Grief, Guns, and Denial: Why Ebola Centers Keep Burning in Eastern Congo

When protesters stormed an Ebola treatment center in Rwampara, in the Democratic Republic of Congo’s Ituri province, last month, witnesses described a group of young men who forced their way into the facility after authorities refused to release the body of a friend believed to have died from the virus.The following day, 18 people with suspected Ebola infections fled a separate facility in Mongbwalu after angry residents torched a treatment tent set up by Doctors Without Borders. Those 18 individuals are unaccounted for.By Sunday evening, Mongbwalu General Hospital was on alert. Young men had forced their way in, demanding the bodies of two relatives as medical staff scrambled to evacuate patients and gunfire crackled outside. It was the third attack on a health care facility in a single week.They are the visible face of a crisis beneath the crisis, one that infectious disease experts and humanitarian workers have warned about for years, and that is now threatening to unravel one of the most serious outbreak responses the world has seen since Covid-19.“When a treatment center is attacked, and patients flee, containment can be set back dramatically,” the public health director of Physicians for Human Rights, Thomas McHale, tells The New York Sun. “Every lost contact, every disrupted isolation process, and every delayed test creates new chains of transmission.”So how does a response built to save lives become the thing communities fight hardest to destroy?A rare strain, an impossible landscapeThe DRC’s 17th Ebola outbreak, declared in May, is caused by the Bundibugyo ebolavirus, a strain for which no approved vaccine or medicine exists.In the two previous Bundibugyo outbreaks, the estimated fatality rate ranged between 25 and 40 percent. However, early figures in this outbreak have suggested a rate lower than 20 percent — a gap experts attribute to undercounting of cases rather than reduced lethality, since patients who reach care quickly are much more likely to survive.The DRC Ministry of Health’s figures as of June 2 put confirmed cases at 363, with 62 dead and 206 people in isolation across 23 health zones. Ituri accounts for the bulk of them. Uganda has recorded 15 confirmed cases and one death, with at least seven tied to local transmission. The WHO, which declared the outbreak a Public Health Emergency of International Concern on May 16, has cautioned that the true scale is likely far higher. Early estimates approached 1,000 cases before a significant downward revision in late May, when officials clarified that many flagged cases had been tested and ruled out.The virus itself is not new to this part of the world. Scientists first detected Ebola during a 1976 outbreak in what was then Zaire, now the DRC, near the Ebola River, a name chosen by researchers specifically to avoid stigmatizing the village at the epicenter.Since then, the virus has emerged periodically from its still-unidentified animal reservoir and infected people across several African countries. The Bundibugyo strain — one of four species capable of causing disease in humans — has historically been considered somewhat less deadly than the Zaire strain, which drove the catastrophic 2014–2016 West Africa epidemic.Yet, in a region with shattered health infrastructure and active armed conflict, that relative distinction offers limited reassurance.The response as it now stands rests entirely on surveillance, contact tracing, infection control, safe burials, and community engagement, and all of it, as Dr. Paul Spiegel of the Johns Hopkins Bloomberg School of Public Health tells the Sun, is “unfolding in an active conflict zone with around 2 million displaced people.”Contact tracing in Ituri hovers at around 44 percent. WHO, however, says it needs to reach 90 percent. The main regional airport in Goma, a critical humanitarian staging ground, has been shuttered since January last year when M23 forces seized the city, cutting off key supply lines at multiple points.The outbreak has since spread into North Kivu, South Kivu, and Uganda’s capital, Kampala.The virus is new. The mistrust is old.At the heart of the violence is a profound and deeply rooted distrust of outside authority, one that propaganda has only deepened. Many residents in Ituri believe Ebola was fabricated by “white men.”Safe burial protocols, a medical necessity to prevent transmission, are perceived by grieving families as an act of coercion, denying them the chance to perform last rites for their dead.In many communities across eastern DRC, death demands an intimate ceremony: Families wash the body, dress it in fresh clothes, and lay it out for neighbors and relatives to see and touch through the night — physical contact considered not merely customary but spiritually essential.Yet a body in the advanced stages of Ebola is among the most dangerous things in nature — the virus peaks in concentration across every bodily fluid after death, capable of transmission for up to a week.Safe burial teams, strangers in white hazmat suits who seal bodies in bags and lower sealed coffins into the ground while family members watch from a distance, do not look like public health workers to a grieving mother. They look like one more intrusion by forces that have never acted in her interest.As Dr. Spiegel sees it, the problem goes far beyond scientific illiteracy.“Attacks on health facilities are rarely about the disease itself; they’re about who is trusted, who is in control, and who benefits,” he explains. “When teams arrive to take away sick relatives, prohibit traditional burials, and spray homes, backed by police or soldiers, in a place that has lived through state abuse and conflict, the response itself can feel coercive and alien.”Years of political violence and state failure have left communities in eastern DRC with little reason to extend trust to any outside institution, and the Ebola response, however well-intentioned, arrives wearing the same face as every force that has come before it.