Congo Ebola epidemic surpasses 8,000 cases as violence against health workers escalates

By late September, the Ebola epidemic spreading through the Democratic Republic of Congo had claimed 3,924 confirmed lives and infected 8,116 people across seven provinces. The numbers alone tell only part of the story. On September 27, a politician named Marie-Celestin Karondwa was beaten to death by residents of his own neighborhood in Butembo, in North Kivu province. His attackers looted his home and burned it down. Karondwa had been acting president of the local committee of the ruling party, and his party says he was killed for going on the radio to tell people that Ebola was real and dangerous. The day before, armed men entered a screening post outside Butembo and shot a health worker who was checking travelers for fever.

The epidemic is not shrinking so much as it is moving. For the first six weeks, four of every five cases clustered around Bunia, a city on Lake Albert in Ituri province, and around goldfields where workers from other regions converge. Since then, the center of gravity has shifted roughly 61 kilometers southwest along the RN4 road, toward Beni, Butembo, and Katwa—the same cities where an earlier Ebola outbreak killed 2,287 people between 2018 and 2020. Ituri still holds three-quarters of all cases recorded to date, but the virus is establishing itself in new ground.

The response is losing ground. Standard practice calls for identifying about 60 contacts for every confirmed case and monitoring each for 21 days. At the rate cases were being reported in late September, roughly 54,000 people should have been under active surveillance. Instead, only 31,034 were on the list. Of those, contact tracers managed to visit just 23,187—a completion rate of 74.7 percent, and falling. According to Jean Kaseya, director-general of the Africa Centres for Disease Control and Prevention, more than 80 percent of newly confirmed cases are being found among people nobody is tracing. The machinery has improved—testing capacity is roughly eight times what it was in May—but it has not grown fast enough to match the spread.

The material constraints are stark. In North Kivu, seven households contained confirmed cases and received zero infection-control kits. In Tshopo province, 97 of 99 health facilities failed to meet basic infection-control standards. Bas-Uélé holds 25 kilograms of chlorine and 80 liters of fuel, no compliant treatment center, and no ambulance to reach one. In Butembo, a city of 2 million people, the MSF treatment center has 29 beds, all full. A 10-year-old boy died in triage before he could be admitted. Across North Kivu, 59.5 percent of diagnosed patients are dying, compared to 48.4 percent nationally. Two in five of those who reach a treatment center do not leave alive.

Community resistance is deepening. Residents burned down a health post they believed was collaborating with the response. A burial worker had his knee broken with a machete. Dr. Michel Paluku Mukuloli, a doctor in Butembo, says his patients believe the hospital is a place to go and die. Only two of nine health checkpoints in his zone are staffed. Provincial authorities have recruited pro-government Wazalendo fighters to enforce compliance on roads, and one commander said people who refuse could be taken to a treatment center by force and whipped. Pepin Kavota, a civil society coordinator in Beni, traces this refusal to the 2018-2020 epidemic, when responders employed by the World Health Organization sexually abused and exploited the population they were sent to protect. The current response monitors 119 health zones for sexual abuse by staff. In 78 of them, nobody knows how to report it.

Meanwhile, world leaders gathered in New York for the United Nations General Assembly last week. On September 23, the United States convened foreign ministers to discuss stopping Ebola in the Congo. The meeting lasted about an hour and produced roughly $700 million in fresh commitments, bringing total pledges since the outbreak was declared to about $2.9 billion. Two days later, in the same building, those same governments refused to adopt a non-binding political declaration on pandemic preparedness. The document obliged nobody to spend anything. It was blocked anyway. The United States objected to language on "equity" and "solidarity," and to commitments on universal access to sexual and reproductive health care. The European Union blocked it over intellectual property, objecting to language reaffirming the 2001 Doha Declaration, which holds that patent rights should be read in a manner that supports states' right to protect public health. An hour of speeches about defeating Ebola was followed, 48 hours later, by a refusal to sign a statement that would have cost nothing, because it used the word equity and because it touched on patents and royalties.