By Michael Bloom, GBI intern, MA Bioethics candidate at New York University

Last month, Doctors Without Borders (DWB) saw attacks on two of their Ebola treatment centers in the North Kivu province. Shortly afterward, there was a high-profile visit to the area by both Dr. Robert Redfield, Director of the Centers for Disease Control (CDC) and Director-General, Dr. Tedros Adhanom Ghebreyesus at the World Health Organization (WHO) .

Dr. Ghebreyesus issued a public statement in response to the violence: “These are not attacks BY the community, they are attacks ON the community. There are elements who are exploiting the desperation of the situation for their own purposes. The people of Katwa and Butembo, as in the other communities affected by Ebola, want and deserve a place to receive care and a chance of survival. They do not deserve to suffer in their homes while infecting their loved ones, they do not deserve to suffer in inadequately resourced health centers while infecting health workers.”

More than a month later, the violence has escalated beyond attacks on the treatment centers, with the murder of Cameroonian Dr. Richard Valery Mouzoko Kiboung. Dr. Kiboung was an epidemiologist who had been recruited by WHO just around the time of the aforementioned visit by Dr. Redfield and Dr. Ghebreyesus. Described as an affable figure and a serious task master in the field, Dr. Kibuong was aware of the danger in his work and was quoted in a Reddit post as saying “I have my kids. I need to be careful so I can go back [to them].”

Dr. Ghebreyesus’ public statement referred to the attackers’ “own purposes”, but the true motivations of these heinous acts of violence remained unclear. It would be easy enough to attribute violence to the antipathy toward these healthcare workers, as a small organized populace violently rejecting foreign interventionists. However, it might also be attributed to the spread of false and misinformed rumors within the community. According to DWB physician Dr. Brian D’Cruz, there was a rumor that thermometers, which detect body temperature through the ear, caused people to change their minds about who to vote for prior to that country’s recent election. However, the election has long since been settled, suggesting there may be other factors contributing to such widespread violence.

The recent attack and subsequent murder of Dr. Kibuong revealed more about the reasoning behind the violence. According to the NPR, Dr. Michel Yao, who leads on-the-ground operations for WHO, said witnesses recalled the attackers saying, “Ebola doesn’t exist! … [You’ve] invented the disease,” and further accused them of profiting off of the population.

Violence against healthcare workers in nothing new. The WHO reports that between 8% and 38% of health care workers experience violence in the course of their career. Research into the determinants of violence against healthcare workers includes one study on Minnesota nurses finding, “Although violence against nurses is a serious problem, the extent of violence against them and the risk of potential factors are uncertain.”

Well, it appears there may be an economic motive in the attacks on the health care clinics and the workers. The attackers who murdered Dr. Kibuong also robbed the healthcare workers of their cell phones.

It is possible that the WHO is in the midst of a “shake down”, or an extortion effort by local criminals who control the area and believe they are entitled to a cut of the action. These criminals clearly believe, through their own ignorance, that the disease outbreak is a concoction and that there is a monetary reason behind it.

According to the NPR, healthcare workers in the Butembo area are threatening to strike unless and until the attacks cease. The workers marched onto the streets and have demanded the government send in the armed forces within a week to protect their lives. With local mistrust and the uptick in attacks on health centers and workers, the health implications of halting care are dire.

See here for a video clip depicting the struggle to mitigate the outbreak.

The image above was obtained from UN Geneva under a Creative Commons license; modifications were made to size.