An Angry Crowd, A Burial Team's Escape: Scenes From The Ebola Outbreak

Last month Virgil Attia found himself surrounded by an angry crowd.

"Some of them had picked up rocks," he recalls, speaking in French. "Some had empty bottles."

Attia is an official with the International Federation of the Red Cross. He's originally from Benin but based in a city in Democratic Republic of the Congo that is the current epicenter of an Ebola outbreak that has been raging there since August.

When someone in the community dies of Ebola at home, the Red Cross has been sending teams to collect the body and conduct a safe burial. Normally Attia coordinates these teams out of his office. But on this day he had come along as a team set out to pick up the body of a 7-year-old boy.

Attia says the crowd of about 150 people started gathering as soon as the team arrived in the neighborhood. At first people were just watching as the team pulled on protective suits and walked into the house.

Then, says Attia, just as the team was about to put the boy into a body bag, "the boy's father rushed in and said he'd changed his mind. He didn't want his son taken this way."

That's when the mood in the crowd shifted in an instant — from curious to menacing. The team immediately backed off and started taking off their suits – now contaminated with Ebola virus — as quickly as they dared.

"You just fear the worst," says Attia. "You're trying not to look like you're rushing because showing fear will provoke the crowd. But you're also trying to get out before someone throws the first rock. Because you know once that happens everyone will start throwing."

Attia and the others managed to drive off in time. Just a few weeks later another burial team in a nearby city was less fortunate. A crowd pelted them with rocks. "Two of the team members were seriously injured," notes Attia.

The DRC's government reports that on average burial teams, health workers and other responders are being threatened like this as often as three or four times a week.

Partly it's because many people in the communities where Ebola is now spreading had never heard of it — so they're resistant to giving up their loved ones to strangers in scary plastic suits.

But there's another issue, says Ashish Pradhan, a U.S.-based senior analyst with International Crisis Group, a research organization that is a leading authority on conflict areas: "The local population is very distrustful of the government. Their default mode is not to trust the government."

Even though this part of the DRC has a lot of mineral wealth, people are desperately poor. "They haven't seen anything from this government," says Pradhan. And so many have concluded that the ruling authorities only care about exploiting the wealth for themselves.

Many people also resent the DRC's president, Joseph Kabila, for staying in office two years beyond his constitutional term limit. And perhaps most of all they are furious that for years now multiple armed rebel groups have roamed the area — and neither the central government nor a thousands-strong force of United Nations peacekeepers has offered much protection. Just ten days ago, one of these groups, called the Allied Democratic Forces or ADF, reportedly killed 15 civilians and kidnapped a dozen children.

And so, says Pradhan, when an authority figure — be it from the government or a foreign health worker — shows up to warn about Ebola, "there's questioning of whether this outbreak is even real, whether there are ulterior motives."

The rebel attacks have another serious impact. After each major attack, people in besieged towns have been staging street protests and that keeps Ebola responders from doing their job. It's too dangerous, for example, for health workers, to travel around tracing anyone who has had contact with an infected person so the contact can be vaccinated and monitored.

"So every time this happens, your teams don't go out — they don't see the contacts," says Ray Arthur, one of the officials tracking the Ebola epidemic for the U.S. Centers for Disease Control and Prevention. And more people are infected.

Arthur says in recent week the impact is starting to show up in the data: the tally of new cases has risen from about 10 per week to more than 30 per week. Most concerning: As many as three quarters of the new cases are people who were not known contacts of a previously infected person.

The World Health Organization has said its imperative is to improve security in the outbreak zone, and on Tuesday, the U.N. Security Council passed a resolution demanding that all parties ensure health workers have access to the outbreak zone.

But Pradhan, of International Crisis Group, says enforcing that is not going to be easy. For one thing, the government and the U.N. have a poor track record of countering the various rebel groups active in the area. They don't even have strong intelligence about these groups, including the ADF, which appears to have stepped up its attacks in recent weeks.

"When you speak to senior officials at the the U.N. there is such a level of uncertainty about the group," says Pradhan. Questions such as: Who exactly is in it? What are their goals? How many fighters do they have?

"The fact that no one really quite knows is a major issue," he says.

The United Nations could boost the size of the peacekeeping force, but that would take an act of the Security Council. And Pradhan says that's unlikely because for months member states and the U.N. leadership have been trying to wind down the presence of the 18,000 peacekeepers in the DRC.

The hope is to do so shortly after national elections, which are scheduled for December. So at present the U.N.'s main focus has been to make sure that the government allows the election to go forward and doesn't crack down on opposition groups.

