Two attacks on Ebola treatment centers in the Democratic Republic of Congo have forced the international aid group Doctors Without Borders to close the facilities, it said on Thursday, warning that the outbreak was not under control.
In the first attack, on Sunday night, unidentified assailants threw stones at a treatment center in Katwa, in northeastern Congo, and set fire to the structure. They destroyed much of the building, equipment and patient wards, and the brother of a patient died, though the circumstances were unclear.
Doctors Without Borders said that its staff members were safe and that patients had been transferred to other facilities, but it called the attack a debilitating blow to efforts to contain the outbreak, which has killed 553 people so far. It is the second-worst Ebola epidemic in history, after the crisis that left 11,310 people dead in West Africa from 2014 through mid-2016.
“This attack has crippled our ability to respond to what is now the epicenter of the outbreak,” Emmanuel Massart, the emergency coordinator for Doctors Without Borders in Katwa, said in a statement on Tuesday.
Three days later there was another attack in the night, this time in the nearby city of Butembo. The attackers tried to set fire to the building, and the next day bullet holes were visible on the wall, said Dr. Michael Yao, the incident manger for the World Health Organization. Patients and medical staff were reported safe by the aid group, including 15 confirmed to have Ebola.
Officials said they did not know what motivated the attacks. “It looks like an organized group that wants to target treatment centers,” Dr. Yao said.
He said the loss of the centers was especially damaging because they were part of an alert system for suspected cases and offered experimental treatments that had shown success. But officials acknowledged that they had struggled to gain the trust of many Congolese.
At first, Dr. Yao said, there was community resistance because it was the region’s first experience with the disease, which carries a stigma. And although health workers slowly built trust with local people, many patients arrived in treatment centers too late — an often deadly delay because of Ebola’s 21-day incubation period.
“When somebody comes late to a treatment center they have less chance to survive,” he said, calling it a “vicious cycle” that creates a negative public perception. In the eyes of many people, he said, treatment facilities began to look like “a kind of center where people come to die.”
Adding to the resistance is a climate of intense distrust toward outsiders, born in part from the long-running conflicts in the region and the divisive campaigns leading up to an election last month, when some politicians spread false rumors about the virus’s origins. There are more than 100 armed groups involved in near-constant conflict in eastern Congo, and militias and security forces alike are accused of brutalizing civilians. That has left many unsure whom to trust.
The violence has frustrated efforts to eliminate the outbreak, and the W.H.O. warned that it could result in the spread of Ebola in the region. Whitney Elmer, deputy country director for the aid group Mercy Corps, said that there had been several waves of distrust and violence before, and that health workers needed to collaborate better with community groups and leaders.
“Community engagement takes time,” she said. “There’s a lot of fear and there’s a lot of misconceptions, and in a 21-day period you’re talking about life and death.”
The workers are trying to address the resistance by speaking with community leaders and offering the testimony of Ebola survivors, who now number more than 300, Dr. Yao said.
The W.H.O. said it was expanding housing and treatment for the patients forced to move. The agency has recorded 814 confirmed infections and 65 probable cases, and determined that risks remain “very high” for the outbreak to spread nationally or across the border into Uganda, Rwanda or South Sudan.
With international groups, Congo quelled an Ebola outbreak last year, and aid workers said the success of that campaign was cause for hope in the current crisis. But for now, Ms. Elmer said, the loss of the two centers was “absolutely crippling in the area where it’s the biggest hot spot right now.”
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