Hélène Akirimari said she takes all precautions against contracting Ebola, including always wearing a mask when in public. But as a cocoa vendor in eastern Democratic Republic of Congo (DRC), the epicenter of the latest outbreak, she is in daily contact with other people, some of whom doubt the disease is even real, and she has no control over their behavior.
“Ebola is a real disease. People should stop deceiving themselves,” Akirimari said, warning that misinformation, myths and lax attitudes about the virus were killing people.
“I always wear a face mask. But when it comes to customers, when they come in, they may or may not be wearing a face mask,” Akirimari told journalists working in the field on behalf of CNN. “We’re not going to chase them away.”
Local residents in Ituri and North Kivu, the provinces hardest hit by the outbreak, say they are dealing not only with a slow response to the outbreak, but also with misinformation about health and cavalier attitudes about masks in their communities.
“When I saw people dying, I used to think it was a joke, but now I know it’s real,” said Eli Ilunga, a resident of Bunia, the capital of Ituri province. “The disease is definitely here.”
The World Health Organization says at least 177 people have died in connection with the Ebola outbreak in the Democratic Republic of the Congo, with nearly 750 suspected cases. The outbreak is believed to have originated in rural areas, but has now spread to cities such as Bunia and Goma. In neighboring Uganda, five cases and two deaths have been confirmed.
The WHO on Friday raised the risk level for the Democratic Republic of the Congo to “very high” and “high” at the regional level, although the risk of an outbreak remains low at the global level. The number of Ebola cases is expected to “continue to rise, given the time the virus was circulating before the outbreak was detected,” the group warned.
“The doubters are probably the ones who haven’t experienced this (death) yet or whose families haven’t been affected yet,” added Ilunga, who installed a sink in her home to protect her family. He urges others to stop doubting the reality of the threat posed by the virus.
Tensions escalated in Ituri on Thursday as relatives of a young man who died from Ebola tried to remove his body “by force” from Rwampara hospital, a local politician told CNN. Officials said protesters started a fire at the medical facility, destroying two hospital tents.
On Friday, local authorities in Ituri announced restrictions on public gatherings and a ban on wakes.
The bodies of Ebola victims are highly contagious, and health officials have warned that traditional funeral and mourning practices can spread the virus quickly. A Bunia-based community activist previously told CNN that local funeral customs, in which mourners touch the deceased, may have contributed to the rise in infections.
WHO Director-General Dr. Tedros Adhanom Ghebreyesus said Friday after the hospital fire that “building trust in affected communities is critical to a successful response and is one of our top priorities.” “We are also committed to ensuring that essential services for affected communities are maintained and enhanced.”
Beyond fear and suspicion, there are multiple factors that greatly complicate emergency response. The region is in a conflict zone, with an estimated 2 million people displaced. Eastern DRC has historically lacked funding for health infrastructure. And there is no approved vaccine or treatment for the virus strain causing the outbreak.
Aid officials also told CNN that the disbanding of the United States Agency for International Development (USAID) and cuts to U.S. funding implemented before the outbreak were hampering the response. But State Department officials denied the claims and said any changes from the Trump administration would not impede that effort.
Shortly after returning from a humanitarian visit to Ituri province, Save the Children organization’s Democratic Republic of the Congo country director Greg Lamb said their team was working with local authorities to deliver basic supplies such as disinfectant and chlorine to clinics. He noted that humanitarian aid funding is significantly lower than it was a few years ago.
“We’re playing catch-up. We don’t have enough medical resources,” Lam told CNN on Tuesday. “It is important that basic infection prevention and control measures are implemented in health centers.”
“The goal is to keep health centers functioning to encourage people suffering from Ebola and other diseases to seek help,” he added. “The last thing we need right now is for our health care system to shut down.”
Experts fear that many more people could die if people become afraid of going to the hospital for other illnesses such as malaria, measles and malnutrition. WHO’s regional director for Africa warned that children under the age of five are particularly at risk of malaria.
Meanwhile, doctors working in the eastern Democratic Republic of Congo are hammering home the message that people should avoid touching people who may be infected with Ebola, refrain from unnecessary physical contact such as hugging others, and avoid touching dead animals.
“Everyone must adopt a preventive attitude to break this chain of infection,” said Dr. Mwarab Hugues.
Ugandan President Yoweri Museveni urged people to avoid shaking hands, although he noted that the majority of infections are in the Democratic Republic of Congo. On Friday, the WHO said the situation in Uganda was “stable”.
Meanwhile, the head of the Africa Centers for Disease Control and Prevention (Africa CDC), which is tasked with coordinating health issues across African Union countries, said authorities were ramping up efforts to ensure medicines are available to treat people, while also moving forward with vaccine development.
“It will take several months for a vaccine to be ready,” Africa CDC Director Dr. Jean Kaseya told reporters. “Anyone who gives a specific number of months is not telling the truth. It could take quite a while.”
Aline Kitambara Masika, a Bunia resident from North Kivu province, said she hopes people will be aware about wearing personal protective equipment.
“Ebola has devastated my entire family,” she said.
CNN’s Niamh Kennedy and Nimi Prince contributed to this report.
