Why Closing the Congo-Rwanda Border Could Spread Ebola

Closing borders in the face of Ebola, experts say, is the worst possible response and only encourages unauthorized border crossings.

A health official checks the temperature of a school going pupil from the Democratic Republic of Congo (DRC) at the Mpondwe border point, separating Uganda and the DRC, as he walks through the computerised Mpondwe Health Screening Facility on August 14, 2019. - Every day at dawn, Doneka Kabowo, a Congolese teenager, walks miles into the jungle, with the threat of armed militiamen who roam the area, to go to school across the border in Uganda. But for some time now, another obstacle has developed for the 15-year-old and hundreds of schoolchildren who daily travel from the Democratic Republic of Congo (DRC) to Uganda to study: health checks for prevent the transmission of the Ebola virus. (Photo by ISAAC KASAMANI / AFP)        (Photo credit should read ISAAC KASAMANI/AFP/Getty Images)
A health official checks the temperature of a Congolese student on Aug. 14, 2019, at the Mpondwe border point between the Democratic Republic of Congo, or DRC, and Uganda. Photo: Isaac Kasamani/AFP/Getty Images

A chora chora is a resourceful man, a clever man, a man who can get things done. He wears no uniform, but he has an easy way with soldiers. He’s no diplomat, but he knows something about international relations. The literal translation of chora chora is unimportant. In street Swahili, it’s a smuggler. One evening, as I laid low in a compound bordering the no man’s land between Congo and Rwanda, I peeked over the wall as a chora chora plied his trade. He crossed the border twice within an hour — first to fetch water and then to buy juice — just to show me how easy it was.

What a chora chora does might be illegal, but it’s also as inconsequential as it is common. After all, in the grand scheme of things, does smuggling a little whiskey or used clothes really matter? Perhaps the only reason to care is a virus, a hemorrhagic fever, and a disease that all goes by one terrifying name: Ebola.

Ebola may be the most feared disease on the planet. Its fatality rate can reach 90 percent. While new drugs hold out the promise of a cure, stopping Ebola still means halting its spread.

For more than a year, the virus has smoldered and flared in the far east of the Democratic Republic of Congo, or DRC. Governments near and far, the World Health Organization, the International Organization for Migration, aid groups, and others have all mobilized to contain the outbreak, and still, almost 3,100 people have come down with Ebola and more than 2,100 of them have died — a devastating case fatality ratio just shy of 70 percent.

TOPSHOT - Health workers carry a coffin containing a victim of Ebola virus on May 16, 2019 in Butembo. - The city of Butembo is at the epicentre of the Ebola crisis, the death toll of the outbreak to date is now over 1000 deaths. The Red Cross warned that critical underfunding could force it to cut vital work to rein in the deadly Ebola virus in the Democratic Republic of Congo at a time when case numbers are soaring. (Photo by JOHN WESSELS / AFP)        (Photo credit should read JOHN WESSELS/AFP/Getty Images)

Health workers in Butembo, DRC, carry a coffin containing the body of an Ebola victim on May 16, 2019.

Photo: John Wessels/AFP/Getty Images

This is where things get worrisome when it comes to chora choras and the many others who find ways to cross out of eastern Congo without a health screening. While the overwhelming majority of people leaving the DRC, formally and informally, are healthy, there’s a danger when public health measures are circumvented — a chance, however slim, of the disease taking hold in a second country.

“The first thing that we can do is to continue to support the DRC, the WHO, and nongovernment organizations in the DRC to stop the spread of Ebola,” said U.S. Secretary of Health and Human Services Alex Azar on a recent trip to the DRC and its neighbors Rwanda and Uganda. “But we must recognize that the threat of spread into other neighboring countries is very real. With hundreds of thousands of people crossing very porous borders, this is a very real threat.”

While the majority of people leaving the DRC are healthy, when public health measures are circumvented, there’s a slim chance of the disease taking hold in a second country.

Ebola travels by motorbike and fishing canoe. It’s spread in private clinics and during burial rites. It’s carried in the bodies of preachers and traders and children. The nightmare scenario, according to experts, is the virus loose in an African city with lots of close contact and insufficient public health resources. The results could be catastrophic — worse than the West African outbreak earlier this decade that killed more than 11,000 people.

