Nine of the twelve health posts in the Heritage health area of Djugu territory, in Ituri Province, have closed after being overwhelmed by patient numbers, Radio Okapi reported on Wednesday 15 July1. Djugu is a territory of roughly a million people in north-eastern DR Congo, already displaced in large numbers by a decade of militia violence, and its health posts are the first and often only clinical contact most residents have.
Customary chiefs raised the alarm rather than the health ministry, which is itself a measure of how far the formal reporting line has thinned. One sector chief told Radio Okapi the closures had "already caused the death of more than one hundred people"2. That is his own assertion and not verified surveillance data; no health ministry or WHO bulletin has published a figure for the Heritage health area at all. He named community resistance to sanitation protocols in the Djatsi and Pitsi sectors as accelerating the chains of infection.
A closed health post does two things at once, and the second is the one that shows up in the national numbers later. It stops treating people, and it stops reporting them. Ebola surveillance in DRC is built upwards from exactly these facilities, so a case that never reaches a post never enters the count. Responder infections had already tripled to 112 with 35 dead before the posts began closing, and the staff who would reopen them come from the same shrinking pool.
