Dozens of attacks against medical facilities and teams have taken place since the outbreak began, primarily due to fear and mistrust within local communities, health care workers tell TIME. They warn that this violence escalates risk for both the professionals and the infected people in their care—and it will undoubtedly raise the death rate.
“Many of the attacks have been carried out by angry mobs who have stormed treatment centers or targeted response teams in the field,” Dr. Pierre Akilimali, incident manager for the Ebola response at the National Public Health Institute of the DRC, said at a press briefing in Bunia on July 18.
Locals told the Associated Press (AP) that health care workers were seen last week fleeing more remote communities in Ituri and heading to its capital, Bunia.
Critical response specialists have also been “held captive” in certain health zones, said Dr. Adelard Lufongola, the operations manager for the DRC’s Ebola response, in a briefing over the weekend according to AP.
And it isn’t just medical staff. Frontline workers, such as those tasked with “safe and dignified burials,” are frequently targeted in local cemeteries, he said.
However, bodies that have been affected by Ebola are “much more contagious” than when they were alive, so health care workers must dispose of bodies in specific ways, she explains. These safety protocols may not be compatible with the rites that family members want to carry out, such as washing and preparing the bodies of their loved ones.
“The health system is quite weak,” Abdou Sebushishe, senior health advisor with the nonprofit International Medical Corps, tells TIME. “Then when the outbreak starts, and [community members] see a lot of resources being deployed for the single disease that they just heard about, they feel like that discrepancy is suspicious.”
The recent attacks against health care workers are especially alarming because a successful Ebola response depends on people seeking care, reporting cases, and working with health officials.
The only way to prevent its rapid spread is through containment—but containment efforts can also fuel mistrust, Sebushishe says, and that’s partly because outreach is often insufficient at the beginning of an outbreak.
“You say it everywhere, that this disease does not have specific treatment, so why are you isolating us—for what reason?” he recalls people asking.
He says it took considerable effort for his team to convince locals that “when someone is treated early, they can have a chance to survive.”
The virus is already spreading “substantially faster” than it did in previous Ebola outbreaks, according to the United States Centers for Disease Control and Prevention (CDC). It’s the third-largest on record, with 2,473 confirmed cases since the crisis began in May, according to DRC government data from Wednesday. In the 2018-2020 outbreak, it took 10 months to reach 2,000 cases, the CDC reported.
Professionals who come in after an outbreak is detected, as part of “response teams,” can only do so much. Sebushishe advocates for a more proactive approach: educating communities and seeking their support. Without community cooperation, he says, the disease is likely to spread exponentially.
Ribes agrees that community cooperation is key. Since Ebola is only contagious once there are symptoms, she believes that community members must be able to identify a potential new case.
Funding is critical for both shoring up resources and implementing the necessary training in the affected areas. However, the World Health Organization said last week that it has received about 40% of the $115 million that it has deemed necessary to fight the outbreak.
The result is often greater resistance to—and even hostility toward—response teams.
Attacks compound the challenges that health care workers face
“When our team goes on the ground now, they have to go through security first,” Sebushishe says. “So it's delaying the deployment of staff.” In some instances, they drive with tinted windows to avoid being identified as health care workers, he says.
Additionally, when people begin to think treatment centers are unsafe, “it will further reduce their care-seeking behavior,” Sebushishe says. Some symptomatic individuals might never come for help—and those who do might leave while they are still contagious.
The response is also being challenged by administrative hurdles. Care providers in Ituri went on strike in July, blocking the entrance to Bunia General Hospital.
As a result, she adds, any delay in funding the response “is just leading to more death.”
Surveillance, she explains, allows health professionals to identify new cases, make sure those impacted are quickly isolated, and begin to trace contacts to try to prevent further spread.
TIME has reached out to the Congolese Health Ministry for comment.
‘We are all at risk if we don’t stop it’
“I know that if we don't stop this outbreak from wherever it has reached, it will spread farther,” he tells TIME. “It will reach our own families and ourselves. So we are all at risk if we don't stop it.”
Sebushishe says his team has made massive strides in increasing trust and cooperation from the community by including them in decision-making.
He gives the example of Kigonze Camp, an internally displaced persons site on the outskirts of Bunia, where he says groups of people initially threw stones at the teams responsible for “safe and dignified” burials. Once Sebushishe’s team invited the community leaders to meet, explained their intentions, and gave them more control over how things would be done, the leaders agreed to allow the medical professionals to do their work without further interruption.
“The key for this outbreak to end—but also for all these new threats to the response to end—is the proper community engagement,” he says. “Reach every community by every means, so that everyone understands that this is not an issue that can be taken lightly.”
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