Fear is spreading across Ebola-hit communities in eastern Democratic Republic of Congo as suspected deaths continue to rise, with officials warning that health teams are still trying to catch up with an outbreak that may have circulated unnoticed before it was formally detected.
“Ebola has tortured us,” says a taxi rider in his late twenties in the gold-mining town of Rwampara.
“I am scared because people are dying very fast… We are really afraid.”
Congolese Health Minister Dr Samuel Roger Kamba visited Ituri province, the centre of the outbreak, over the weekend and admitted that response teams are now racing to contain a virus that may have been spreading before it was first identified on April 24.
The presumed first patient was a nurse who died in the provincial capital, Bunia, before being buried in Mongwalu, another gold-mining town. Most suspected infections and deaths have since been reported in Mongwalu and nearby Rwampara.
By Tuesday, officials said 514 suspected cases had been recorded, while 136 people were believed to have died from the virus. One death has also been confirmed in neighbouring Uganda.
Cases have also been found in Butembo and rebel-held Goma in North Kivu province, as well as in South Kivu province.
Health authorities said several people died in their communities without their deaths being reported, leaving officials unable to investigate those cases at the time.
The health ministry said formal alerts from communities were only registered from May 8.
“At community level, this hasn’t been effective,” Dr Kamba explained. “It means someone may have died before him [the presumed index case], or someone else may have been sick before him, but no one reported it.”
He added: “We really need to look within the community to understand what happened – how people became ill and sometimes even died without any report being filed.”
A Virus Hiding in Plain Sight
The outbreak has been linked to the Bundibugyo strain of Ebola, a form less familiar to DR Congo, which is now facing its 17th Ebola outbreak and has more experience with the Zaïre species.
Bundibugyo has caused only two previous outbreaks, in 2007 and 2012, killing around 30% of those infected.
Dr Kamba described the symptoms, saying: “There is heavy bleeding everywhere, very high fever. But Bundibugyo can show fewer obvious signs, which delays diagnosis because people think, ‘No, this is just malaria.'”
Officials believe that delay may have allowed the virus to move quietly through communities before being recognised.
In Mongwalu, some deaths were initially blamed on witchcraft rather than disease. The belief became known locally as the “coffin phenomenon”, based on the fear that anyone who touched the coffin of a dead person would also die.
International charity Save the Children said the Bundibugyo strain had not previously been detected in Ituri. Limited testing available in the province had been focused on the Zaïre strain, which meant results were not coming back positive.
“By the time the Bundibugyo strain was detected, it had already spread quite far. We are in a game of catch-up,” its DR Congo representative Greg Ramm said in a statement.
Authorities have warned that the spread of Ebola into major urban areas could make containment far more difficult.
Despite Dr Kamba’s visit to Bunia over the weekend, some residents say efforts to slow the outbreak remain too slow.
“If there’s no treatment centre here in the capital,” one resident asked, “then what about other areas?”
Bunia in Ituri, along with Butembo and Goma in North Kivu, are home to hundreds of thousands of people. However, none had a fully operational Ebola treatment centre five days after the outbreak was declared.
Residents in Goma, eastern DR Congo’s largest city, said basic health precautions, including avoiding handshakes, reducing gatherings and washing hands regularly, are still widely ignored.
“I’m heading to the border to report on people stranded there,” said José Mutanava, a local journalist. “I’m wearing a face mask, but not many people are.”
Another resident, who asked not to be named, said: “Nobody can follow the barrier measures – maybe only when we see more deaths. Today in the city centre I saw only four people wearing masks.”
Others said the struggle to survive each day has made public health guidance harder to follow.
“It’s too much to ask people struggling to eat to follow these rules,” one resident said.
The outbreak is unfolding in eastern DR Congo, a region already severely affected by conflict, displacement and weakened healthcare services.
Save the Children described the Ebola outbreak as a “new massive crisis on top of an already difficult situation”.
“It is in an area of conflict, an area of humanitarian crisis, with hundreds of thousands of people displaced, and healthcare systems are already severely compromised,” it added.
