Trust is almost as important as the health response itself
In the eastern reaches of the Democratic Republic of Congo, a rare and uncured strain of Ebola has grown to nearly a thousand suspected cases, not only because of the virus itself, but because the ground it moves through has been salted by years of conflict, broken promises, and the particular grief of people who have learned that outsiders rarely come bearing gifts. The outbreak was discovered late, spreads faster than responders can follow, and has now crossed into Uganda — a reminder that disease does not honor the borders drawn by either nations or trust. What unfolds in Bunia is not simply a public health emergency but a reckoning with what happens when the institutions meant to protect life have lost the consent of those whose lives depend on them.
- A rare Bundibugyo Ebola strain with no vaccine and no cure has surged to nearly 1,000 suspected cases and over 220 deaths in eastern Congo, with the true toll almost certainly higher than reported.
- Healthcare facilities have been stormed, burned, and evacuated three times in a single week, scattering infected patients back into communities and turning each attack into a new vector of spread.
- Weakened surveillance systems and a weeks-long misidentification of the strain allowed the outbreak to take root before anyone understood its scale, and testing capacity in the region remains dangerously scarce.
- Aid workers move through territory controlled by armed groups, face stones and curses from the communities they serve, and are themselves falling ill and dying — at least one doctor and three Red Cross volunteers confirmed dead.
- Cases have crossed into Uganda, the WHO warns the epidemic is outpacing the response, and health officials say the only path forward runs through community trust — a resource that years of conflict have nearly exhausted.
Vanny Birungi walks into Bunia's neighborhoods carrying a warning about Ebola, and the neighborhoods respond with stones and curses. She works for the Red Cross, but in eastern Congo, where armed groups have killed thousands and displaced many more, the word "aid worker" has come to mean something closer to "threat." The distrust she encounters is not irrational — it is the accumulated scar tissue of a population that has learned, repeatedly, that outsiders do not stay.
The outbreak at the center of this crisis involves the Bundibugyo strain of Ebola, a rare variant with no vaccine and no approved cure. It spreads through contact with the bodily fluids of the sick and the dead, which places healthcare workers and grieving families at the highest risk — and puts disease prevention practices in direct conflict with funeral rites that communities consider sacred. When health centers refuse to release bodies, families do not hear epidemiology. They hear desecration. That anger has become kinetic: three healthcare facilities were attacked in a single week, their patients scattered back into the surrounding population, each one a potential new chain of transmission.
The outbreak was also discovered late. Early testing focused on a more common Ebola strain, wasting critical weeks. Surveillance systems, hollowed out by cuts to international aid funding, failed to catch the virus when containment might still have been possible. The WHO now counts over 900 suspected cases and more than 220 suspected deaths, but officials believe the real numbers are larger. The Bundibugyo strain is difficult to test for in a region where clinics run on generators and the main humanitarian airport has been held by rebels for more than a year. There is evidence the virus may have been circulating since late March — weeks before it was formally identified.
Health workers are not only targets of community violence; they are also victims of the disease itself. A Congolese doctor died on Sunday. At least three health workers in neighboring Uganda, where infected individuals have already crossed the border, have been infected. Meanwhile, some Bunia residents insist the disease does not exist at all — that Ebola is a fiction invented by outsiders seeking profit. An older woman named Mado Nditamba remembers the last outbreak and says this one feels worse. People go to hospitals and die there anyway. She has stopped knowing what to believe, and so she leaves everything to God.
The WHO's director general has said plainly that the world is playing catch-up with a very fast-moving epidemic. Aid organizations know that medicine alone cannot contain it — that trust is as essential as any treatment. But how to rebuild trust in a place where conflict has made every stranger a potential enemy, where prevention requires abandoning sacred custom, and where the clinics meant to save lives have become targets, remains the question that no one has yet answered while the case count continues to rise.
Vanny Birungi walks into neighborhoods in Bunia with a message about disease, but the message is not welcome. Stones have been thrown at her. People have cursed her name. She works for the Red Cross, trying to warn residents about Ebola—specifically the Bundibugyo strain, a rare variant with no vaccine and no cure—but the city where she lives is gripped by something deeper than fear of illness. It is gripped by distrust so complete that it has become its own kind of contagion.
Bunia sits at the center of an outbreak that has grown to nearly 1,000 suspected cases. The virus spreads through contact with bodily fluids of the sick and the dead. Healthcare workers and family members face the highest risk. But in eastern Congo, where armed groups have killed thousands and displaced many more over recent years, the population has learned to be suspicious of outsiders. When aid workers tell people not to touch the bodies of their dead—a practice central to funeral rites—residents hear not science but disrespect. When health centers refuse to release corpses, families see not epidemiology but cruelty. The anger has turned violent.
