Trust is almost as important as the health response itself
In the eastern reaches of Congo, a rare strain of Ebola with no vaccine and no proven treatment has found a second adversary beyond biology: the accumulated grief, trauma, and distrust of communities long battered by war and institutional failure. Nearly a thousand suspected cases and more than two hundred deaths have emerged in Ituri province, where healthcare workers are met not only with a fast-moving epidemic but with fire, stones, and gunfire from the very people they are trying to protect. The World Health Organization acknowledges the response began too late and is still falling behind, while the deeper wound — the severing of trust between aid institutions and the people they serve — may prove harder to heal than the outbreak itself.
- A rare Bundibugyo Ebola strain with no vaccine is spreading faster than responders can track, with nearly 1,000 suspected cases and over 220 deaths — and experts cannot yet determine when it actually began.
- Healthcare workers and volunteers are being attacked, hospitals stormed, and treatment tents set ablaze by residents who believe the disease is a fabrication or a foreign scheme to profit from their suffering.
- Burial restrictions that prevent traditional funeral rites have become a flashpoint, with one treatment center burned after a family was denied the right to retrieve a loved one's body — grief transformed into violence.
- Decades of armed conflict, displacement, and weakened infrastructure have left communities deeply skeptical of outside institutions, making the standard tools of outbreak containment — surveillance, isolation, community messaging — nearly impossible to deploy.
- The outbreak is now crossing into Uganda, health workers are among the infected and the dead, and the WHO warns that reported numbers almost certainly undercount the true scale of the crisis.
Vanny Birungi walks through Bunia carrying a message about disease prevention, and the stones arrive before anyone listens. A Red Cross volunteer in eastern Congo, she has become a target not of the Bundibugyo Ebola virus itself but of the fear it has unleashed — residents hurling rocks and insults as she tries to warn them about a strain for which there is no vaccine and no proven treatment.
The outbreak has produced nearly 1,000 suspected cases and more than 220 deaths, according to WHO director general Tedros Adhanom Ghebreyesus, who acknowledged that responders are chasing an epidemic they failed to catch early. Initial testing focused on a more common Ebola variant, costing weeks of critical time. The region's surveillance infrastructure, already hollowed out by aid cuts, could not keep pace.
But the virus is only half the crisis. In a single week, three healthcare facilities were attacked. Armed men stormed a hospital treating Ebola patients, forcing staff to evacuate under gunfire. Residents set fire to a Doctors Without Borders tent in Mongbwalu, sending more than a dozen patients fleeing into the community. A treatment center in Rwampara was burned after a family was denied the right to retrieve a body for traditional burial — the prevention protocols that prohibit customary funeral rites cutting at the heart of how these communities grieve.
The distrust runs deeper than ritual. Pierre Basola, a 56-year-old Bunia resident, dismissed aid workers as opportunists and called Ebola a foreign invention. Surveys conducted in mid-May found widespread disbelief that the virus exists at all. Mado Nditamba, 70, remembers the last outbreak but says this one feels more chaotic. "We go to the doctors in the hospitals, but they also die," she said. "We don't know what to do and we leave everything to God."
The region is a wound long in the making. Armed groups have killed thousands and displaced many more across Ituri province. A major airport serving as a humanitarian hub has been under rebel control for over a year. Testing capacity for the Bundibugyo strain is almost nonexistent. A Congolese doctor died on Sunday; an unknown number of health workers have been infected or killed. Three Red Cross volunteers died in late March after handling bodies in work unrelated to Ebola — a discovery that, if confirmed, would push the outbreak's true beginning back by weeks.
Heather Kerr of the International Rescue Committee named the paradox plainly: without trust, people hide symptoms, bury their dead in secret, and attack the workers trying to contain the spread. The WHO and Africa CDC both believe the true scale of the outbreak exceeds what is being reported. And in the neighborhoods of Bunia, the message about prevention continues to meet stones.
Vanny Birungi walks through the neighborhoods of Bunia with a message about disease prevention, but the stones come before the listening. A Red Cross volunteer in eastern Congo, she has become a target not of the virus itself but of the fear and anger it has unleashed—residents pelting her with rocks and insults as she tries to warn them about the Bundibugyo strain of Ebola spreading through their region. There is no vaccine for this virus. There is no proven treatment. And there is something else working against containment: the deep, corrosive distrust of the very people trying to stop it.
The outbreak has produced nearly 1,000 suspected cases and more than 220 suspected deaths, according to the World Health Organization director general Tedros Adhanom Ghebreyesus, who acknowledged on Monday that responders are now chasing a fast-moving epidemic they failed to catch early. Initial testing looked for a more common Ebola variant, costing weeks of lost time. The region's disease surveillance infrastructure, already weakened by cuts to international aid, could not keep pace. Experts still cannot pinpoint when the outbreak actually began.
