Despite a worsening Ebola epidemic in the Democratic Republic of Congo, the World Health Organization on Friday again decided not to declare the outbreak a global health emergency.
While expressing “deep concern” about the number of increasing cases in parts of Congo, and the potential risk of the disease spreading to neighboring countries, the W.H.O. said the epidemic did not meet the criteria for declaring an international public health emergency.
This is the second time since the outbreak began last year that the W.H.O. has declined to issue such a declaration. Some researchers have urged the organization to do so for months; such pronouncements are reserved for epidemics that pose a serious threat to public health and could spread internationally. A global health emergency signals an urgent need for more money and international help to stamp out the disease.
The epidemic, in its eighth month, has sickened 1,206 people and killed 764 as of Wednesday, the W.H.O. reports. The disease has struck two northeastern provinces, North Kivu and Ituri, which are a conflict zone, rife with armed militias. There have been multiple attacks on treatment centers by unknown assailants.
Case counts have jumped recently, with 20 new cases on Wednesday, the highest number in any one day since the outbreak began in August, according to the International Rescue Committee.
“The situation is bad and it’s getting worse,” said Tariq Roland Riebl, the emergency response director for the I.R.C.
Fear and distrust of the government run deep in the region, and extend to the Ministry of Health and organizations thought to be associated with it, including aid groups and the W.H.O. Suspicion has led some people to avoid testing and treatment altogether, or to postpone it until they are too sick to be saved.
A particular concern is that many deaths have occurred in the community, rather than in treatment centers. Keeping the sick at home helps spread the virus, because the disease becomes more contagious as it progresses. It is spread by bodily fluids, so caregivers who lack protective gear are almost certain to become infected, as are those who prepare corpses for burial.
Some of the anger and distrust stem from the way aid groups have operated, said Dr. Natalie Roberts, the emergency operations director for Doctors Without Borders. She said people in the communities did not understand why those with potential Ebola symptoms like fever, even children, would be isolated for as much as 48 hours while waiting for test results, and why those who tested negative might be released without a diagnosis or treatment for their fever, which might well be malaria.
Dr. Roberts said the group was changing the way it deals with patients, letting them wait at home for test results, and making sure to address their other health concerns.
Earlier declarations for a “public health emergency of international concern,” the official title, were issued for swine flu in 2009, polio in 2014, Ebola in West Africa in 2014 and Zika virus in 2016.
Some researchers say that W.H.O. should have declared an emergency months ago. The committee had met in October, but decided then not to issue the emergency declaration.
Experts from Johns Hopkins University called for the declaration back in November, in an article in The New England Journal of Medicine, saying that the move “would increase both political attention and the financial resources flowing to the control effort.”
In an interview, one of the authors, Jennifer B. Nuzzo of the Johns Hopkins Center for Health Security, said, “I think it’s absolutely essential that they do declare it now. They need to make clear for countries the urgency of the situation and to increase pressure on W.H.O. members states to do more to bring this outbreak under control.”
She said there is sometimes hesitation about declaring emergencies, out of concern that they will prompt other nations to impose needless bans on travel or trade that would further stigmatize countries with outbreaks and batter their economies. But she said that there were ways to discourage such bans, and that an emergency declaration should be made strictly on the basis of health concerns, not politics.
The outbreak is the second largest ever. The deadliest Ebola epidemic occurred from 2014 to 2016, in Guinea, Liberia and Sierra Leone, and sickened 28,610 people and killed 11,308. The W.H.O. faced sharp criticism for its slow response in the early phases of that outbreak.