Three times in a single week, healthcare facilities came under attack. On Sunday, gunfire erupted as young men stormed a hospital treating Ebola patients, forcing medical staff to evacuate them. On Saturday, residents set fire to a tent housing suspected and confirmed cases run by Doctors Without Borders in Mongbwalu; more than a dozen patients fled into the surrounding area. On Thursday, a health center in Rwampara was burned after relatives were barred from retrieving a body. Each attack has scattered patients back into the community, each one a potential vector for further spread.
The outbreak itself arrived late to the attention of those trying to contain it. Early testing focused on a more common Ebola strain, wasting weeks. Surveillance systems, weakened by cuts to U.S. and other international aid, failed to catch the outbreak when it might have been manageable. Now the World Health Organization estimates over 900 suspected cases and more than 220 suspected deaths. The actual numbers are likely higher. Testing capacity for the Bundibugyo strain is scarce in a region where clinics run on generators and the major airport serving as a humanitarian hub has been controlled by rebels for over a year. The distance from Bunia to Mongbwalu—more than 620 miles through territory controlled by armed groups—means aid workers risk their lives simply to move between outbreak zones.
Health workers themselves are falling ill. A Congolese doctor died in Rwampara on Sunday. In neighboring Uganda, where cases have begun to spread after infected people crossed the border, at least three health workers have been infected. Most troubling: the International Federation of Red Cross and Red Crescent Societies believes three volunteers in Mongbwalu died after handling bodies on March 27, work unrelated to Ebola response. If confirmed, that date would push back the known timeline of the outbreak by weeks, suggesting the virus has been circulating longer and farther than anyone realized.
Yet even as coffins are dusted off and displayed for sale along Bunia's roads, some residents insist Ebola does not exist. A 56-year-old man named Pierre Basola told a reporter that Ebola is a white man's invention, that aid workers are trying to get rich, and that he wanted nothing to do with their warnings. An older woman, Mado Nditamba, said she has watched students flee from aid workers. She remembers the last Ebola outbreak but says this one is worse. People go to hospitals and die there anyway. She does not know what to do, so she leaves everything to God.
Heather Kerr, country director for the International Rescue Committee in Congo, understands the mathematics of the crisis: trust is as essential as medicine. Without it, people will not go to health centers. They will hide symptoms. They will bury their dead in secret. The virus will spread unseen. The WHO's director general, Tedros Adhanom Ghebreyesus, said on Monday that the world is now playing catch-up with a very fast-moving epidemic. Yakubu Mohammed Saani, country director for Action Aid, says the only path forward is community engagement. But how to build trust in a place where armed conflict has made outsiders synonymous with danger, where disease prevention practices violate sacred custom, and where the institutions meant to help have themselves become targets—that question remains unanswered as cases continue to climb.
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, 56-year-old Bunia resident
We are now playing catch-up with a very fast-moving epidemic.— Tedros Adhanom Ghebreyesus, WHO director general
The Hearth Conversation Another angle on the story
Why are people attacking the very people trying to stop the disease from spreading?
Because stopping the disease means breaking their funeral traditions. When someone dies, family members wash the body, prepare it, say goodbye. Ebola spreads through those fluids. So aid workers say no—you cannot touch them. To residents, that is not science. That is desecration. That is outsiders telling them their dead do not matter.
But surely people understand the danger?
Some do. But the outbreak was discovered weeks late. Early tests looked for the wrong strain of Ebola. By the time anyone knew what was happening, people had already seen others die in hospitals. They saw health workers get sick too. Why would you trust a system that cannot save anyone?
Is there a vaccine?
No. There is no vaccine for Bundibugyo Ebola. There is no treatment. That is part of what makes this outbreak so frightening—and so hard to convince people to take seriously when they are already traumatized by years of armed conflict.
How many people are actually sick?
Over 900 suspected cases, more than 220 suspected deaths. But those are the ones they know about. The WHO believes the real numbers are larger. People are hiding symptoms. Patients are fleeing health centers. The virus is moving faster than anyone can track it.
Are the aid workers themselves safe?
No. A doctor died. Three Red Cross volunteers died. Health workers in Uganda have been infected. The people trying to contain this are getting sick and dying too. They are underprepared, underprotected, and working in a region where armed groups control territory and attack health facilities.
What happens next?
That depends on whether trust can be rebuilt quickly. If it cannot, the outbreak will continue to spread unseen. People will keep dying at home, in secret. The virus will move across borders. The mathematics are simple: without community trust, containment becomes impossible.