In the week before the attack on Nov. 28, that victory seemed near: Tallies of new cases had dropped below 10, from a high of more than 100 per week earlier this year.
But a sudden resurgence of violent incidents has dashed that optimism and cast a pall of fear over the response. More than 500 health workers have had to be moved away from the violence, and the World Health Organization now says there is a risk the outbreak could come roaring back.
“We are of course expecting to see new cases that wouldn’t have otherwise been transmitted,” said Margaret Harris, a WHO spokeswoman. “Our hard work will be saved only by the unbelievably brave people who are still out there despite the threats.”
In a region beset by conflict and wary of outsiders, the attack in Biakato was a brutal wake-up call for responders, leaving many to wonder whether MONUSCO, the United Nations peacekeeping force here, can ensure their safety and in turn ensure that the progress against the virus is not lost.
On Sunday night in Goma, eastern Congo’s largest city, several people who survived the attack recounted the night of terror to the WHO’s director general, who had come in to rally his team.
A young woman who specializes in community engagement could barely make her voice audible, her head and arms swathed in bandages covering deep machete wounds. The camp manager showed his sliced-open hand, lacerated as he tore a hole through a corrugated iron fence big enough for him and four others to escape. He described how he ran, terrified in the total darkness, right into a tree, leaving a gash across his face and eyes.
The three policemen who had been guarding the compound attempted to flee, and one was killed. A driver for Congo’s Health Ministry was also killed, as was Belinda Kasongo, 30, a logistician for the vaccination team. In addition to the three killed in Biakato, another person was killed in a separate attack in nearby Mangina, and six were injured in both attacks.
A U.N. peacekeeping force stationed in Biakato, with a mandate to use force, did not reach the compound until three hours after the attack began — despite being less than a 10-minute drive away.
“We all got into the same room and hid under the beds so at least we would die together,” said another young woman. “We could hear Belinda scream when they chopped her with the machete outside the room. The attackers did whatever they wanted for hours, as if they knew no one would stop them.”
The United Nations’ top Ebola response official, David Gressly, who oversees MONUSCO’s provision of security for health workers, acknowledged lapses in protection and said emergency meetings were being held this week to expedite the return of teams to areas hit by attacks.
On Monday, the treatment center in Biakato admitted nine suspected cases and two confirmed cases, “but the testing lab is not operating, and surveillance and follow-up are not ensured because of lack of staff,” said Ewenn Chenard, a Doctors Without Borders emergency coordinator. “The reality is that now we don’t have enough medical personnel to provide the required care.”
Eastern Congo is often described as a nightmare setting for an Ebola outbreak. The region has seen near-constant conflict for 25 years, since the perpetrators of the genocide in neighboring Rwanda fled here, bringing huge caches of weapons and triggering ethnically tinged conflicts that eventually engulfed all of Congo in rounds of civil warfare that, despite formally ending in 2003, persist in pockets.
In North Kivu and Ituri provinces, where the Ebola outbreak is centered, locals formed countless militias of various sizes, some protecting just one town, others eventually coming to control larger chunks of provinces. The insecurity has also given groups such as the Allied Democratic Forces, or ADF, a shadowy but well-armed Ugandan separatist group that follows an extremist form of Islam, a place to operate more freely.
While it is not completely certain who carried out the Biakato attack, Gressly said initial evidence pointed to the small cartels that wreak havoc across the region, forcibly taking over parts of lucrative mining, timber and transport industries, and who may now be trying to prolong the Ebola outbreak so as to corner some of the hundreds of millions of dollars it has plowed into the local economy.
“The pattern is attacks where there is ongoing transmission. It is starting to look like a pattern to me,” he said.
The attack in Biakato coincided with an increase in ADF attacks on the nearby towns of Beni and Oicha. The ADF periodically raids towns, killing, pillaging and kidnapping children who eventually become its foot soldiers. The group has killed nearly 100 people since the end of October, when the Congolese army began an offensive against it.
In an echo of the doubts some health workers have expressed, residents of Beni have accused MONUSCO of not offering them adequate protection. As the attacks have become more frequent, the town of 250,000 has teetered between rage and fear.
On Nov. 25, protesters stormed and ransacked the MONUSCO compound, sending peacekeepers fleeing and triggering the first wave of departures of health workers from the active transmission zone. The Beni mayor’s office was burned down soon after.
Harris, the WHO spokeswoman, described how the chaos was eventually aimed toward health workers, who are commonly seen as affiliated with MONUSCO. A vehicle transporting her to Beni’s airport had its windows smashed with a brick.
The tension in Beni is not thought to be directly related to the attack in Biakato, but the pressure it has put on MONUSCO has strained its ability to provide logistical and security support to the Ebola response. The United Nations’ heads of safety and security and peacekeeping traveled to eastern Congo this week to assess the deteriorating situation.
“There is no more trust in MONUSCO, no more patience,” said Desire Mukanirwa, the Anglican bishop of Goma. “Now the problem isn’t that we don’t understand Ebola. It’s that people say, ‘We are being massacred by the ADF and we don’t see MONUSCO. It would be better if they left for good.’ ”
Gressly, the coordinator of the United Nations’ Ebola response, said that in his view, the current tension in Beni largely boiled down to MONUSCO’s failure to coordinate its operations with the Congolese army. He said the army’s offensive against the ADF that began on Oct. 30 has sparked the group’s retaliatory attacks on civilians.
Gressly said discussions were underway between MONUSCO and the army to begin joint planning and operations soon. “We’ve hit a big bump in the road, but it’s one we’ll get over relatively quickly if certain issues are addressed.”
A Congolese army spokesman did not respond to repeated requests for comment.
Abdou Salam Gueye, the WHO’s response manager, said that he is still waiting for MONUSCO to convince him that security for front-line health workers is a top priority. Instead, he said, his requests for support have been met with stifling bureaucracy. He said it took him months to persuade MONUSCO to send troops that could use lethal force if needed to Biakato.
“When I visited that camp, I had the thought, ‘My God, if something happens here, we will all die.’ So, I wrote officially to MONUSCO,” Gueye said. “Even after the attacks, we are still begging and screaming, and saying we deserve better than what you’ve given us.”
On Saturday, Gueye’s colleagues from the WHO and Congo’s Health Ministry gathered at Goma’s cathedral for the funeral of Kasongo, the member of the vaccination team who was hacked to death in Biakato. The hall echoed with the sobs of people who knew her. Speech after speech recounted her determination to see the end of the outbreak.
But Gueye and others voiced concern that despite the deaths of Kasongo and at least 10 other Ebola responders over the course of the outbreak, they weren’t sure their security was being taken seriously.
“A simple safe room in each compound would cost $1,000 — I’ve priced it out and communicated that to MONUSCO. Even just two well-trained, well-armed soldiers could deter these criminals with machetes,” said Gueye, worn down by a week of almost no sleep. “That’s all it might take, and we still don’t even have that.”