that were originally supposed to take place on 22 December were delayed until 30 December. This decision caused tensions throughout DRC, especially in areas such as Beni and Butembo in eastern North Kivu Province. On Wednesday 26 December, the national electoral commission (CENI) announced that elections will be further postponed in three areas including Beni and Butembo because of the ongoing Ebola outbreak and risks of attacks. This announcement resulted in violent protests, especially in Beni where the MSF transit centre was partly vandalized on 27 December, leading to the temporary evacuation of the MSF teams for a few hours. 
 
The current unrest situation is causing delays on surveillance, identification of new cases, contact tracing, vaccination and infection prevention and control activities, such as safe and dignified burials and decontamination of health centres and households. This can lead to a higher rate of propagation of the disease, potentially increasing the time it will take to bring the outbreak under control.  But the impact of the violence on people’s access to health goes well beyond Ebola care. During the protests, several health centres were targeted and damaged. This leaves the population with a limited access to medical care that can have a serious impact on the overall health of the population and on the monitoring of the outbreak. This is why transit centres like the one managed by MSF in Beni are important. They allow decreasing the caseload on the local health structures by triaging patients with non-specific symptoms and by referring them to the appropriate health centres for the care they need .
 
As of 7 January, there have been 577 confirmed Ebola cases, 329 of which have died in the country.
 
MSF ACTIVITIES 
In North Kivu, MSF is responding to the Ebola outbreak in Beni (with a transit centre), Butembo (with an Ebola treatment centre) and Katwa (eastern part of Butembo city, where MSF has just opened a second Ebola treatment centre). MSF is also providing outreach and community awareness-raising activities, as well as support to health centres on infection prevention and control.
 
BENI transit centre 
On 27 December, the transit centre managed by MSF in Beni was targeted by protesters, who threw stones, broke into the centre and looted small equipment. These acts of violence led to a temporary evacuation of the MSF team. A medical team quickly returned to care for the patients present in the transit centre. Of the 28 patients that were in the transit centre at the time of the demonstrations, 9 left spontaneously during the troubles, 18 were referred to Beni’s general hospital and 1 was discharged. As no patients remained in the transit centre, the medical team remained on standby at the project’s base, waiting for the situation to quiet down. On 31 December activities resumed with reduced staff. 
 
Beni transit centre patient numbers as of 07/01/2019:
  • 9 new admissions 
  • 17 discharged patients (17 tested negative for Ebola) 
  • 33 patients in total in the transit centre 

BUTEMBO Ebola treatment centre 
Activities at the ETC are proceeding as normal but with reduced teams. On 27 December the decision was taken to temporarily evacuate all non-essential staff because of the tense climate created by the elections and the coming proclamation of results.

Butembo ETC patient numbers as of 07/01/2019: 
  • 13 new admissions 
  • 22 discharged patients (1 cured, 2 deceased, 19 tested negative for Ebola) 
  • 44 patients in total in the ETC

KATWA Ebola treatment centre (in construction) 
The new ETC in Katwa (eastern part of Butembo city) was inaugurated on 3 January, with the opening of 16 beds. On 4 January, the first 3 patients were admitted. The centre has a modular design that allows construction to go on while being operational. Another 16 beds are planned to be available soon. 

Katwa ETC patient numbers as of 07/01/2019: 
  • 3 new admissions 
  • 6 discharged patients (6 tested negative for Ebola) 
  • 8 patients in total in the ETC 

Outreach, community awareness-raising and infection prevention and control

MSF was running these activities in communities and health centres in and around Beni and Butembo. Due to the current insecurity, they have been temporarily suspended, with the exception of occasional, ad-hoc decontamination of health centres. MSF teams are ready to resume the bulk of these activities as soon as the situation allows.
 
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