Fighting Ebola When Mourners Fight the Responders

BENI, Democratic Republic of Congo — When Ebola came to this city in the Democratic Republic of Congo, Janvier Muhindo Mandefu quit farming and got work burying the highly contagious bodies of Ebola victims.

But Mr. Muhindo is less afraid of Ebola than of the mourners he encounters at funerals. He and his burial team have been attacked by relatives of the dead, one swinging a hoe. Mourners have shouted at team members, accusing them of stealing the organs of corpses, and have threatened to throw them into the open graves. Last month a mourner brandished a hand grenade, he said, sending everyone scattering and leaving a 3-year-old Ebola victim unburied.

“Someone like me can be buried alive,” Mr. Muhindo said as his colleagues hosed down their trucks at the Red Cross compound after another day of burials.

This Ebola outbreak in eastern Congo, the second-largest ever recorded, is now spiraling out of control. Despite some early success — helped by a new and effective vaccine — the disease has come roaring back in the past two months.

Making matters worse, police officers and soldiers accompanying Ebola response teams have on occasion opened fire during confrontations with grieving family members and neighbors, according to interviews with health workers who described three such episodes — one that is being examined by the United Nations. The confrontations tend to occur when Ebola responders try to take bodies away from grieving family members and take charge of the burial.

As the disease spread to Butembo, a larger, more prosperous city of about one million, many patients who had Ebola resisted going to designated treatment centers, seeing them as a place to die rather than be cured.

Other patients who went to see their doctors with common symptoms, such as headaches and fevers, were often forced into Ebola quarantine centers for a few days pending tests.

Many of the symptoms of Ebola resemble those of more common maladies, such as malaria. At one quarantine facility in Beni, fewer than 2 percent of patients tested positive for Ebola, according to interviews with health officials and an epidemiological report provided by a medical organization.

Mistrust settled in, affecting even those who have seen Ebola up close.

“The way my wife died, it is not Ebola that killed her that day,” said Héritier Bedico Zawadi, an engineer, one sleepless month after the death of his wife, Suzanne Kahindo Kitseghe, a 29-year-old doctor.

She had been exposed to the disease when a patient at her hospital wouldn’t stop bleeding, a classic Ebola symptom, after an IV line had been inserted, according to Dr. Michel Kalongo, an official in the local doctors union who knew Dr. Kahindo.

Many of the patients fled into the night. Some of those too sick to flee were transferred to a nearby treatment center — which was in turn attacked.

In the days that followed, the Ebola response ground to a standstill in the epicenter of the outbreak. Doctors Without Borders pulled out of the city. When work resumed, the numbers of those infected began to rise — a pattern that would repeat.

In April, a Cameroonian doctor working on the Ebola response with the World Health Organization was shot to death by intruders while leading a meeting at a university hospital in Butembo.

Who is behind these attacks? Many health workers and foreign medical organizations say they do not fully understand the forces aligned against them. But they are all aware that resentment has been stirred up by the sight of late-model S.U.V.s carrying foreigners and Kinshasa bureaucrats through town, offering high-paying jobs to some but not others.

“The Ebola response has a lot of money, and this amount of money is kind of shifting power around, challenging the equilibrium,” said Mr. Massart of Doctors Without Borders. “I think that is one motivation” for the hostility to Ebola responders.

The outbreak remains confined to a single region, largely thanks to an effective vaccine, doctors say. More than 110,000 people have been vaccinated, including front-line responders such as doctors and burial teams, which has slowed the spread.

Finbarr O’Reilly contributed reporting from Beni, Democratic Republic of Congo.

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