Attack on Ebola Hospital in Eastern Congo Echoes Past Violence Against Health Workers

Ebola

An angry crowd set fire to Ebola isolation tents outside a hospital in the Democratic Republic of Congo’s (DRC) Ituri province on Thursday after the family of a young man who died of the virus was refused permission to take his body to be buried.

The attack on Rwampara General Hospital, near the city of Bunia, came as the World Health Organization (WHO) raised its risk assessment of the DRC outbreak from “high” to “very high” for the country, citing the rapid spread of cases and growing insecurity.

The risk remains “high” regionally and “low” globally, WHO Director-General Dr Tedros Adhanom Ghebreyesus told a Geneva media briefing on Friday.

Six patients were being treated in the two tents set alight, according to ALIMA, the medical charity that ran the isolation unit. Police fired warning shots and teargas to disperse the crowd, and local authorities placed health workers at the hospital under military protection.

Dr Anne Ancia, WHO’s representative in DRC, told reporters that the incident would “significantly jeopardize” containment efforts in Bunia, one of three hotspots in the outbreak.

The tents had been set up to separate suspected Ebola patients from those receiving routine care in the main hospital building, said Ancia, addressing the media briefing via phone from the DRC.

She said that WHO security teams were meeting with the provincial governor and health authorities, and hoped that operations at the hospital “will be able to start again tomorrow”.

Contact tracing is uneven across the affected provinces. Ancia said tracing in South Kivu was “sufficient” at around 80%, with 89 contacts already identified for a single new case confirmed in Riho. 

But in violence-affected Bunia, the figure stood at just 11% as of Wednesday evening.

Dr Anne Ancia, WHO’s lead in the DRC.

“This outbreak can still be contained, but the window for action is narrow,” said Gabriela Arenas, the International Federation of the Red Cross’ region lead. “What happens in the coming days – in homes, in communities, and across borders – will matter enormously.”

While some media reports suggested that the infected patients had fled into the community during the chaos, all six patients from the isolation tents “are currently being cared for at the hospital,” ALIMA said in a statement.

ALIMA CEO Dr Moumouni Kinda told Health Policy Watch the response was being held back by a combination of conflict, weak local administration, and community members’ lack of knowledge about the disease in a region that had not previously faced Ebola.

“The war, the disorganization of local public authorities, and the lack of resources mean that, of course, the Ebola outbreak will continue to worsen,” Kinda said.

“This is a region that has not known Ebola. It is new, and the people do not necessarily have the reflexes as in zones like Goma or others which have seen Ebola in the past.”

A rare strain, with no vaccine or treatment

Health workers in the DRC put together protective gear during an Ebola outbreak in 2019.

The outbreak is caused by the Bundibugyo strain of Ebola, a rare and deadly variant with no licensed vaccine or therapeutic that kills up to half of those it infects. WHO officials said this week that candidate vaccines in the pipeline could take up to nine months to reach patients.

The outbreak is “spreading rapidly”, with 82 cases and seven deaths confirmed in DRC, Tedros told reporters on Thursday.

“We know the epidemic in DRC is much larger,” Tedros said.

The outbreak is centred in Ituri province, with cases also confirmed roughly 350 miles southwest in Goma, in North Kivu. Across the two provinces, around four million people need urgent humanitarian assistance, two million are displaced, and 10 million face acute hunger, according to UN figures.

In neighbouring Uganda, two cases have been confirmed in people who travelled separately from DRC, including one death. Yet the situation in Uganda remains “stable”, Tedros said.

Ugandan authorities have suspended flights, boats, buses and all other public transport across the border for at least four weeks, a significant decision in a region where cross-border movement is fundamental to livelihoods.

More than 186,000 people per month moved across eight border points during the previous Ebola outbreak that killed 2,299 people over nearly two years, according to the International Organization of Migration (IOM).

Local beliefs, deep distrust

Ebola response workers in the DRC.

“There is significant distrust of outside authorities among the local population,” Tedros said. “Building trust in the affected communities is critical to a successful response, and is one of our highest priorities.”

The man whose death triggered Thursday’s violence was a well-known local footballer. His mother told Reuters she believed her son had died of typhoid fever, not Ebola.

Meanwhile, a local politician who witnessed the attack told the BBC that residents did not believe that the virus existed.

The bodies of Ebola victims remain highly infectious after death. Traditional funeral rites in the region, during which mourners touch and wash the deceased, have been a persistent driver of transmission in past outbreaks.

While WHO guidelines mandate “safe and dignified” burials handled by trained teams, convincing the local population to set aside their rituals can be a difficult task.

“We have learned from the past that epidemics are not contained by medical response alone,” Arenas said. “They are contained when communities trust the response, when people have reliable information, and when local action is supported quickly and consistently.”

He described community reactions as mixed: “For some people, the outbreak is very real, and they are seeking information on how to protect themselves and their families. For others, there is still suspicion and misinformation with claims that Ebola is fabricated.”

Valet Chebujongo, a community mobiliser in Bunia, told CNN that fear in the affected communities was being fuelled by superstition, and people were turning to prayer and traditional remedies.

ALIMA, the charity operating the tents, also warned against social media rumours that could “fuel fear, misinformation and mistrust towards health facilities and the teams involved in the Ebola response.”

A region with a history of attacks on health workers

WHO Scales Back Ebola Response Following Deadliest Attacks Ever On DRC Health Workers

The fire raised dark memories for veterans of DRC Ebola outbreak response in North Kivu and Ituri a few years ago, the second-largest on record.

At least 25 health workers were killed in violent attacks between 2018 and 2020, 13 of them working for international agencies, while 27 were abducted by armed groups, according to an analysis by Insecurity Insight. 

In total, more than 450 acts of violence or threats against health workers were recorded, the analysis found. 

Some attacks were targeted assassinations. Dr Richard Mouzoko, a Cameroonian WHO epidemiologist, was shot dead during a raid on a hospital in Butembo in April 2019. 

In Lwemba, civilians associated with a Mai-Mai militia set fire to four health facilities and 18 houses belonging to Ebola responders following the death of a local Red Cross worker.

Others were driven by community mistrust. A Lancet Infectious Diseases study conducted in Beni and Butembo found that one in four respondents believed the Ebola outbreak was not real, and that such beliefs were strongly associated with a “decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines.”

The violence in late November 2019 forced WHO to evacuate non-essential staff from the Biakato Mines area, the first time it had pulled personnel at that scale during an outbreak.

Cases surged in the weeks that followed.

Health workers also paid a direct toll from the virus itself. By the end of the outbreak, 171 health workers had contracted Ebola, accounting for roughly 5% of all cases.

Logistical challenges in the current outbreak compound the risks. Goma’s airport, the nearest major hub to Bunia, is under the control of the M23 rebel group and is no longer functioning.

In a statement this week, M23 – which has never handled a public health crisis as a governing authority – said it had identified and isolated all contacts of the confirmed Goma case and urged residents of “the liberated areas to remain vigilant, avoid panic, and strictly adhere to the preventive measures recommended by health services.”

“Surveillance and emergency response teams remain fully mobilised to monitor the situation and protect communities,” a spokesperson for the group said.

Image Credits: WHO, John Wessels/ MSF, WHO AFRO.

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