NAIROBI, Kenya – The medical anthropologist was in the shower when she heard the first puppets of shooting. Originally, she…
NAIROBI, Kenya – The medical anthropologist was in the shower when she heard the first puppets of shooting. Originally, she thought it was the action film she had left at high volume. Then the wall shook.
The violence in eastern Congo, which has stymied the international response to a growing ebola eruption in the region, had come to the guesthouse used by many who work to prevent the spread of the disease.
Horror Julienne Anoko fell to the floor and crept into the corridor outside her room. She and five others from UN agencies, Congo’s Ministry of Health and the World Health Organization, for which she works, hid in another bathroom for three hours until a UN peacekeeping force arrived and made it clear.
“It was like a horror movie” Anoko said about the November 1
6 attack in the city of Beni, the outbreak’s epicenter.
Attacks of armed groups occur daily in the Congo north kivu province where the Ebola virus has spread since August infects nearly 500 people and kills more than 270. It is now the second largest outbreak ever after the major epidemic swept through Guinea, Sierra Leone and Liberia between 2014 and 2016.
The constant uncertainty in northern Kivu has proved to be a huge obstacle and counteracts trying to contain the virus. According to WHO’s estimation, the outbreak will last for at least six months.
“The fear we know and society knows makes our job 10 times more difficult,” says Abdourahmane Diallo, a Guinea doctor who coordinates the management of an experimental Ebola vaccine. He was in another association in Beni who was attacked the same day as Anokos.
“We know violence is a constant risk. But that’s why I was ready to go to work the next day,” said Diallo. “We simply can not stop our response if we hope to overcome this outbreak.”
This is the first Ebola outbreak where healthcare professionals regularly have collision-proof helmets and vests. To reach at least 20 percent of the affected areas in Ebola, health workers need armed police or UN escorts, “said Michel Yao, the WHO response coordinator in Beni.
The US government recalled its only staff in the region at the end of August and has no plans to redistribute them. WHO has 300 specialists from all over the world in northern Kivu. Those on the ground describe a chaotic effort to either negotiate or simply avoid the region’s different militias.
“It’s going to be a cat and mouse game – we’re the mouse trying to avoid the armed groups,” says Anoko, who is from Cameroon. But Anoko, whose job involves conducting extensive interviews with locals, warned the assumption that health workers are targeting their work. “It has been decades of war, it can not be understood easily,” she said.
A quarter of evil conflict, triggered by spillover from the 1994 Rwandan genocide, has been accompanied by deprivation of food, medicine and shelter that has split the North Kivus community. As a result of widespread trauma and desperation, foreign companies have continued to extract the region’s extensive mineral wealth, often pay protection money to armed groups and support the conflict. UN peacekeeping mission – established in 1999 and now the most expensive in the world – has been the target of violent protests because of its perceived inefficiency. Suspect about third parties is commonplace and rooted in history.
To protect themselves, many societies have raised arms. The resulting militias, which vary widely in size, are collectively known as Mai-Mai. Other groups, such as the Allied Democratic Forces (ADF), an extremist group in Uganda famous for their child soldiers, routinely brag about Congolese government forces and attack anyone they perceive to cooperate with them. The fate of their revenge falls on civilians.
An effective Ebola response is dependent on persuading people in the affected area to collaborate with health workers, but the distrust of years of conflict makes it much more difficult. Yao, the WHO coordinator in Beni, did not say a week goes, where his law is not attacked by skeptical locals.
“Yesterday, one of our investigative group’s cars was destroyed and a team member’s house burned” Yao, who is ivorian Canadian.
Generating trust is the task of medical anthropologists such as Anoko, as well as local politicians and traditional leaders. On top of the conflict, they fight against Ebola’s news in northern Kivu. Although this is the Congo 10th Ebola eruption, there has never been one in this region, and the knowledge about the virus is low.
Marie Roseline Belizaire, a Haitian doctor dealing with WHO’s response in Butembo, a 1.3 million south of Beni where the disease spreads, has tried to introduce money into the local economy as a way of buying trust. Recently, for example, she bought 30 motorcycles for her team locally, even though she had the approval to have them imported.
But Belizaire also takes a more practical attitude. Ebola is transmitted in worrying numbers in May-May-controlled suburbs of Butembo. She spends days of negotiations with the militias for access.
“New May-Mai groups continue to call us and make their demands, it’s like a new every day,” she said. “But they are very hostile for third parties coming in. In some cases, we have agreed to send them members so that we can train them instead of vice versa.”
While many Mai-Mai groups are open to such arrangements, the automatic document feeder will not engage. Local workers have called to call an ADF-controlled area between the cities Mbau, Eringite and Kamango “le triangle de la mort” – the triangle of death. That’s where many are worried. The ebola transfer happens without the sins of the respondents.
Congo Health Minister Oly Ilunga Kalenga said in an interview that he appreciated the help of the international community and with the help of Congolese health personnel “thousands of cases and deaths have so far been avoided.”
But with each attack comes a break in the health care response and with every break a jump in the number of cases.
“We can not abandon these people in northern kivu,” Anoko said. “They’ve suffered so much. We have great sympathy for them.”