North Kivu held Ebola patients at 134% of its isolation-bed capacity on 27 July, the thirteenth consecutive day the province ran between 119% and 136%, according to Africa CDC's latest situation report on Bundibugyo virus disease1. Ituri, the province at the outbreak's centre and carrying nine times North Kivu's caseload, sat at 67% occupancy with 264 beds standing empty.
Both provinces lie in eastern DR Congo and both have Ebola treatment centres, so the mismatch is not a question of whether capacity exists. It is a question of where it was built and how a patient gets from one to the other. The road between Bunia in Ituri and the affected North Kivu health zones is unpaved for long stretches and passes through territory contested by armed groups; moving a suspected Ebola case along it costs a day, a vehicle, an escort and a decontamination team. A bed a day's drive away does not help a patient bleeding today.
That geography explains part of a number Lowdown reported a fortnight ago, when DRC's isolation rate slipped to 39%, well below the 70% threshold Africa CDC treats as the fork between containment and sustained community spread. A national average conceals a distribution. One province turning patients away while another runs a third of its ward empty produces exactly that kind of average, and no amount of additional construction fixes it. Closing the gap means one of two expensive things: convoying patients west into Ituri's empty wards, or stripping those wards and rebuilding the capacity beside the North Kivu health zones now overflowing.