“People don’t attack a clinic because they misunderstand the science,” Dr. Spiegel continues. “They attack it because the response feels like one more powerful outside force acting on them without their consent. The virus is new; the mistrust is old.”A senior epidemiologist and strategic adviser who has studied trust dynamics in outbreak responses, Maureen Miller, points to the fear that keeps even healthy residents away.“Not only do patients flee, but others never seek treatment in the first place, fearing both disease and attack,” she tells the Sun.The West Africa epidemic offers some insight. Communities there concealed the sick at home rather than bringing them to treatment centers, meaning the virus spread invisibly while official case counts stay low. A near-empty Doctors Without Borders outpost in Liberia was not a sign the outbreak was contained, it was a sign that fear had driven people underground, a lesson that responders in eastern DRC are now confronting again. The deeper problem, Ms. Miller argues, is that community trust is rarely built until after the violence has already set the response back, by which point the damage to containment is done. “Recovery will always be difficult,”she underscores, “though it should at this point include local perspectives and collaboration; arguably, this should be done right from the start in hopes of avoiding the need for recovery.” The pattern, however, is well-documented. During the 2018 to 2020 DRC Ebola outbreak, the second largest on record with nearly 3,500 cases and 2,300 deaths, treatment centers were destroyed in Beni and Oicha, roads were barricaded in Butembo, and nine attacks on treatment centers occurred in February and March of 2019, directly triggering transmission spikes.Researchers found that each wave of violence pushed the effective reproductive number of the virus above one, meaning the epidemic was once again expanding rather than declining.In 2019, Mai Mai militiamen hit the Butembo Ebola treatment center, killing a police officer — days after unknown assailants had already torched it. Doctors Without Borders pulled out. Since then, the landscape of armed actors has become even more fragmented.A weakened West, a harder fightBeyond community anger, deliberately organized armed violence adds another lethal dimension.“Armed groups may see an outbreak response as a source of resources to loot, a symbol of a government or foreign presence they oppose, or information they want to control,” Dr. Spiegel says.On May 28, ahead of his visit to the outbreak’s epicenter in Ituri, Director-General Tedros Adhanom Ghebreyesus of the WHO made a rare public appeal to warring factions: “Please, declare a ceasefire. Even briefly. Even just enough to let health workers through.”That the head of the world’s premier health body felt compelled to beg armed militias for a temporary pause reflects just how completely the violence has paralyzed the response.It is unfolding, moreover, against a backdrop of dramatically reduced Western financial engagement. The Trump administration has withdrawn funding from the WHO, dissolved USAID, cut back the CDC, and reduced health aid to both the DRC and Uganda.The Department of Health and Human Services sent nearly $33 million in foreign aid to the DRC in the 2024 fiscal year; that figure fell to less than $10 million in 2025. Front-line physicians have reported being forced to rely on personal resources, using their own phone credit, fuel, and transportation, to maintain basic epidemiological surveillance.“The withdrawal of United States and other global funding has been devastating to the people caught in crisis in the DRC,” Oxfam’s country director in the DRC, Manenji Mangundu, tells the Sun. “The cuts led to a deadly delay in reporting the outbreak, and they have caused millions to no longer have access to medical care, clean water, sanitation, and many more vital services which are the systems needed as the foundation to prevent and stop an outbreak.”Dr. Spiegel acknowledges the State Department’s position that Ebola programs were carried over, that experienced staff were retained, and that the United States responded swiftly once the WHO identified the outbreak — yet stops short of accepting it at face value.“Writing a check is the easy part,” he says. “What we dismantled was the harder part, the people who could actually get supplies to a clinic in a conflict zone, and whom the local health director would pick up the phone for.”Mr. McHale of Physicians for Human Rights is no less direct.“Family members should not be bringing food and water into Ebola treatment facilities while wearing little more than paper masks,” he tells the Sun. “If families are filling the gaps left by global health aid cuts, the response system has already failed them.”There is a model that experts agree on. In the 2018 to 2020 North Kivu outbreak, trusted local leaders conducted contact tracing. When outsiders took over, it didn’t work. During the West Africa epidemic, community-based organizations boosted tracing rates from 88 to nearly 99 percent.“The most repeated lesson is to respect and adapt burial practices rather than ban them, and to train local people to carry out safe but dignified burials themselves,” Dr. Spiegel says. “The problem is never that we don’t know the model. It’s that trust has to be built before the outbreak, and that’s the investment we keep cutting.”

Grief, Guns, and Denial: Why Ebola Centers Keep Burning in Eastern Congo

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