In June and again in August, Congolese infected with Ebola crossed into Uganda, the first times the disease jumped the border during this outbreak. In August, suspected cases surfaced in neighboring Tanzania.

In July, a pastor who ministered to Ebola victims carried the virus, undetected, through three health screening posts to Goma, the capital of Congo’s North Kivu province and the primary crossing to Rwanda, prompting WHO to declare the outbreak a Public Health Emergency of International Concern. Days later, a miner traveled to Goma from Ituri Province and infected his family. Last month, a mother and child with Ebola traveled through Goma to Mwenga, becoming the first cases in South Kivu province.

“Since Goma is a city of millions of people, and since it has an international airport, it is a great concern. If Ebola could get into Goma and spread in Goma, that increases the likelihood that it could spread beyond the DRC into neighboring and distant countries. That was why even one case in Goma was kind of like the straw that broke the camel’s back,” Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases, told The Intercept.

Many people, including the U.S. president, believe that closing borders is the key to stopping the spread of Ebola. “KEEP THEM OUT OF HERE!” Donald Trump tweet-shouted about American health workers who became infected with the virus while providing care as the largest Ebola epidemic in history raged in West Africa in 2015. They should, he wrote, “suffer the consequences” because “Ebola is much easier to transmit than the CDC and government representatives are admitting,” before pivoting to his preferred panacea for America’s supposed ills. “The U.S. must immediately stop all flights from EBOLA infected countries or the plague will start and spread inside our ‘borders.’ Act fast!” he insisted.


Ebola Fears Turn Into an Epidemic of Racism and Hysteria

It may seem counterintuitive, but closing borders in the face of Ebola is the worst possible response, according to experts. Met with border or travel restrictions, people who rely on crossing borders to feed their families — from chora choras to traders — will find a way to do so. “I emphasize that WHO does not recommend any restrictions on travel or trade, which rather than stopping Ebola, can actually hamper the fight,” said Tedros Adhanom Ghebreyesus, WHO’s director-general, noting that “restrictions force people to use informal and unmonitored border crossings, increasing the potential for the spread of disease.”

More than 100 million Ebola screenings have occurred during the outbreak. Twenty-eight times, health checks have stopped people with the Ebola virus in transit. But many are crossing borders without anyone ever taking their temperature or checking them for symptoms. An investigation by The Intercept found that Congolese and Rwandans are regularly traversing the frontier between the two countries without safeguards and health screenings. Some are bypassing public health efforts at formal borders. Others are slipping through informal crossings. Recent actions by the Rwandan military — efforts that seem to employ the Trumpian logic of closed borders — may also serve to encourage even more clandestine crossings and a greater chance for Ebola to find its way into that country. “These are a huge danger,” said Margaret Harris, a WHO spokesperson and medical doctor who also responded to the West African Ebola outbreak between 2014 and 2016. “These crossings are happening all the time.”

Congolese are seen lining up to wash their hands and get their temperatures taken at a Ebola screening station on the road between Butembo and Goma on July 16, 2019 - The first patient to be diagnosed with Ebola in the eastern DR Congo city of Goma has died, the governor of North Kivu province said on July 16, 2019. The case -- the first in a major urban hub in the region's nearly year-old epidemic of the disease -- has sparked deep concern in neighbouring Rwanda and at the UN. (Photo by JOHN WESSELS / AFP)        (Photo credit should read JOHN WESSELS/AFP/Getty Images)

Congolese people line up to wash their hands and get their temperatures taken at an Ebola screening station on the road between Butembo and Goma on July 16, 2019.

Photo: John Wessels/AFP/Getty Images

Petit Barrière

With around $100 million in cross-border commerce, the DRC is Rwanda’s largest trading partner. All that trade means lots of traffic. The International Organization for Migration, or IOM, is currently supporting 106 Ebola screening points at international borders in the provinces of North Kivu, Ituri, and South Kivu. Goma has the largest of them. About 14,000 people per day cross at Grand Barrière, according to Dede Ndungi Ndungi, chief of the technical division of the DRC’s National Program of Hygiene at Borders. About two miles away, the incongruously named Petit Barrière, connecting Goma and Gisenyi, Rwanda, is one of the busiest border crossings in the world. If there’s a front line to this fight, this is it.

