DR Congo

Rebels, Doctors and Merchants of Violence: How the fight against Ebola became part of the conflict in eastern DRC


Executive Summary

The outbreak of the Ebola virus in the eastern Democratic Republic of the Congo in 2018, the 10th outbreak in the DRC, was the first time that the disease emerged in a conflict zone. This report, the second in a series on the Ebola epidemic, attempts to explain how the epidemic and the transnational effort launched to contain it (the Riposte) was affected by this violence, and how they in turn influenced the armed conflict.

Building on months of research and investigation, we argue that the Riposte became a source of both grievances and opportunism, inadvertently triggering resistance and aggravating the conflict. In its haste to prevent the spread of the deadly disease, and to protect its own staff, the Riposte paid both government security forces and armed groups, prompting it to be perceived as a de facto conflict actor and rendering itself indirectly complicit in the ongoing armed violence. The World Health Organization (WHO) was particularly involved in these payments, breaking with United Nations regulations, carrying out most of the payments and deciding how much they would be paid; they therefore had a particular responsibility in the security consequences.

This militarization of the Riposte sparked a vicious cycle of resistance and coercion. The local population was already wary of the Kinshasa government and foreign intervention due to past abuse and apathy. This mistrust was further exacerbated by a type of top-down engagement that failed to sufficiently engage and consult with local communities. In particular, interlocutors complained that the humanitarian community had done little to bring an end to the gruesome violence that had engulfed their region since 2014, and that the Riposte could be heavy handed, in some instances allegedly transporting suspected patients to health centers by force and breaking up funerals.

Within this context, the payments to Congolese security forces had two critical consequences. First, they undermined the most important asset in dealing with the epidemic—trust toward healthcare workers. Second, they made the Riposte an unwitting contributor to conflict–– armed violence became a way for actors in the conflict to call attention to themselves so as to be bought off, as well as a means of prolonging the epidemic in order to extract more resources from the Riposte.

This experience provides lessons for public health interventions in conflict situations and beyond. Communities affected by public health emergencies, including epidemic outbreaks, are likely to be skeptical of outside or government intervention whether in the Congo or elsewhere. Public health interventions—whether led by UN bodies, national governments, or both—must take communities seriously, seek compromise when deciding whether to hire outside experts or locals with extensive knowhow, and avoid involvement in conflicts. While each situation will have its own security dynamics, the lesson from this case suggests that hiring armed escorts ended up creating more problems than it solved.