In the cramped, dilapidated Ebola ward, a 5-year-old boy languished on a bare mattress, a tissue stuffed into his nose to stanch the incessant bleeding. His father stood
over him, eyes clouded with worry.

A few beds away lay the body of Christiane Bahati, 21, who had died seven hours earlier but had not yet been taken away. Her shoes were still tucked under the bed, her wailing relatives gathered outside the ward doors.

The body, covered by a thin sheet, was highly contagious. Yet hardly anyone in the ward was protected. Relatives came and went, carrying food and water to ailing patients because the hospital had none to give them. A few wore rubber gloves or pulled a scarf across their mouths. Most had nothing at all.

In the next ward lay the hospital’s laboratory technician, also sick. Seven other hospital workers had already died from suspected Ebola. Few of the staff members had ever been trained to fight the disease, and the most rudimentary equipment was in dangerously short supply: tests, protective suits, goggles, masks, even drinking water.

Outside, the sound of hammering broke the hushed silence. Aid workers from Doctors Without Borders were racing to erect isolation tents and disinfection stations.

Dr Alex Bogole, a Congolese doctor in the hospital’s intensive care ward, was furious.

The virus had been spreading for months, virtually unimpeded, “and this is the best we can do?” he said, the frustration pouring through his protective gear.

This is the epicentre of the Ebola outbreak in Congo, and the front line is completely overwhelmed.

The Congolese Health Ministry declared the outbreak on May 15, and it has ballooned into the third largest on record. Two weeks later, the international response is being outpaced by the virus, and there is almost nothing to slow it down. Aid groups warn that without urgent intervention, this could be the world’s deadliest Ebola outbreak ever.

Bogole was never trained for this and was angry at everyone – at the Congolese Government for failing to detect the outbreak until perhaps six weeks after it began, and at the world, which has barely mobilised help here in Mongbwalu, a remote gold mining town of about 150,000 where the outbreak is believed to have started.

“They hold meetings and meetings,” he said, struggling to contain his disdain. “What is the purpose of these meetings? People are dying, people are getting infected, people are in danger. It’s very slow.”

I arrived here with Arlette Bashizi, a photographer for The New York Times, after taking a bumpy, three-hour journey from the regional capital, Bunia, on what has become the Ebola highway, a rutted dirt road that began spreading the disease long before anyone detected it.

Giant trucks, curling through lush hills, leave blinding clouds of dust. Edgy-looking Congolese soldiers guard checkpoints that are often little more than string. Gold miners and people fleeing rebel conflict stream in and out of Mongbwalu, providing an excellent vector for the spread of the virus.

Through April and into early May, doctors in Mongbwalu found themselves fighting a mysterious disease that was taking dozens of lives in the town. It turned out to be Bundibugyo, a virus that causes Ebola. There is no approved vaccine or treatment.

As of Thursday, at least 1077 suspected cases and 246 suspected deaths had been recorded in this outbreak, according to the Africa Centres for Disease Control and Prevention. More than 400 of those cases are in Mongbwalu, a town in the heart of gold country and surrounded by rebel-held territory in Ituri province, in northeastern Congo.

Ebola has swamped this hospital’s meagre capacities.

Test kits for this species of the disease are hard to come by, and there is no triage station, so arriving patients who do not have Ebola risk being infected by those who do. In fact, it is hard to know who has Ebola because test results from the regional capital, some 80km away, take four days or more to arrive, said hospital director Dr Richard Lokudu.

By then, many patients have died.

“I’ve been telling people that we need results immediately,” Lokudu said.

Wailing drifted into his office. Several times a day, news of the death of an Ebola patient sets off explosions of grief, he said. Relatives screamed, gesticulated and rolled around on the grass. Looking into his notebook, Lokudu produced a tally: at least 30 patients had died at the hospital over the previous 12 days. Many more had died in their homes across the town.

Beyond the hospital gates, residents were gripped by fear and confusion, he said. Mongbwalu had not been touched by the last Ebola outbreak in Ituri, which began in 2018 and did not end until 2020. Now, faced with a sudden surge in deaths, many refused to accept that the virus was real and focused their ire on the hospital, Mongbwalu General, which has 135 beds.

Some said the outbreak was a moneymaking plot concocted by Congolese doctors and foreign aid workers. Others called it a curse. Often, doctors say, the early symptoms of Ebola resemble other ailments, such as malaria or typhoid, so by the time patients go to the hospital, many are already very sick and die quickly, heightening suspicion and distrust.

