With more than 20,000 cases and 300 deaths officially reported in 2015, the measles outbreak in Katanga is the largest since 2011, when MSF immunised 2.1 million children against the disease.

"In June, 10 health districts out of the 68 in Katanga were facing an epidemic situation. Today that number has more than doubled and continues to grow, while the Congolese government has still not made any official declaration about the epidemic," says Jean-Guy Vataux, MSF Head of Mission in DRC.

The delay in acknowledging the gravity of the epidemic may have held up the release of funds, hindering a timely response. The United Nations finally announced on August 19 the disbursement of $2.4 million to help the government and humanitarian actors responding to the outbreak. But Jean-Guy Vataux warns that money alone is not enough. "We need more actors in the field. MSF remains one of only two organisations in Katanga today involved in treating measles and immunising children against it."

MSF teams are currently deployed in more than 10 health zones in Katanga, supporting local health authorities. During the last three months, MSF treated more than 20,000 measles-infected patients in 5 hospitals and approximately 100 health posts, and also vaccinated above 300,000 children. Measles is now almost endemic in the region and particularly dangerous for the very young already exposed to other pathologies such as malaria and acute malnutrition.

"Every day we discover new deaths related to measles that have not been accounted for. The absence of free care in public health facilities often discourages mothers from taking their sick children," says Augustin Ngoyi, MSF coordinator of the response. "In a village of 500 inhabitants two hours’ drive from Kabalo, more than 30 children under 5 years of age have died in the last 2 months. Their little graves are still visible in the cemetery. This represents one third of this age group in the community."

The geography of Katanga, with challenging access to some remote villages in the heart of the forest, is the main factor limiting the implementation of vaccination campaigns. “The vaccine against measles is very effective but it is not well suited to this type of environment," says Aurore Taconet, MSF vaccination referent in Paris. "It requires a thorough cold chain that is difficult to maintain in such conditions, and a second booster dose at least one month after the first. Such constraints mean huge needs in terms of equipment and human resources, and therefore a significant cost. "

Vaccination against measles and other diseases is normally part of the routine immunisation performed in Congolese health centres. Catch-up campaigns to raise the proportion of vaccinated children are also organised every year. But Dr Michel Janssens, MSF medical coordinator on site, says that many children seem to be missing out. "An epidemic of this magnitude should not occur if the reported immunisation coverage rates against measles in Katanga are accurate," he says.