With more than 1,100 dead, Congo’s Ebola outbreak is only getting worse. Now doctors are forced to go undercover.

Health workers prepare a grave just outside of Beni, Congo, for a woman who died of Ebola. Many health workers are facing harassment and violence as the death toll in the country has risen. (Hugh Kinsella Cunningham/EPA-EFE/Shutterstock)

By Danielle Paquette and Lena H. Sun-May 16

DAKAR, Senegal — Some doctors fighting the second-deadliest Ebola outbreak in history are afraid to wear scrubs.

They mask their identities to avoid harassment and violence in Congo, where the epidemic is spreading at the fastest rate since it started in August — and where rampant misinformation fuels a distrust of outsiders in medical garb. The World Health Organization has logged 119 attacks this year against health workers. Eighty-five have been wounded or killed.

Fear is changing tactics among aid staffers, who set out to convince communities that Ebola is real and they were there to help end it. Now some downplay their mission in public, swapping white coats for street clothes and attention-grabbing SUVs for motorbikes that blend into traffic.

“Our staff has to lie about being doctors in order to treat people,” said Tariq Riebel, emergency response director in Congo for the International Rescue Committee (IRC), a global aid group.

And the violence hampers the response effort in a more direct way: Ebola infections tend to spike after attacks, experts say, because emergency responders are forced to take cover and halt the distribution of immunity-boosting vaccinations.

The death toll in the central African country reached 1,136 this week, government officials said. The infection count, meanwhile, has climbed to 1,632 — with 88 more suspected, Congo’s Ministry of Health said. Concerns are growing that the crisis in Congo’s North Kivu province could become as lethal as West Africa’s battle against the hemorrhagic fever from 2013 to 2016, which killed 11,310 people across three countries. 

“The tragedy is that we have the technical means to stop Ebola, but until all parties halt attacks on the response, it will be very difficult to end this outbreak,” WHO Director General Tedros Adhanom Ghebreyesus tweeted May 10.

An April assault on a hospital killed a Cameroonian epidemiologist in the verdant city of Butembo, the outbreak’s current hot spot. The killing drove hundreds of Congolese doctors and nurses into the streets. They threatened to strike if the mayor did not support them with stronger security. 

But a string of assaults followed.

Here's how the virus spreads and how contact tracing works to stop outbreaks. (Gillian Brockell/The Washington Post)

A WHO team was attacked in early May after burying an Ebola victim. Five days later, dozens of gunmen stormed the team’s neighborhood and exchanged ­bullets with security forces near their temporary homes. 

Riebel, who oversees a team of about 100 IRC workers in Goma, said his staff had to suspend treatments last week after taking cover from gunfire in nearby streets.

The doctors don’t wear their uniforms in public because people throw rocks at them, he said, and they’ve stopped driving SUVs through town. Motorbikes draw less attention. “When our doctors try to find housing,” he said, “some say they are lawyers.”

Congolese soldiers take up a position in Beni that overlooks the “triangle of death,” a volatile region where the Allied Democratic Forces, an extremist rebel group, operates. (Hugh Kinsella Cunningham/EPA-EFE/Shutterstock)

A burial ground in Beni for the victims of Ebola. (Hugh Kinsella Cunningham/EPA-EFE/Shutterstock)

After attackers killed WHO epidemiologist Richard Valery Mouzoko Kiboung in April, a city official told the Associated Press that armed fighters believed foreign health workers had started Congo’s epidemic. 

“According to witnesses at the scene, these militiamen wanted all the expatriates to go home because, according to them, Ebola does not exist in Butembo,” said Patrick Kambale Tsiko, the deputy mayor of Butembo. “They said they will continue if these expatriates do not return as soon as possible.”

U.S. officials are assessing the American role in curbing the crisis after sending a delegation — including Tim Ziemer, acting assistant administrator at the U.S. Agency for International Development — to Congo this month to meet with Ebola experts on the ground, USAID acting spokesman Tom Babington said in an email. 

The U.S. Centers for Disease Control and Prevention pulled Ebola experts from North Kivu last year after an armed group attacked a Congolese military site along a road near where the team was traveling. 

The CDC has 17 people in the cities of Kinshasa and Goma but hopes to expand its response team in Congo to 40, CDC Director Robert Redfield said in an interview Wednesday. Timing will depend on whether the State Department approves security precautions for those experts.

“The outbreak response is not succeeding despite all the efforts,” he said.

Redfield said the additional personnel for Goma are in anticipation of new cases moving to the city, which is home to more than 1 million people and has direct flights to key transit hubs including the Ethio­pian capital of Addis Ababa and Entebbe, Uganda.

Redfield said a long-term plan needs to be put in place, which he added could take as long as two years. “We make a mistake underestimating the complexity of this outbreak,” he said.

Experts are urging the global community to pour more resources into Congo’s struggle. “We’re at a breaking point,” said J. Stephen Morrison, a senior vice president at the Center for Strategic and International Studies in Washington who has tracked the outbreak. “Violent attacks are winning, and infections are unchecked.”

Health workers carry the coffin of a woman who died of Ebola near Beni. (Hugh Kinsella Cunningham/EPA-EFE/Shutterstock)

People take part in the funeral of Kahumbu Ngalyakuthi, who was infected in her home village of Mutwanga, near Beni, after sharing a hospital room with a patient infected with Ebola. (Hugh Kinsella Cunningham/EPA-EFE/Shutterstock)

Suspicion and bloodshed have gripped Congo since conflict crossed the border from the 1994 Rwandan genocide. Hunger, a lack of medicine and foreign companies mining the area’s natural resources — while paying militias for protection — have exacerbated tensions.

More than 140 armed groups operated last year in North and South Kivu provinces, according to a 2019 Human Rights Watch report. 

The WHO has twice decided against declaring the outbreak an international public-health emergency, as it did for the Ebola epidemic that ravaged Liberia, Sierra Leone and Guinea. 

“We need to call the situation what it is,” said Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security. “Countries will be forced to act if the outbreak spills across [Congo’s] borders, but by then, the cost of response will be much greater and the prospects for containment will be much more difficult.”

Sun reported from Atlanta.