“We’ve had too many instances of people crossing borders or coming from the infected areas down to Goma, and Goma is the gateway to Rwanda and the rest of the world,” said Harris. “It’s the point at which Ebola will most likely be transmitted abroad.”

Every day, between 25,000 and 50,000 people pass through Petit Barrière, mostly on foot. Small-scale trade in foodstuffs is the largest driver of movement and constitutes a “survival economy” for tens of thousands on both sides of the border.

Not so long ago, you walked along an open sewer through a Congolese market, crossed Petit Barrière, and that was that. Now, instead of proceeding straight toward the border gate, you’re diverted into a mucky fenced-in pen where you begin the Ebola equivalent of Martin Scorsese’s Copacabana sequence from “Goodfellas.”

Off to the right, two women sit at a blue plastic table, pens in hand. They’re waiting to record you on a fiche de pointage de voyageurs au point d’entree, which is nothing more than a big grid divided into 600 tiny numbered boxes, three sets of 200. If you’re the 401st person to cross that day, one of them puts an “X” across the third number one on the form. To the left, you stop at supersized wooden picnic tables topped with huge black plastic tanks, where taps of water and .05 percent chlorine solution empty into bright purple, orange, red, and blue buckets. As the smell of bleach wafts up from your freshly washed hands, you walk toward a man dressed in a white butcher’s apron holding what looks like a 1950s-vision of a ray gun.

The man is there to take a hard look at you. If you appear sick or febrile, he puts the gun to your head and pulls the trigger. In an instant, he can tell if you’re running a temperature. If you pass this first screener, you enter a hangar-like structure, turn right down a short corridor to another observation station where you’re sized up again. If you pass muster, then it’s a quick left down a long hallway, with an obstacle course of orange safety cones. A little further ahead, one man clad in a neon-yellow IOM vest sits on a tall stool while another stands, nominally looking at a thermal camera pointing your way. If you have a fever, it comes to life. “Beep, beeep, beeeep!”


Petit Barrière in Goma, DRC, the primary crossing between Congo and Rwanda, in August 2019.

Photo: Nick Turse for The Intercept

Set off that alarm and one of the IOM team checks your temperature with his ray gun. If, at any time, you’re flagged as potentially infected, you’re quickly escorted to an isolation room, a bright white concrete hut near the entrance of the Copa border zone. Continuing down the hallway, you encounter two officials from the DRC’s Directorate General for Migration. If they allow you to pass, you walk through a doorway out into the light of day and the heavily trafficked no man’s land between Congo and Rwanda. Continue onward, beneath a sign reading “Welcome to the Republic of Rwanda,” and you begin a similar process.

“Petit Barrière is the second-busiest land crossing on earth, and the flow of people is just constant,” Harris said. “I’m really impressed with the International Organization for Migration. They insist on everybody washing their hands, they watch people at about two or three different points. Even though it looks ugly, even chaotic, when you look at what they’re doing, they really are following everybody coming and going to Rwanda.”

“Goma is the gateway to Rwanda and the rest of the world. It’s the point at which Ebola will most likely be transmitted abroad.”

And that’s exactly how it worked — when I visited on a slow Sunday afternoon. It was a marvel of efficiency and efficacy in a country that too often lacks both. But when I went early on a Monday morning, it was a different situation, as traders bumped and jostled into the screening maze. Most people followed the protocols, but at least two merely feigned hand-washing. The first screener was there, but the second checkpoint was not. In the midst of a large group, the thermal scan can miss you. And all of that presumes that you’ve entered the surveillance scheme at all.

