BUNIA, Democratic Republic of the Congo — Doctors operating on the front lines of the fight against Ebola in Congo, already grappling with shortages of basic supplies, are now also having to deal with attacks on their facilities and fleeing patients as the virus spreads rapidly.

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At least three such incidents have occurred in the northeastern province of Ituri where the first Ebola cases were reported, including two at the weekend targeting the same hospital that permitted more than two dozen patients to run away.

The attacks recall the widespread violence targeting health facilities during a 2018-2020 outbreak in eastern Democratic Republic of Congo that killed more than 25 health workers.

Some were perpetrated by civilians who were angry about not being able to bury their loved ones or were convinced that the outbreak was a hoax. The influx of money and manpower into an area that had felt neglected during decades of conflict and humanitarian crisis has spurred local suspicions about the real motives for the sudden spike of interest.

A similar dynamic seems to be playing out now, said Dr. Richard Lokodu, medical director of the Mongbwalu General Referral Hospital, which came under attack first on Saturday and again on Sunday.

“There is denial of the disease within the population, with some members wanting to claim the bodies of suspected and/or confirmed cases,” he said.

The World Health Organization has declared the outbreak of the rare Bundibugyo ​strain of Ebola, the third-largest such outbreak on record, a public health ​emergency ⁠of international concern.

WHO chief Tedros Adhanom Ghebreyesus said on Sunday there had been ⁠more ​than 900 suspected cases in ​the outbreak so far, including 101 confirmed cases.

On Monday, Tedros said there had been 220 suspected deaths in the current Ebola outbreak and that a delay in detecting cases meant responders were now “playing catch-up.”

18 patients fled

At the Mongbwalu General Referral Hospital, located in Mongbwalu town where many cases have been reported, 18 Ebola patients fled on Saturday after “unidentified individuals” burned tents, erected by medical charity Medecins Sans Frontieres, where patients were being isolated, Lokodu said.

Four lab results from those patients have come back — three negative results and one positive result, he said.

“So we have one confirmed case of Ebola that continues to circulate in the community and evade the response,” Lokodu said.

On Sunday, the hospital came under four waves of attacks by young people mobilised by relatives of a Christian religious leader who died of Ebola, he said.

Seven other patients escaped and Congolese police and soldiers had to mobilise to restore order, he said.

A suspected Ebola patient who was in critical condition with hemorrhaging died in the second attack while trying to flee from his bed, Lokodu added.

The perpetrators of the attacks wanted dead Ebola victims’ bodies released for burial, Lokodu said.

The bodies of Ebola victims are highly infectious after death, and unsafe burials — in which family members handle ⁠the body without proper protective equipment — are a leading driver of transmission.

History of attacks

Health workers faced a handful of attacks by angry mobs during the 2013-2016 Ebola outbreak in West Africa, the largest on record, some of whom accused them of spreading the virus.

But the phenomenon exploded during the 2018-2020 outbreak in eastern Congo, a region marked by rampant insecurity and mistrust of formal authorities.

In addition to more spontaneous outpourings of anger by local communities, many attacks were carried out by militia groups looking to exploit the outbreak for political and financial gain, researchers found.

The current outbreak is believed to have originated in Ituri before spreading to North and South Kivu provinces – including areas under the control of Rwanda-backed M23 rebels – and across the border into neighbouring Uganda.

On Monday Uganda reported two more confirmed cases of Ebola, bringing the total number of cases in the country to seven.