DRC Health Workers Battle Ebola Without Pay, Facing Infection and Mob Violence

In Bunia, a city in the eastern Democratic Republic of the Congo, health workers are fighting an Ebola outbreak under conditions that would break most people. They show up to work without paychecks. They face communities that don't believe the virus exists. They risk their lives knowing that more than a hundred of their colleagues have already been infected, and roughly thirty-five have died.

The outbreak itself is moving with unusual speed. By mid-July, authorities had recorded more than 2,500 cases and roughly 1,000 deaths. To understand how fast that is: during the 2018 Ebola outbreak in the same region, it took more than ten months to reach 2,000 cases. This time, the disease reached that threshold in a matter of weeks. The World Health Organization has warned repeatedly that this could become one of the worst outbreaks on record. The 2014-2016 West African epidemic killed more than 11,000 people over two years. The 2018-2020 DRC outbreak killed 2,287. This one is accelerating faster than any documented before it.

Part of the reason is the strain itself. The Bundibugyo variant spreading through eastern DRC has no approved vaccine and no proven treatment. The disease had been circulating for weeks before anyone officially declared an outbreak on May 15, a delay that epidemiologists trace to cuts in global health funding that have weakened disease surveillance systems. The outbreak is also unfolding in a region fractured by protracted conflict, where people distrust authorities and where conspiracy theories about Ebola spread as readily as the virus itself. Some communities believe the disease is punishment from ancestors. Others insist it was manufactured to reduce the world's population. In this environment, tracking cases is nearly impossible.

Paluku Audrey is twenty-nine years old and works as a community engagement officer at Rwampara General Hospital, one of the major treatment centers. His job is to walk through neighborhoods in Bunia every day, talking to people about Ebola, explaining hygiene measures, describing symptoms, urging the sick to seek care. He has not been paid since May, when the outbreak was declared. He lives more than six miles from the hospital. Some days he takes a bus, but most days he walks because he cannot afford transport. He carries a bottle of disinfectant and a mask, though supplies are scarce. What he cannot protect himself against is the anger. Once, while doing his work, young people detained him, accused him of lying about Ebola to make money, and threatened to stone him. Only because he had contacts in the neighborhood was he rescued. He thinks about his family, who depend on his income and fear for his life. He wonders what will happen to them if he does not come home.

Ghislain Maneba is thirty-five, an epidemiologist at the same treatment center. His work is to go into homes, identify suspected cases, transport the sick to the hospital, help treat them. He takes a motorbike taxi to work each morning, thinking about the oath he swore to save lives, thinking about the case numbers climbing, thinking about the doctors who have fallen ill. He has been given some protective equipment—boots, gloves—but not enough. He is disinfected after contact with confirmed or suspected cases. He has not been paid. He struggles to afford transport to and from work. His worst memory is attending the funeral of a fellow doctor who died of Ebola, a person he describes as brave and full of ambition. The outbreak took that life. When Maneba thinks about it, his heart breaks. But it also drives him to work harder, to honor the dead colleague by fighting on.

In May, residents of the neighborhood surrounding Rwampara burned parts of the treatment center and chased health workers fleeing in trucks. Last week, dozens of workers at the hospital went on strike, refusing to work until they were paid. The hospital operates a major Ebola treatment center. The strike threatened to disrupt care in the middle of an accelerating outbreak. Health workers across the region report the same conditions: months without salary, inadequate personal protective equipment, communities that view them with suspicion or outright hostility, and the constant knowledge that the virus kills hard and fast.

What sustains these workers is partly duty, partly pride in the historical moment they are living through. Audrey says his awareness-raising efforts are working—people promise to follow his advice and pass his messages to others. He believes his country will one day be grateful. Maneba speaks of writing a page of history, of putting his experience to good use. Both men say they will keep working. But they also say clearly what needs to happen: the international donors funding the response must pressure the government to pay them. They need vehicles, food, adequate protective equipment. Without these things, the outbreak will continue to spread in a region where health workers are already stretched to breaking.