“The [Rwandan] health ministry is engaged in screening individuals coming from the Eastern DRC and the impacted zone, and we continue to work with Minister [of Health, Diane] Gashumba and the Ministry of Health in Rwanda to assist them with technical support and expertise on enhancing the screening procedures,” said Azar on his trip to the region. But you don’t need to spend weeks watching the border to begin seeing a significant number of people who bypass the Copa complex entirely. I watched, for example, a woman on crutches exchange angry words with screeners on both sides of the border and avoid hand-washing and a temperature check. There are also many able-bodied women who followed the same path, avoided the hand-washing and screening in Congo and simply crossed the border to join the queue for entry in Rwanda. Do Rwanda’s Ebola surveillance measures catch them? Maybe. But when I visited the border one Tuesday, they had run out of water for hand-washing on the Rwandan side.

Then there are the smugglers out to beat the duties on alcohol and other items, as well as Rwanda’s tariffs and impending total ban on the import of secondhand clothes. They mill around Petit Barrière, walk nonchalantly near the Rwandan side, and wait. One afternoon, for instance, I watched as a woman in a blue dress and a woven bag walked matter-of-factly through the gate where Rwandans exit their country. None of the many uniformed officials stopped her. That same day, a woman wearing a long, tight-fitting green, yellow, and orange dress crossed the border at least six times without ever passing through the DRC screening maze. None of these women looked even remotely sick, and there is no reason to suspect that they were infected with Ebola virus — or anything else — but it’s clear that border controls are in no way ironclad. The question is whether it’s worth incentivizing border-screening evasion to collect taxes or keep out cast-off American T-shirts, or whether the danger, however remote, from unscreened smugglers necessitates a change in policy?

And this, keep in mind, is the best-regulated border point in all of Goma. Officially, the city has 11 points of entry. But in the two miles between Petit Barrière and Grand Barrière, 14 separate footpaths connect Rwanda and Congo, according to a Congolese soldier who works at these informal crossing points and spoke on the condition of anonymity. A high-ranking police official, who also spoke on background, put the tally at 18.

This August 1, 2019 image shows the deserted offices of the immigration at the border between the Democratic Republic of Congo and Rwanda in Goma. - Rwanda has shuttered its frontier with Ebola-hit Democratic Republic of Congo after a third case of the deadly virus was detected in the border city of Goma, the Congolese presidency said on August 1, 2019. The announcement coincided with the first anniversary of an epidemic that has claimed more than 1,800 lives, stoking dread that the disease may spread from eastern DRC to vulnerable neighbours. (Photo by Pamela Tulizo / AFP)

The deserted immigration offices in Goma, at the border between the DRC and Rwanda, on Aug. 1, 2019.

Photo: Pamela Tulizo/AFP/Getty Images

Desperate Measures

For the entirety of the Ebola outbreak — and long before it — unofficial agreements between troops on opposite sides of the border have resulted in unregulated foot traffic between Congo and Rwanda, according to soldiers, police, officials from the Directorate General of Migration, and dozens of people living or working along the frontier. But at the beginning of August, after Goma saw its second death from the disease, Rwandan authorities closed the border for everyone other than Congolese citizens leaving their country.

WHO immediately requested Rwanda’s scientific justification, needed to uphold treaty obligations, for closing the border. Hours later, people were again passing through Petit Barrière and have been ever since. But it’s clear that Rwanda has throttled back the foot traffic, slowing the number of traders entering their country.

Experts say that border closures, as well as travel bans and restrictions, just don’t work. A 2014 study in the journal Eurosurveillance found that travel bans could only delay, not prevent, the international spread of the Ebola outbreak and only “at the risk of compromising connectivity to the region, mobilization of resources to the affected area and sustained response operations, all actions of critical value for the immediate local control of [Ebola virus disease] and for preventing its further geographical spread.” A 2016 retrospective epidemiological study of the West African epidemic found that “travel restrictions were not effective enough to expect the prevention of global spread of Ebola virus disease.” The research, in PLOS One, found that it was “more efficient to control the spread of disease locally during an early phase of an epidemic.”

“If people’s children go hungry, they’re going to find a way to cross.”

