‘The world has never seen anything like this’

The head of the World Health Organization, Tedros Adhanom Ghebreyesus, is distraught. The Ebola outbreak in the Democratic Republic of the Congo (DRC) continues to worsen, and his front-line responders are under attack.

On 4 May, Ghebreyesus will attend the funeral of a 41-year old epidemiologist, Richard Mouzoko, who was shot dead in the city of Butembo on 19 April by men who reportedly shouted, “Ebola doesn’t exist!” Dozens of other Ebola responders have been assaulted in recent months in the northeastern DRC — a region that has been wracked by conflict for decades.

Since the outbreak started nine months ago, nearly 1,000 people have died from Ebola, and the rate of new infections is climbing. Nature spoke with Ghebreyesus shortly after he returned from a visit to Butembo. The conversation has been edited for length and clarity.

How was your visit with Ebola responders?

When we arrived, they were waiting for us in big numbers. I couldn’t stop thinking about Richard. I couldn’t even control my emotions. I was supposed to speak with them, but it was difficult to express how I felt. I just broke. I was thinking of his four kids, and looking at his friends there in the field, and thinking about the risk they were taking to save others.

How did they feel?

I could see how shocked they were. But at the same time, many said, “We are life-savers — we will not be intimidated by this attack. We will strengthen our resolve, and we will fight to finish Ebola.”

They could have said, “Take us away, we don’t want to risk our lives.” They didn’t say that. They said, “We will fight,” and I was so humbled and proud.

You should imagine the conditions they are living in. They have a curfew of 6 p.m. Getting hot water for baths is difficult. There is the risk of Ebola infection. And the attacks are frequent.

Why do the responders stay?

The commitment they have to their profession. They are saying that they promised to save others — to serve others. It’s an oath that is driving them. And they see people suffering from three decades of conflict with all types of disease. They see the level of poverty, and all of the problems the population faces, and they feel that what they are doing is right.

What did people living in Butembo tell you?

We met with business leaders, political leaders, religious leaders, traditional leaders and government officials. We’ve heard that some political leaders were saying that Ebola doesn’t exist [as a political tactic leading up to the DRC’s elections in December]. And when the cities of Beni and Butembo were excluded from voting in the election, it angered the community and they felt that the ‘there is no Ebola’ message must be right.

We have been pushing the message that fighting Ebola should have a bipartisan approach. The first goal is to get political leaders to be honest and help communities instead of fuelling attacks. The majority of people want to be cooperative.

The religious leaders we met — Christian, Catholic, Protestant, Muslim and other denominations — expressed that they will mobilize their followers to explain what Ebola is. They also advised us to bring in more protection, not only for the Ebola responders but for community members who can be attacked, too. For instance, a nurse in Butembo Hospital was killed in March.

Who will provide protection?

Both the DRC government and [United Nations peacekeeping troops] MONUSCO have agreed to help. But there needs to be a delicate balance so that we have effective protection, and at the same time avoid intimidating the community. The new president of the DRC has also visited Butembo and established a new ministerial committee focused on Ebola. That shows the government’s commitment.

Are you still worried?

I’m profoundly worried, because the number of cases increases with the frequency of attacks. They are almost every day. It disrupts our operations, and when operations are disrupted, the virus gets a free ride.

After Richard was killed, we were operating at very low levels for three days. And if we can’t find cases as soon as possible, and if we aren’t able to vaccinate everyone, there is a build-up of the chances of this spreading to other provinces and neighbouring countries. That chance gets higher and higher.

To be honest, with conflict, high morbidity, high population density, political problems and security problems, it’s a miracle we don’t have cases spreading more. This is because of the hard-working colleagues we have there — the WHO plus other agencies, non-governmental organizations and the leadership of the government.

We need to be as aggressive as possible, and we need to improve our speed and scale.

But we need funds. We have just 50% of what we need. I talked with Penny Mordaunt today, before she was appointed as the UK defence secretary, and she pledged support from the UK and promised to mobilize other donors. The US has been supporting us, but we hope they increase their contribution. We are also appealing to Germany, China, Japan and some Nordic countries.

Have you ever experienced anything like this outbreak?

This is unique. The world has never seen anything like this. It is very complicated.

There are some lessons we can apply from the Ebola outbreak from 2014 to 2016, but not all, because this is very different, with armed conflict that has been there for decades now, and the overlap with the election. It’s a perfect storm.

I would expect that the level of commitment [from donors] needed to end this would be very high — but that’s not what I am seeing. I am really worried and very, very concerned. I assure you we will give it our best, although I cannot forecast when it will be controlled.