The Economist: THE GREATEST fear of most health workers battling Ebola is catching the deadly virus. But to Dr. Richard Valery Mouzoko Kiboung, an epidemiologist from Cameroon working with the World Health Organisation (WHO), violence was also a pressing worry. Dr. Mouzoko was stationed in Butembo, a city in the east of the Democratic Republic of Congo and the centre of an Ebola outbreak that was detected nine months ago. The area around it is in effect a war zone, home to over 100 militias. Locals misunderstand and distrust health workers.
On April 19th gunmen burst into a meeting of the local Ebola response team that he led. The attackers took everyone’s phone, then started shooting. Two people were wounded. Dr. Mouzoko was killed. Hours later a group of people armed with machetes tried to set fire to an Ebola treatment centre at a hospital in nearby Katwa.
The violence is part of a trend. In February and March several clinics were attacked, leading Médecins Sans Frontières, a medical charity, to pull its staff from the area around Butembo. A car carrying experts from the WHO was ambushed and damaged by men with sticks. Machete-wielding attackers slashed the head of a health worker responsible for safely burying Ebola victims, so that their corpses do not infect new victims. Congo “is as complex and as volatile an environment as I’ve seen,” says Mike Ryan, who directs the WHO’s health-emergency programme.
The WHO and other responders appeared to be getting a handle on the outbreak in January, but the violence has set their efforts back. The virus has infected nearly 1,400 people and killed nearly 900. In April the WHO said there was a very high risk that Ebola would spread, including to neighbouring countries such as Uganda, Rwanda and Burundi. Those countries have been asked to start vaccinating health workers and watch out for the virus. The WHO says that more work is also needed in mapping the movement of people, such as workers and refugees, across borders.
Tedros Adhanom Ghebreyesus, the head of the WHO, says it is becoming difficult to persuade his staff to go into the field. He is visiting Butembo to try to calm his workers and analyse the situation. He is now expecting a rise in the number of cases of Ebola. “Whenever there is an attack it slows down the response, and the number of cases immediately increases as the virus gets the advantage and continues unabated,” he says.
Locals, whose basic needs have long been neglected, resent the massive deployment of resources just to fight the virus. Earlier efforts by the police and armed forces to compel people to take preventative measures alienated the local population. Some even imagine that the government is using Ebola to exterminate the Nandes, the biggest ethnic group in the region, or that the emergency was manufactured to keep people from voting in elections last year. The idea that Ebola does not actually exist has been spread by some groups for political advantage, says Dr. Tedros, who described it as “playing with fire”. Though he says local leaders have agreed to deliver the same message about the dangers of Ebola.
The WHO has thus far declined to declare the outbreak a public-health emergency of international concern, its loudest alarm bell. The means of controlling Ebola are well understood from previous outbreaks. These include quickly and safely burying victims, tracing the contacts of those infected and vaccinating people in affected areas. Dr. Tedros says he has agreed to increase vaccination coverage as soon as possible. There is also discussion of using a different type of vaccine that could be administered to many more people than the one currently in use. But it is almost impossible to do any of this unless health workers can be kept safe.
“And there shall be. . . pestilences.” Matthew 24:7.