But the virus is only half the crisis. Three times in a single week, healthcare facilities came under attack. On Sunday, armed young men stormed a hospital treating Ebola patients, forcing staff to evacuate them as gunfire erupted. The day before, residents set fire to a Doctors Without Borders tent housing suspected and confirmed cases in Mongbwalu; more than a dozen patients fled into the community. On Thursday, a treatment center in Rwampara was burned after families were denied access to retrieve a body of a man suspected of having Ebola. The anger is rooted in something the virus itself cannot explain: the prevention protocols that keep the dead from receiving traditional funeral rites, a practice central to how these communities process loss and honor their dead.
The distrust runs deeper than ritual. Pierre Basola, a 56-year-old Bunia resident, spoke with contempt about the aid workers: "These people should stop bothering us. They just want to get rich. Let's not forget that Ebola is a white man's invention." He is not alone. Action Aid, surveying residents in mid-May just after the outbreak was announced, found high levels of skepticism and fundamental disbelief that the virus exists at all. Mado Nditamba, 70, has watched students flee from aid workers. She remembers the last Ebola outbreak but says this one feels worse, more chaotic. "We go to the doctors in the hospitals, but they also die," she said. "That's what worries us. We don't know what to do and we leave everything to God."
The region itself is a wound. For years, armed groups have killed thousands and displaced many more. The population is traumatized, wary of outsiders, skeptical of institutions. Bunia sits in Ituri province, more than 1,000 kilometers from Congo's capital. To reach Mongbwalu, aid groups must travel through territory where armed groups operate. A major airport that serves as a humanitarian hub has been controlled by rebels for over a year. Clinics run on generators. Testing capacity for the Bundibugyo strain is almost nonexistent.
The human toll is mounting. A Congolese doctor died in Rwampara on Sunday. An unknown number of health workers have been infected; some have died. The International Federation of Red Cross and Red Crescent Societies reports that three volunteers died in Mongbwalu after handling bodies on March 27 during work unrelated to Ebola—a discovery that, if confirmed, would push back the timeline of the outbreak significantly, suggesting it began weeks earlier than the first confirmed death in late April. In neighboring Uganda, where cases have begun to spread as infected Congolese crossed the border, at least three health workers have been infected.
Heather Kerr, country director for the International Rescue Committee in Congo, articulated the paradox: "Trust is almost as important as the health response, because if you get this massive distrust in the communities, they're not going to go to the health centers." Without trust, people hide symptoms, avoid treatment, bury their dead in secret. The virus spreads through close contact with bodily fluids—blood, vomit, sweat, feces. Healthcare workers and family members caring for patients face the highest risk. But if families do not believe the disease exists, or believe it is a conspiracy, they will not seek care. They will not follow prevention protocols. They will attack the workers trying to contain it.
Yakubu Mohammed Saani, country director for Action Aid in Congo, said the only path forward is community engagement. But how that will happen, and how quickly, remains unclear. The WHO and Africa Centers for Disease Control and Prevention both believe the outbreak is larger than the cases being reported. The virus is moving faster than the response can manage. Health workers say they are underprepared and underprotected. And in the neighborhoods of Bunia, the message about prevention continues to meet stones.
Notable Quotes
These people should stop bothering us. They just want to get rich. Let's not forget that Ebola is a white man's invention.— Pierre Basola, Bunia resident
Trust is almost as important as the health response, because if you get this massive distrust in the communities, they're not going to go to the health centers.— Heather Kerr, International Rescue Committee country director
The Hearth Conversation Another angle on the story
Why does the distrust run so deep? These are aid workers trying to save lives.
Because this region has been at war for decades. Armed groups have killed thousands. When you've lived through that kind of violence, when institutions have failed you repeatedly, why would you trust outsiders now?
But the virus is real. People are dying.
They are. But some residents have never seen a confirmed case themselves. They see restrictions on funerals, on handling bodies. They see their loved ones dying in hospitals. And they see aid workers they don't know telling them not to touch the dead. In a place where tradition and family ritual are how you grieve, that feels like another kind of violence.
So the attacks on healthcare facilities—those come from grief?
Partly. But also from a deeper skepticism. Some people believe Ebola is invented, a conspiracy. Others think aid workers are profiting. When you've been lied to by powerful people for years, you become suspicious of anyone claiming to help.
What happens if the distrust doesn't break?
The virus spreads unchecked. People hide symptoms. They bury their dead in secret. Families care for the sick without protection. Health workers get infected. The outbreak becomes larger than anyone can measure or contain.
Is there a way to rebuild trust quickly enough?
That's the question no one has answered yet. Community engagement takes time. But the virus doesn't wait.