Congo's Ebola death toll tops 4,000 as strikes, attacks and mistrust hamper containment

In Bunia, the capital of Ituri province in northeastern Congo, health workers gathered this week carrying placards that read "No money, no data!" and "No payment for months." Authorities dispersed them. Many of the protesters belonged to the surveillance teams that trace people who may have been exposed to infected patients, the work that tells responders where the virus is going next.

The protest took place at the center of what is now the fastest-growing Ebola outbreak on record. The Health Ministry said Thursday that 4,018 people have died, close to half of the roughly 8,300 confirmed cases. Congo declared the outbreak on May 15, after cases of the rare Bundibugyo virus were detected. There is currently no known vaccine or treatment for that strain. It is the country's 17th Ebola outbreak.

The unpaid wages are one strain among several. Front-line health workers have gone on strike several times since the outbreak began, disrupting efforts to track and contain infections. The response has also suffered from shortages of funding and staff.

Earlier this week, soldiers searching for weapons burned down an Ebola-hit camp in Kigonze, on the outskirts of Bunia, the United Nations said. The camp held a transit centre for infected patients, and about 19,000 people living there had to flee. The UN said the loss made an already enormous challenge harder. Julien Harneis, the UN senior Ebola coordinator, said building transit and treatment centres has been a struggle that demands money and staff, both in short supply. "When we lose a centre, that means we lose capacity, we lose investment, and we have to start again," he said, adding that above all it means people do not get the care they need.

The numbers are moving in a more complicated direction than the death toll alone suggests. Confirmed cases have slowed in recent weeks, from around 850 cases and 470 deaths a week in mid-July to an average of 490 cases and 230 deaths in September. Even so, the source reports a similar 33 per cent rise in both confirmed cases and deaths through September. Africa CDC said at its latest news conference that newly confirmed cases are falling, but cautioned that the dip could reflect insecurity and difficulty getting communities to cooperate in some hot spots, rather than real progress. The disease has slowed in some areas and accelerated in others, a situation experts describe as delicate. The World Health Organisation has recently raised the alarm about spread into new health zones, which stretches limited resources further.

Mistrust has turned violent. On Sunday, Marie-Célestin Karondwa, a local official with Congo's ruling Union for Democracy and Social Progress party, was attacked and beaten at his home in Butembo, an Ebola hot spot in eastern North Kivu province. He had been defending government measures against the outbreak. His house was set on fire afterward, and he died of his injuries at a hospital.

The killing reflects a wider problem. Widespread distrust of health workers and authorities has hampered efforts to slow the outbreak. Last month, authorities launched a village-centred approach, but it faces resistance from residents who dismiss Ebola as a hoax. Distrust of the government runs deep, stemming from how it handled past outbreaks and from chronic corruption.

What to watch now is whether the spread into new health zones can be brought under control, and whether falling case counts reflect genuine progress or simply fewer people being reached and tested.