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Arson attacks on Ebola treatment centers in eastern Congo show how authorities are faced with a number of serious complications – including a backlash in local communities – as they try to stop an outbreak of an infectious disease that has been declared a global health emergency.
The burning of the centers in two towns at the heart of the outbreak shows the anger in a region beset by violence linked to armed rebel groups, the displacement of a large number of people, the failure of local government and international aid cuts that experts say have stripped health facilities in vulnerable communities.
“A devastating set of emergencies are converging,” said the Physicians for Human Rights nonprofit.
Here’s a look at the longstanding crises in eastern Congo that have made it home to one of the world’s worst humanitarian disasters, and how they are now affecting the response to a rare type of Ebola:
The region has a constant threat of violence
Eastern Congo has seen violence by dozens of separate rebel groups for years, some of them with links to foreign countries or Islamic State.
The Rwanda-backed M23 rebels are in control of parts of the region. While the Congolese government still largely controls the northeastern Ituri Province, which is the epicenter of the Ebola outbreak, that control is tenuous. The Allied Democratic Forces, a Ugandan Islamist group linked to Islamic State, is one of the dominant rebel groups there and responsible for violent attacks against civilian targets.
Before the outbreak, Doctors Without Borders said in an assessment of the situation in Ituri that the insecurity had worsened recently, causing doctors and nurses to flee and leaving overwhelmed health facilities and “catastrophic” conditions in some parts.
Nearly a million people are displaced in Ituri
Nearly 1 million people in Ituri have been displaced from their homes by conflict, according to the United Nations humanitarian office.
That means this Ebola outbreak is “unfolding in communities already facing insecurity, displacement and fragile health care systems,” said Gabriela Arenas, Regional Operations Coordinator at the International Federation of Red Cross and Red Crescent Societies.
It’s a significant concern that the disease might spread to the large displacement camps near the city of Bunia, where the first cases were reported.
Authorities have announced more than 700 suspected Ebola cases and more than 170 suspected deaths, mostly in Ituri. But cases have been reported in two other eastern provinces, North Kivu and South Kivu, where M23 are in control, and also in the neighboring country of Uganda.
That means that part of the outbreak in Congo is being managed by the government and part by rebel authorities, with an array of aid agencies also helping.
Aid cuts were devastating for eastern Congo
Health experts say international aid cuts last year by the United States and other rich nations were devastating for eastern Congo because it has so many problems.
The cuts “reduced the capacity to detect and respond to infectious disease outbreaks,” said Thomas McHale, public health director at Physicians for Human Rights. Congo has had more than a dozen previous Ebola outbreaks.
Aid groups fighting this outbreak on the ground say they don’t have the equipment they need, like face shields and suits to protect health workers from infection, testing kits, and body bags and other materials needed to safely bury the bodies of victims, which can be highly contagious.
“We have made requests to different partners, but we have not yet really received anything,” said Julienne Lusenge, president of Women’s Solidarity for Inclusive Peace and Development, an aid group operating a small hospital near Bunia.
“We only have hand sanitizer and a few masks for the nurses.”
The Bundibugyo type of Ebola virus responsible for the outbreak has no approved vaccine or treatment.
Health and aid workers also face anger from local communities
The burning of two treatment centers by people in the Rwampara and Mongbwalu areas – which have the highest case counts – show how a backlash in some communities is further complicating the response.
Colin Thomas-Jensen, director of impact at the Aurora Humanitarian Initiative, said the attacks may reflect the “built-in skepticism and anger” of people in eastern Congo over how the region has been treated, with years of violence from foreign-linked rebel groups and a failure of their government and international peacekeepers to protect them, he said.
Another source of anger has been the strict protocols around the burial of suspected victims of Ebola, which authorities are taking charge of wherever they can to prevent further spread of the disease when families prepare the bodies and people gather for a funeral.
The first burning of an Ebola center in Rwampara was by a group of local youths trying to retrieve the body of a friend who died, according to witnesses and police. The witnesses said the crowd accused the foreign aid group operating there of lying about Ebola.
Authorities in northeastern Congo have now banned funeral wakes and gatherings of more than 50 people in an effort to curb the spread, and armed soldiers and police are guarding some burials carried out by aid workers.
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AP writers Mark Banchereau and Wilson McMakin contributed to this report.
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