At about the same time as the August border closure, the Rwandan government made potentially more dangerous changes along its frontier. Instead of instituting public health and screening measures — such as hand-washing stations and temperature checks — the Rwandan army transferred almost all of the soldiers that had been manning neighborhood crossings to other duty stations elsewhere in Rwanda, according to those with an intimate knowledge of the border. This had the effect of disrupting informal agreements between Congolese and Rwandan troops and, as a result, local trade — of secondhand clothes, signature Congolese wax fabric, foodstuffs, and hard liquor — that provides the primary source of income for many people on both sides of the border.

The Rwandan Ministry of Defense did not respond to repeated requests for an interview about these personnel changes.

A busy intersection is pictured on July 16, 2019 in Goma. - The border between the DRC and Rwanda in Goma sees around seventy thousand people per day going back and forth. The town of Goma, which has a population of around two million has registered its first official case of Ebola. (Photo by JOHN WESSELS / AFP)

A busy intersection in Goma on July 16, 2019. About seventy thousand people cross back and forth across the border between the DRC and Rwanda each day.

Photo: John Wessels/AFP/Getty Images

“Congolese and Rwandans are both really suffering,” said a Congolese official who spoke on the condition of anonymity. Many people, according to the official, lack the necessary documents to travel to Rwanda or carry out legal trade, but were dependent on crossing the border to make ends meet. This was echoed by numerous Congolese military personnel and civilian officials. “If people’s children go hungry, they’re going to find a way to cross,” remarked another soldier who works on the border.

That desperation, say experts, is a recipe for a catastrophe. Aurelien Pekezou Tchoffo, another WHO doctor specializing in emergency preparedness, strenuously discouraged closing the border as a public health mechanism. “People are always going to find a way to cross,” he said as we stood together in the no man’s land of Petit Barrière. “It will just make it more difficult to screen people.”

That difficulty, in turn, means giving Ebola the opportunity to spread undetected. Closing or even slowing down legal crossings and imposing onerous restrictions increases the likelihood that people will use alternative means to bypass formal sites and encourages evasion of screening processes.

The Graveyard Crossing

The dead are laid to rest out on the edge of town, not far from Goma’s international airport. Behind a tumbledown neighborhood lie fields crisscrossed by walls of cement and volcanic rock topped with shards of broken glass and a forest where a herd of cattle grazes amid the trees, and men and women who arrive separately on foot and bicycle couple up in relative privacy. Beyond are the graves: some made of white tile topped with a cross; others look like jail cells, caged in by metal bars to prevent desecration.

A decade ago, almost as many people crossed between Congo and Rwanda at the Gabiro cemetery as at Grand Barrière. Today, this graveyard is not nearly as heavily trafficked, but it’s still in use — and bereft of any of the elaborate health checkpoints at Petit Barrière.

After being tipped off to an impending crossing, my fixer, driver, and I sat in the graveyard for a couple hours. As dusk approached, two men on a motorbike buzzed by a couple times. It wasn’t long before seven more with hard stares stalked down the road toward us — several of them carrying lengths of rebar. They stood on both sides of the car and shouted questions, indicating that it was time for us to go.

A few nights later, we went back again in a different car. A lot of people were hanging around and they weren’t from the local neighborhood. There were soldiers too. One came over to talk, climbed in the back seat of our car, and rested his Kalashnikov across his lap. As I shifted my leg down so the barrel rested atop my knee, instead of pressed into the side of it, he told us that many people were crossing the border. Since then, he and others stationed there said, the traffic has only increased.

Soldiers, police officers, and other government officials would speak only on the condition of anonymity because, officially, this is a criminal enterprise and in many cases they’re involved in some way. “Of course, it’s happening. Those informal entrances are functioning,” said a senior police official who insisted that his forces were serious about securing the border. Several soldiers, however, admitted that they and their local commanders were involved in cross-border trade. But instead of facing reality and reducing the Ebola risk through the type of screenings performed at Petit Barrière and other formal border crossing points, both Rwanda and DRC are turning a blind eye.

There is, in fact, no need to take such chances. “IOM supports screening at informal border crossing points,” Daco Tambikila, a spokesperson for the organization told The Intercept, noting that medical screenings can “easily be established at informal BCP.”

