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‘Like a horror film’: The efforts to contain Ebola in a war zone

NAIROBI, Kenya – The medical anthropologist was in the shower when he heard the first shots of a firearm. Initially, he thought it could be the action film he had let play at high volume.

The violence in eastern Congo, which hindered the international response to a growing Ebola outbreak in the region, had reached the retirement used by many who worked to prevent the spread of the disease.

Terrified, Julienne Anoko dropped to the ground and crawled into the corridor outside her room. She and five others from the UN agencies, the Congo Ministry of Health and the World Health Organization, where she works, hid in another bathroom for three hours until the arrival of a peacekeeping force of the United Nations and gave the go-ahead.

"It was like a horror movie," said Anoko of the November 1

6 attack in the town of Beni, the epicenter of the epidemic.

Attacks by armed groups occur daily throughout the province of North Kivu of the Congo, where the Ebola virus has spread since August, infected almost 500 people and killed more than 270. It is now the second largest epidemic of all time, after the vast epidemic that has swept Guinea, Sierra Leone and Liberia between 2014 and 2016.

The constant insecurity in North Kivu has proved to be a huge obstacle, thwarting the attempts to contain the virus. According to the WHO estimate, the epidemic will continue for at least another six months.

"The fear that we feel, and that the community feels, makes our work 10 times more difficult," said Abdourahmane Diallo, a Guinean doctor who coordinates the administration of an experimental Ebola vaccine. He was in another complex in Beni that was attacked on the same day as Anoko.

"We know that violence is a constant risk, but that's why I'm ready to go to work the next day," said Diallo. "We can not simply stop our response if we hope to overcome this outbreak."

This is the first Ebola outbreak during which health professionals have regularly had to wear hard hat and bulletproof vests. To reach at least 20 percent of the areas affected by Ebola, health care workers need armed police or UN escorts, said Michel Yao, coordinator of WHO's responses to Beni.

The US government withdrew its only personnel to the region at the end of August and did not plan to redistribute them. The WHO has 300 specialists from all over the world in North Kivu. Those on the ground describe a chaotic effort to negotiate or simply avoid the various militias in the region.

"It turns into a game of cat and mouse – we are the mouse that tries to escape from armed groups," said Anoko, who comes from Cameroon. But Anoko, whose work involves conducting extensive interviews with the locals, warns against the hypothesis that health workers are targeted for their work. "There have been decades of war, it can not be understood so easily," he said.

A quarter of a century of vicious conflict, triggered by the spillover of the Rwandan genocide in 1994, was accompanied by deprivation of food, medicine and shelter that destroyed the North Kivu society. Between widespread trauma and despair, foreign companies continued to extract the region's vast mineral wealth, often paying protection money to armed groups, fueling the conflict. The U.N. mission peacekeeping – set up in 1999 and now the most expensive in the world – was the goal of violent protests due to its perceived ineffectiveness. The suspicion of strangers is common and rooted in history.

To protect themselves, many communities have taken up 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 of Ugandan origin of infamous origin for its child soldiers, usually joking with the forces of the Congolese government and attacking anyone who perceives as a collaborator with them. The weight of their revenge falls on the civilians.

An effective ebola response is based on convincing people in the affected area to cooperate with health workers, but distrust sown by years of conflict makes it much more difficult. Yao, the WHO coordinator in Beni, said he did not spend a week in which his teams were not attacked by skeptical people.

"Even yesterday, one of our investigative team's cars was destroyed and a team member's house was burned," said Yao, who is the Ivorian Canadian.

Generating trust is the task of medical anthropologists such as Anoko, as well as local politicians and traditional leaders. In addition to the conflict, they are struggling with the novelty of Ebola in North Kivu. Although this is the 10th epidemic outbreak of the Congo, there has never been one in this region, and knowledge of the virus is low.

Marie Roseline Belizaire, a Haitian doctor who manages the WHO response to Butembo, a city of 1.3 million south of Beni where the disease is spreading, has tried to infuse money into the economy local as a way to buy trust. Recently, for example, he bought 30 bikes for his team locally, although he was allowed to get them imported.

But Belizaire also has a more practical approach. Ebola is transmitted in alarming quantities on the outskirts of Butembo controlled by Mai-Mai. He spends days of negotiations with the militias for access.

"The new Mai-Mai groups continue to call us and to advance their requests, it's like a new one every day," he said. "But they are very hostile to the strangers who come in. In some cases, we have agreed to send members of the community to train them instead of the other way around."

While many Mai-Mai groups are open to these provisions, the ADF will not commit itself. Local workers have started calling an area controlled by the ADF between the cities of Mbau, Eringite and Kamango "le triangle de la mort" – the triangle of death. It is here that many are worried that the transmission of the ebola is going out of sight of the rescuers.

Congo's health minister, Oly Ilunga Kalenga, said in an interview that greatly appreciated the help of the international community and that with the help of Congolese health workers, "thousands of cases and deaths have so far been avoided. "

But with each attack comes a pause in the response of health workers, and with each break a jump in the number of cases.

"We can not abandon these people in North Kivu," said Anoko. "They have suffered so much, we have a great liking for them"

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