Health teams responding to the Ebola outbreak in the Democratic Republic of Congo say their efforts are being severely hampered by attacks on medical staff.
The virus has spread mainly in the eastern provinces of North Kivu and Ituri, areas occupied by rebel and militia groups and where the government has a limited presence.
“The mistrust and violent attacks against the Ebola response [teams] show no signs of abating,” says the charity Medecins Sans Frontieres.
So where have these attacks taken place and why are health professionals being targeted?
The World Health Organization (WHO) tracks attacks on health workers and healthcare facilities.
This year, DR Congo experienced the most with 174, compared with 41 in Afghanistan and 35 in Syria.
These include attacks on medical centres, health workers, patients and transportation.
The WHO says five deaths have been recorded this year, with 51 injuries sustained.
Threats and attacks vary from the throwing of stones at health workers to medical buildings being attacked and burnt down.
There is evidence of a lack of trust among local populations with regard to the advice provided about the Ebola outbreak and the intentions of the foreign aid workers.
A 2018 study published in the Lancet medical journal says “belief in misinformation was widespread” concerning the Ebola outbreak in North Kivu.
One in four respondents believed in the statement that Ebola does not exist, with an even higher proportion saying the Ebola outbreak was fabricated for financial gains, or to destabilise the region.
“There’s already been civil unrest in the region and that’s exacerbated when a foreign response comes into an area that’s heavily guarded,” says Lara Salahi, an author who has written about responses to Ebola outbreaks.
In North Kivu, community-based militia groups called Mai-Mai, have been behind some of the attacks against health centres and workers.
Another militia group, the Allied Defence Forces (Ugandan rebels operating within DRC) have also been accused of causing widespread disruption to medical units.
There have also been a series of attacks by other unidentified groups on Ebola response centres.
In one incident, family members assaulted health workers who were overseeing the burial of their relative last month.
International aid agencies have acknowledged their failure to gain the trust of local populations and, given the highly insecure environment, the level of community mistrust is understandable.
“What we know is that the actors of the Ebola response — MSF included — have failed to gain the trust of a significant part of the population,” said Meinie Nicolai, MSF’s director general in February.
The MSF says in an atmosphere where rumours and misinformation are widespread, people can be hesitant about accepting help and taking action to tackle the virus.