GOMA, NORTH KIVU, DEMOCRATIC REPUBLIC OF CONGO - 2019/06/15: A health worker dressed in a full protective outfit stands next to an ambulance at an Ebola treatment centre in Goma.
DR Congo is currently experiencing the second worst Ebola outbreak in recorded history. More than 1,400 people have died. (Photo by Sally Hayden/SOPA Images/LightRocket via Getty Images)

A health worker, dressed in a full protective suit, stands near an ambulance at an Ebola treatment center in Goma on June 15, 2019.

Photo: Sally Hayden/LightRocket via Getty Images

Worst-Case Scenario

The Democratic Republic of Congo’s most endangered neighbors: Burundi, Rwanda, South Sudan, and Uganda have all taken steps to halt Ebola at their borders and joined with partners to strengthen their public health systems. But many challenges remain. “The worst-case scenario is if it spreads into some neighboring African countries that have very vast populations,” said Anthony Fauci, director of the NIAID.

Wracked by poverty and years of civil war, South Sudan has very little effective public health infrastructure and sophisticated medical care is all but nonexistent. “If it gets into a country like South Sudan, where it would be difficult for their health system to contain it, then it could really spread and cause a lot of havoc in that country,” said Fauci. Rwanda’s relatively good infrastructure, especially the smooth, paved roads from the DRC border to its capital, Kigali, poses its own unique risks. “The more sophisticated the infrastructure, the better the transport, the more quickly the disease can spread,” notes the WHO’s Margaret Harris.

Several cases of a disease with Ebola-like symptoms in Tanzania have led to a recent standoff between that country, which claims it has no suspected or confirmed cases of Ebola, and the WHO which says that vital clinical data and the results of the investigations and laboratory tests have been withheld from it, making it impossible to accurately assess the situation.  Tanzania, like all of Congo’s other “priority two” neighbors (Angola, Central African Republic, the Republic of Congo, and Zambia) lacks sufficient “financial support for implementing emergency preparedness activities,” according to the WHO.

“The current Ebola outbreak in the Democratic Republic of the Congo is a poignant reminder of the importance of a strong surveillance system,” said Matshidiso Moeti, WHO’s regional director for Africa. But neither Congo, Rwanda, nor any of the other 45 member states of the WHO African Region — despite being signatories to the 2005 International Health Regulations and thus, legally bound to work together to stop the international spread of disease — meet all the required IHR capacities and have the full capability needed to prevent outbreaks from spreading beyond their borders. More worrying still, WHO doesn’t even have sufficient funds to fight the outbreak in DRC into the near future. In a recent financial update, WHO said it needed at least $120 million to pay for its own operations and $287 million, in total, to fund its partners until the end of the year. To date, the organization has only received $60 million, about a fifth of the money it needs.

Since the beginning of the Ebola outbreak in August 2018, the U.S. Agency for International Development has provided close to $150 million in funding for the Ebola outbreak in Congo and almost $10 million to enhance preparedness in neighboring countries. “U.S. health care workers, including some of the brave heroes of the Centers for Disease Control and Prevention,” are also “operating in the front lines of the response,” according to Azar.

In 2015, these “brave heroes” were just the sort of people citizen Donald Trump said should “suffer the consequences” and be barred from returning to the United States. Whether President Trump’s thinking on Ebola has evolved in the years since is unclear. Does he still favor border restrictions as a response?  A senior administration official offered only stale talking points about the Ebola outbreak but wouldn’t comment on the president’s understanding of the disease and ways to combat it.

The World Health Organization’s Margaret Harris, now a veteran of the response to the two largest Ebola outbreaks in history, has no qualms about explaining exactly what such restrictions mean in the real world. “Closing borders will just force the disease underground,” she told The Intercept. When virus transmission went underground in Guinea during the West Africa outbreak, due to fears about seeking treatment, it allowed Ebola to take root and then cross into Sierra Leone. The results were catastrophic.  “It was like a bushfire,” Harris recalled. “I was in Freetown when it hit. It’s not something that you want to see in a populated area. There were people dropping dead in the streets.”

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