"In fear of that the U.N. has had to shift its pieces around the chessboard," says Pradhan. "It's been moving its troops from the eastern part of the country [where Ebola is spreading] to somewhat more urban areas," where the concern is that opposition parties could stage large demonstrations that the government then tries to violently suppress.

The CDC's Arthur says that the saving grace in all this is that health workers have managed to vaccinate a record number of people — more than 24,500 to date, most of whom had contact with an infected person. That's why, despite the violence the outbreak is not spiraling uncontrollably.

"But the longer this goes on," says Arthur, "we may get to the point where that dampening effect of using the vaccine is no longer keeping the level of transmission down."

And if that happens, he says, Congo could see a more explosive outbreak.

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ARI SHAPIRO, HOST:

Ebola has been spreading through an eastern region of the Democratic Republic of Congo for more than three months. More than 240 people have been infected, and recently, the tally of new cases has risen from about 10 to more than 30 per week.

NPR's Nurith Aizenman explains why this outbreak is proving difficult to end.

NURITH AIZENMAN, BYLINE: Last month, Virgil Attia found himself in a town near the epicenter of the outbreak, surrounded by an angry crowd.

VIRGIL ATTIA: (Through interpreter) Some had rocks. Some had empty bottles.

AIZENMAN: Attia is with the International Federation of the Red Cross and coordinator of these safe burial teams they sent into the community when someone has died of Ebola at home. On this day, the team had come to pick up the body of a child.

ATTIA: (Speaking French).

AIZENMAN: A boy of 7. Attia says the crowd of about 150 neighbors started gathering as soon as the team arrived. At first, people were just watching as the team pulled on protective suits and walked into the house. Then, just as the team was about to put the boy into a body bag...

ATTIA: (Through interpreter) The boy's father rushed in and said he'd changed his mind. He didn't want his son taken this way.

AIZENMAN: That's when the mood in the crowd shifted from curious to menacing in an instant. The team immediately backed off, started taking off their suits as quickly as they dared.

ATTIA: (Through interpreter) You fear - you just fear the worst. You're trying not to look like you're rushing because showing fear will provoke the crowd. But you're also trying to get out before someone throws the first rock because you know once that happens, everyone will start throwing.

AIZENMAN: Attia and his team did manage to drive off in time. But the DRC's government reports that health workers are being threatened like this three or four times a week. Partly, it's because many people in the communities where Ebola is now spreading had never heard of it. So they're resistant to giving up their loved ones to these strange people in scary plastic suits.

But there's another issue. Ashish Pradhan is a senior analyst with International Crisis Group.

ASHISH PRADHAN: The local population is very distrustful of the government.

AIZENMAN: Even though this part of the DRC has a lot of mineral wealth, people are desperately poor. Many believe the ruling authorities only care about exploiting the wealth for themselves.

PRADHAN: We haven't seen anything from this government.

AIZENMAN: Perhaps most of all, they are furious that, for years now, multiple armed rebel groups have roamed the area. And neither the central government nor a United Nations peacekeeping force that is thousands strong has offered much protection.

Just 10 days ago, one of these groups reportedly killed 15 civilians and kidnapped a dozen children. And so, says Pradhan, when an authority figure, be it from the government or a foreign health worker, shows up to warn about Ebola...

PRADHAN: There's a questioning of whether this outbreak is even real, whether there are ulterior motives that the government has.

AIZENMAN: Also, after pretty much every attack by a rebel group, people in the affected town or city have been staging street protests, during which Ebola responders are forced to hunker down. That includes health workers who would normally be tracing anyone who has had contact with an infected person so the contact can be vaccinated and monitored. Ray Arthur is one of the officials tracking the Ebola epidemic for the U.S. Centers for Disease Control and Prevention.

RAY ARTHUR: So every time this happens, your teams don't go out, they don't see the contacts.

AIZENMAN: And the disease spreads.

The World Health Organization has called for more security in the outbreak zone, but Pradhan of International Crisis Group says the U.N. is trying to wind down its presence in the DRC. So it's very unlikely they'll add peacekeepers in the outbreak zone.

Right now, the U.N.'s main focus in the DRC are elections that are set for December, making sure the government actually holds them and doesn't crack down on opposition groups.

PRADHAN: In fear of that, the U.N. has had to shift its pieces around the chessboard.

AIZENMAN: Away from the east, where Ebola is spreading, to other parts of the country. Health workers have managed to vaccinate a record number of people, more than 24,000 so far. And the CDC's Arthur says that's why, despite the violence, this outbreak is not spiraling.

ARTHUR: But the longer this goes on, we may get to the point where that dampening effect that we have of using the vaccine is no longer keeping the level of transmission down.

AIZENMAN: And then, Arthur says, we could move into a more explosive outbreak. Nurith Aizenman, NPR News.

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