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When doctors tried to touch Ebola patients in a village in the eastern Democratic Republic of Congo during a recent outbreak of violence, they were blocked by men armed with machetes and axes.
Fearing to be kidnapped, they turned around, the latest in a series of unsuccessful attempts to contain the worst epidemic of the deadly virus in this Central African country.
As fighting intensified between rival militias seeking to control their land and natural resources, life-saving vaccinations and treatments were increasingly delayed and the Ebola virus spread.
The situation has become so dangerous in eastern Congo that humanitarian workers have been temporarily evacuated from their base in Beni, in the North Kivu region, near Rwanda and Uganda.
With the vast country of more than 80 million inhabitants also suffering from political instability and facing a refugee crisis, experts from the World Health Organization regard it as one. some of the most complex public health problems of recent history.
"Sometimes, on the pitch, we hear bullets flying from left to right and we tell ourselves that we are going to touch one of us," said Mimi Kambere, coordinator of the group's emergency response interventions. nonprofit Oxfam, whose team was confronted with men armed with machetes.
"Sometimes insecurity forces us not to answer calls and not to enter certain areas for several days," she told Reuters in Goma, a town north of Lake Kivu. where she was evacuated with other health workers on 17 November.
The tenth outbreak in Congo since the discovery of the Ebola virus in 1976 has infected 422 people and killed 241 in the last four months.
It will become the second largest epidemic of the disease, surpassing the 425 recorded cases in Uganda in 2000, according to Congo's Ministry of Health records.
The disease is spread by contact with body fluids and causes hemorrhagic fever with severe vomiting, diarrhea and bleeding.
In many outbreaks, more than half of the cases are fatal. In the worst epidemic, which began in 2013, more than 11,000 people were killed in three years, mainly in Liberia, Guinea and Sierra Leone.
Screening for patient contact and immunization with a preventative vaccine quickly closed an Ebola outbreak in a peaceful area in western Congo this year. This gave rise to the hope that new methods of fighting Ebola could reduce its mortality, even in urban areas.
But in what a World Health Organization official in Geneva has described as a "perfect potential storm," densely populated North Kivu is now at the epicenter of fighting and Ebola.
A WHO emergency committee said in October that the epidemic could escalate dramatically if the response is not strengthened. In November, the number of new cases increased and the virus spread to areas previously untouched.
An internal memo from the United Nations Office for the Coordination of Humanitarian Affairs (UNHCR), consulted by Reuters, recorded 28 violent incidents affecting Ebola teams between August and November.
International and Congolese health workers are not only embarrassed by the shots. They often face what the WHO calls "the reluctance, refusal and resistance" of some Congolese to accept treatment.
Some Congolese think that doctors are spreading the disease with their vaccination needles. Others do not believe that the virus exists at all.
A number of doctors, especially local staff, received verbal death threats and stones were thrown at their cars, they told Reuters.
According to the WHO, such actions are motivated by fear of the Ebola virus and are exploited by local politicians before a presidential election scheduled for December.
Those seeking medical help often end up in unhealthy medical facilities where the virus spreads, a doctor said.
The scope of humanitarian workers is also limited by the shortening of the working day under the curfew imposed by the government, non-governmental organizations (NGOs) and the UN because of the fighting.
This delays crucial services such as blood tests and the safe burial of Ebola victims to prevent the spread of the virus.
"The armed groups that attack Beni pose a huge obstacle to our staff," said Michel Yao, head of the WHO Incident in Beni.
In some areas, WHO must seek permission from armed groups to access new patients. Telephone negotiations to secure passage can delay essential early care, Yao said, and halt vaccination plans.
"We had never had to negotiate access to patients before. This is a specificity of this Ebola outbreak, "said Yao.
WHO staff and representatives of the World Food Program and Unicef aid agency were among dozens of evacuees for psychological assessment after clashes in Beni two weeks ago, during which 12 Congolese soldiers and seven peacekeepers were killed, said the WHO.
Shots were fired near the city's Ebola emergency center and a hotel housing humanitarian workers. A shell landed on a building housing WHO staff but did not explode.
"It was scary because normally the violence is not so close," Unicef said.
To avoid stray bullets, he followed the advice given during his training.
"I went into my room and squatted in the shower. I was stuck in the shower for three hours, "he said.
Efficiently containing Ebola involves quick work under pressure: health workers need to check all new possible cases, take blood samples, isolate patients and follow everyone with whom a patient has been in contact.
The slow pace of the international response has contributed to the rapid spread of the Ebola virus in West Africa in 2013, an epidemic that has worsened so far.
In Congo, visiting potential patients often means driving long hours on rough country roads, health workers said. In eastern Congo, this can mean a danger.
A laboratory in Beni receives between 50 and 70 blood samples from health workers every day, but their analysis has slowed down due to time restrictions imposed by curfews, the spokesman said. Ministry of Health of Congo, Jessica Llunga.
"As long as we do not have confirmation that the patient has Ebola, we can not transfer him to a center and we can not vaccinate his contacts, which also hampers the fight against Ebola." epidemic, "she said.
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