An angry crowd gathered outside the hospital’s front gate, where armed soldiers stood guard. “Killers!” people shouted at us when we arrived, confusing us for foreign aid workers.

Two nights earlier, assailants had burned down an isolation ward in the hospital, shortly after Doctors Without Borders put it up. In the chaos, 18 patients suspected of having Ebola fled their beds and vanished into the town, potentially spreading the virus even more.

A four-wheel-drive vehicle with a smashed window was parked outside Lokudu’s office. A day earlier, angry residents had chased him through the hospital grounds, flinging rocks, he said.

“We really are in a terrible crisis,” he said.

“We’re here to save them,” he added. “They think we want to kill them.”

Other factors help explain why Mongbwalu is the centre of the outbreak. Fruit bats, which scientists believe are a natural reservoir for the Bundibugyo virus, roost in huge numbers in trees on the edge of the town, introducing the risk of transmission.

Gold mining and conflict mean that a diverse stream of people is constantly flowing through the town. Miners seeking an income come here from other provinces, or even across borders, then return home. The gold business brings traders, prostitutes and smugglers.

Before the outbreak, the city was a haven in a volatile region where ethnic conflicts have raged for decades. Displaced people flock to Mongbwalu from the surrounding countryside, seeking safety. But they also go back, perhaps now with the virus.

“It’s a perfect storm,” said Dr Esther Sterk, a tropical medicines adviser with Doctors Without Borders, who arrived in Mongbwalu this past week.

Lokudu believes he may have treated one of the outbreak’s first victims.

On April 6, he said he operated on a young woman who had suffered a miscarriage during a late stage of her pregnancy. As he performed a caesarean section, he noticed unusual splotches of blood on her organs. Six hours later, he said, the woman died. In the weeks that followed, the medics who treated her fell sick.

The anaesthesiologist died on May 9, Lokudu said. The surgical assistant died a day later. Lokudu said he also fell sick around the same time, but survived. He is not sure how, though he noted that he had been vaccinated during the previous outbreak, albeit for a different species of Ebola.

“Perhaps that saved me,” he said.

Now, his focus was on the crowd at the gate. They were followers of Sylvestre Atama, a charismatic Catholic preacher who had died the day before, only hours after tests confirmed he had Ebola. His anguished supporters converged on the hospital, demanding his body to hold his funeral. Lokudu refused.

Traditional burial practices involve touching the body. Lokudu feared an unmanaged funeral could turn into a superspreader event, passing the disease to even more people. The crowd attacked Lokudu, hitting his car with stones. Although soldiers were now positioned at the gate, the threats continued.

“They absolutely want the body,” he said.

That night, as we settled into our hotel, gunshots rang out. A crowd of more than 100 men, some armed with machetes and sticks, attacked the hospital in an effort to spring the preacher’s body. The police and soldiers fired warning shots to repel them, witnesses said.

The battle went on for five hours, the police chief, Djuma Yaweli, said. In the chaos, yet more Ebola patients left their beds and ran for safety, potentially taking the virus home to their loved ones.

The next morning, after careful negotiations, a line of soldiers accompanied Atama’s body as it wound through the town for a safe burial beside the Catholic church.

Experts at the WHO say that a vaccine against this species of Ebola could take six to nine months to develop. Until then, “we must make do with what we have,” Lokudu said. “Otherwise, who will do it?”

The doors of the Ebola ward swung open. A Red Cross worker emerged, wearing the same kind of protective suit we had put on to enter the hospital wards. Spraying disinfectant in his path, he was followed by volunteers carrying a sealed white bag.

It contained the remains of Bahati, the 21-year-old whose body had lain there for many hours after she had died.

Mourners grieved as the body bag was placed in a coffin, wailing and beating themselves. “Show us her body!” one cried out.

Her husband, Héritier Alezo, watched from a distance. He still had not told their boys, aged 2 and 3, that their mother was gone. “How would they understand?” he said.

He impatiently rejected the conspiracy theories that were circulating in the streets to explain the scourge. He had the ultimate, most painful proof.

“In my opinion,” he said firmly, “Ebola exists.”

The door to the Ebola ward closed again. But there were also glimmers of hope. The ailing 5-year-old boy, Emmanuel Cyrille, fought on.

Only days earlier, he had been at school, until the teachers sent him home when he became feverish. Soon, he began to bleed.

By Friday afternoon, his father sent a message to say that Emmanuel was sitting up, asking for toys. The bleeding had stopped.

Emmanuel hoped to go home soon, he said.

This article originally appeared in The New York Times.

Written by: Declan Walsh

Photographs by: Arlette Bashizi

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