Vianney Kambale Kombi cannot hear the word "Ebola" without experiencing a visceral flood of recollections. His memories of the 2018-2020 outbreak in Beni, an eastern Congolese city nestled near the borders with Uganda and Rwanda, remain etched with the anguish and dread that enveloped his community during what became history's second-largest Ebola crisis. The outbreak claimed more than 2,200 lives from over 3,400 documented cases before vaccines brought it under control. Yet Kombi's most haunting recollection is not of the illness itself, but of something perhaps more insidious: the widespread denial that the outbreak was even real.
In the years since that catastrophic chapter concluded, eastern Congo is confronting a fresh epidemic that threatens to echo past traumas. A separate outbreak caused by the rare Bundibugyo virus has already generated 550 confirmed cases as of early June, resulting in 101 deaths and 19 recoveries. The emergence of this new threat has prompted survivors and healthcare professionals from the 2018-2020 period to speak openly about the barriers they faced—not from the virus alone, but from their own communities. Their warnings carry particular weight now, as authorities struggle to contain a disease for which no approved vaccine yet exists, creating a vastly different operational landscape from the previous crisis.
Kombi's account reveals the depth of misconception that hampered the earlier response. When the outbreak first swept through Beni, many residents attributed the illness to witchcraft rather than a biological pathogen. This supernatural interpretation was not merely a curious folk belief; it represented a fundamental rejection of the disease's existence itself. Alongside this mystical explanation, some residents dismissed Ebola as a "Western conspiracy for funding reasons," a perspective that reflected broader geopolitical anxieties and historical distrust of external actors. These competing narratives created a fragmented community response where even as healthcare workers laboured to contain the spread, significant portions of the population remained unconvinced that the outbreak was anything more than fiction or manipulation.
The psychological toll of community rejection extended far beyond the acute phase of illness. Kombi described the profound difficulty he encountered reintegrating into his community after recovering, a struggle rooted not in lingering physical symptoms but in social stigma. His recovery should have been celebrated as evidence that survival was possible, yet it instead became a source of alienation. The very fact that he lived was sometimes interpreted through a conspiratorial lens, with neighbours questioning whether his survival was authentic or whether he had somehow been implicated in spreading the disease rather than suffering from it.
Bienfait Wanzire, another survivor from the 2018 outbreak, corroborated these experiences while adding a political dimension to the confusion. In his account, the outbreak became entangled with electoral politics playing out simultaneously in eastern Congo. Some residents reframed Ebola not as a medical emergency but as a deliberate tool wielded by competing political factions. Others initially categorized it as a spiritual affliction requiring prayers and traditional remedies rather than medical intervention. This layering of multiple, mutually contradictory explanations created an environment where rational public health messaging struggled to gain purchase.
Dr Babah Mutuza Lusungu, a physician at "Dieu Est Grand" Medical Centre in Beni, witnessed these dynamics from the frontlines of the response. He endured the anguish of losing his uncle and two colleagues to the disease while simultaneously battling community scepticism about whether the outbreak was authentic. Dr Lusungu identified the root problem as a pervasive climate of mistrust that fractured relationships between the population, government authorities, international health partners, and healthcare workers themselves. This erosion of institutional trust created cascading failures: patients avoided treatment facilities, community members obstructed contact tracing efforts, and healthcare workers found their warnings dismissed as propaganda.
Dr Lusungu's perspective on preventing future outbreaks emphasizes the necessity of earlier, more community-embedded engagement. He specifically highlighted the absence of youth participation in response efforts during 2018, arguing that local youth leaders could have served as trusted intermediaries to educate peers about the disease. His warning carries sobering implications: waiting until case numbers proliferate to implement comprehensive public education campaigns means the window for effective containment has already closed. The disease gains inexorable momentum while community understanding lags dangerously behind.
Esperance Masinda, who worked for the United Nations children's agency in Beni throughout the 2018 outbreak, encountered the epidemic from a different vantage point, managing the complex needs of children orphaned by Ebola. She contracted the virus herself while caring for her husband, a medical doctor who had similarly become infected. Though both ultimately recovered thanks to access to vaccines, their survival came with a peculiar social cost. Some community members warned them that the vaccine itself was lethal and that they would not survive another five years, a belief rooted in distrust of pharmaceutical interventions developed outside Congo and administered under emergency circumstances.
Masinda's reflection on the lingering social impact reveals an important transition. Years after the outbreak, she observes that community attitudes toward survivors have softened considerably. The stigmatization that once accompanied recovery has gradually diminished as time proved that survivors could live normal lifespans and reintegrate successfully into social networks. Yet this evolution in attitudes took years to materialize, and the damage to individual survivors during the acute stigma period was substantial. Her insistence that "all of us are humans, even though we have been victims of Ebola" reflects a hard-won wisdom about human dignity that should have required no articulation, yet proved essential to communicate in the aftermath of the crisis.
The implications for the current Bundibugyo outbreak are sobering. While the 2018-2020 response benefited from vaccine availability after the initial period of confusion, the current outbreak proceeds without an approved vaccine option, fundamentally altering the strategic calculus. Healthcare authorities cannot rely on rapid vaccination campaigns to eventually contain transmission. Instead, they must depend entirely on the very community cooperation that proved so elusive during the previous outbreak. The absence of vaccines removes one barrier that had eventually persuaded sceptics, making the work of rebuilding institutional trust even more critical and more difficult.
The survivors' collective testimony underscores that epidemiological response in eastern Congo cannot be reduced to technical medical interventions. Success requires sustained engagement with community belief systems, political contexts, and historical grievances about external intervention. The lessons from 2018-2020 offer both cautionary tales and constructive blueprints, but only if contemporary authorities genuinely incorporate them into their response planning rather than repeating the patterns of denial, scepticism, and failed communication that allowed the previous outbreak to spread so rapidly and claim so many lives.
