Arson attacks on Ebola treatment facilities in the Democratic Republic of Congo underscore the huge challenges authorities face – including the backlash of local communities – as they try to contain an outbreak of the infectious disease that has been declared a global health emergency.
On Sunday, Congolese authorities said that suspected cases have now exceeded 900 in the east of the country, mainly in Ituri province, where the disease is spreading.
The burning of facilities last week in two towns at the center of the outbreak has exposed anger in a region wracked by violence linked to armed rebel groups, mass displacement, local government failure and cuts in international aid that experts say have stripped vulnerable communities of health facilities.
“Emergencies are converging,” said the non-profit organization Physicians for Human Rights.
Here’s a look at the long-running conflict in eastern Congo that has made it home to some of the world’s worst humanitarian disasters, and how it is now affecting the response to a rare strain of Ebola.
Constant threat of violence
Eastern DRC has for years seen attacks by a number of different groups and rebels, some of which are linked to foreign countries or the Islamic State group.
The pro-Rwanda M23 rebels control parts of the region. While the Congolese government still largely controls the northeastern province of Ituri, the epicenter of the Ebola outbreak, that control is not easy. The Allied Democratic Forces, a Ugandan Islamist group linked to ISIS, is one of the main rebel groups and has been responsible for violent attacks against targeted civilians.
Before the outbreak of the disease, Doctors Without Borders revealed that the insecurity situation in Ituri has worsened recently, which has caused doctors and nurses to flee, leaving health facilities burdened and in other places, “catastrophic conditions.”
About 1 million left their homes in Ituri
The UN office says nearly a million people have been displaced from their homes by the conflict in Ituri.
That means that this Ebola outbreak is “occurring in communities that are already facing insecurity, displacement and fragile health care systems,” said Gabriela Arenas, regional coordinator at the International Federation of Red Cross and Red Crescent Societies.
There are concerns that the disease could spread to large displacement camps near the town of Bunia, where the first cases were reported.
Congo’s Ministry of Communications said as of Sunday there were 904 suspected cases of Ebola, most of them in Ituri – a huge jump from the 700 suspected cases previously announced.
The Ministry also said that the number of people who have died due to Ebola stands at 119, but the numbers released separately for each region reached 220.
Cases were also reported in two other eastern provinces, North Kivu and South Kivu, where the M23 rebels are in power, and in neighboring Uganda.
As a result, the outbreak in the DRC is controlled partly by the government and partly by the rebel authorities, with aid agencies also helping.
Devastating aid cuts
Health experts say that the reduction of international aid last year by the United States and other rich countries hurt the east of the DRC because of its many problems.
The cuts have “reduced the ability to detect and respond to infectious disease outbreaks,” said Thomas McHale, director of public health at Physicians for Human Rights. The DRC has had more than a dozen Ebola outbreaks.
Aid groups fighting the outbreak on the ground say they do not have the necessary equipment, such as face shields and suits to protect health workers from infection, testing equipment, and body bags and other items needed to safely bury the bodies of the dead, which can be highly contagious.
The World Health Organization expects Ebola cases to rise, which it considers a public health emergency of global concern, but not a pandemic emergency. The Democratic Republic of Congo and Uganda have both declared outbreaks.
“We have made requests to different partners, but so far we have not received anything,” said Julienne Lusenge, president of Women’s Solidarity for Inclusive Peace and Development, an aid group working in a small hospital near Bunia.
“We only have hand sanitizer and a few masks for the nurses,” she said.
The Bundibugyo strain of Ebola virus causing the outbreak has no approved vaccine or treatment.
Anger from local communities
The burning of treatment centers in Rwampara and Mongbwalu areas – which have high Ebola rates – shows how the backlash in some communities is driving the response.
Colin Thomas-Jensen, director of impact at the Aurora Humanitarian Initiative, said the attack may reflect the “built-in skepticism and anger” of people in eastern DRC at the way the region has been treated, with years of violence from affiliated rebel groups and the failure of their government and international peacekeepers to protect them, he said.
Another source of anger has been strict rules around the burial of suspected Ebola victims, with authorities taking action wherever they can to stop the spread of the disease at traditional funerals – where families prepare bodies and people gather for funerals.
The first incident of burning the Ebola center in Rwampara was done by a group of local young men who were trying to remove the body of his friend, according to witnesses and the police. Witnesses said the mob accused a foreign aid agency working there of lying about Ebola.
Authorities in northeastern Congo have now banned funerals and gatherings of more than 50 people, while soldiers and armed police are monitoring other funerals by aid workers.
