MONGBWALU, Democratic Republic of Congo — Long before the Congolese government declared an Ebola outbreak, Joseph Mute, a neighborhood leader in the gold-mining town of Mongbwalu, watched a string of mysterious deaths unfold. The dead, he said, showed signs of bleeding.
“They had blood in the nose, blood in the mouth,” Mute said, standing on an unpaved road in the Shuni neighborhood, where the deaths were concentrated.
Mongbwalu is a town of about 130,000 people in Ituri province, one of the epicenters of eastern Congo’s outbreak. The World Health Organization said the outbreak is believed to have started here, but this has yet to be fully confirmed, according to NPR reporting from the region.
From Mongbwalu, the virus likely spread across Ituri and into its capital, Bunia, a city of more than 1 million. Confirmed cases have also appeared in the Congolese provinces of North Kivu and South Kivu, as well as in Uganda, which shares a long border with Ituri.
At first, the cause of the deaths was unclear. Mongbwalu’s population is largely made up of poor gold panners, and disease is common among this marginalized group. Mute said some suggested the sickness was tuberculosis, AIDS or even mercury poisoning from the chemical miners use to extract gold from ore. Others offered a supernatural explanation, which gained wide belief.
In February, mourners traveling from Bunia to Mongbwalu brought a coffin that was damaged en route. Family members decided to get a new coffin and burned the old one in the Shuni neighborhood, violating a traditional taboo. Soon after, residents of Shuni began to sicken and die, giving rise to rumors of a cursed coffin. “People said it was the flames of the coffin spreading through the neighborhood,” Mute said, referring to the then-unidentified disease. “But that’s not true.”
The government eventually identified the illness as Ebola, but only after a significant delay. The first-known suspected case was of a nurse who developed fever and vomiting on April 24, according to the health ministry. The nurse died in Bunia but was buried in Mongbwalu. In early May, four health workers in Mongbwalu died within four days, sparking alarm. But testing at Congo’s National Institute for Biomedical Research initially came up negative because scientists screened for the Zaire and Sudan species of the virus.
On May 15, the government at last declared an outbreak, after genomic sequencing confirmed that the rarer Bundibugyo species of the virus was circulating. By that point, more than 50 people had already died in the Shuni neighborhood, Mute said. “It hurts me,” he said, pointing out houses that now lie empty because the former occupants had died or fled.
As of June 20, the country had 1,003 confirmed cases, according to the health ministry, with 220 in Mongbwalu and its surrounding area. However, aid workers said the official numbers vastly understate the scale of the crisis. Many people avoid seeking medical care when they get ill, and superstition and fear run deep. Testing delays have also meant that some probable Ebola victims died without being confirmed as having the disease.
The rapid spread of the virus over a large range reflects the nature of gold mining, the bedrock of Mongbwalu’s economy. Muddy pits filled with miners surround the town, where workers dig, pump water through sluices and sift for gold ore. The miners, who come from across eastern Congo, are highly mobile, officials said, contributing to Ebola’s proliferation. Bisimwa Biragi, a miner from South Kivu province about 300 miles south, said he arrived in Mongbwalu after being displaced by the conflict with M23 rebels. “We’re scared,” he said, washing ore sediment with mercury in a plastic tub. “Lots of people are dying.”
Eastern Congo has been devastated by decades of armed conflict, leading to repeated waves of mass displacement. More than 900,000 people live in displacement camps in Ituri alone. In the gold pits, there were no visible health measures: no protective equipment, sanitation controls or medical oversight. Around town, hand-washing stations are also rare. Only 20% of Mongbwalu residents have access to safe water, according to Oxfam, and a quarter lack access to toilets or hygiene facilities.
Local resistance has also hampered the response. In some parts of Mongbwalu, residents have fiercely resisted health responders. Rumors are rife that aid groups are spreading the disease to enrich themselves. Funerals have become a flash point. This month, police fired warning shots and tear gas to disperse a crowd trying to seize the coffin of a suspected Ebola victim.
Despite the challenges, the town’s hospital, run by Doctors Without Borders, remains active. Ambulances arrive regularly with suspected patients, and disinfection teams spray each vehicle. Coffins are common, and mourners weep over deceased loved ones in the courtyard.
But some survive. On June 16, the hospital’s bookkeeper, Florence Mangembo, who contracted Ebola, was discharged at the same time as a 3-year-old girl. Hospital staff lined up to sing and dance, celebrating their recovery. “I don’t recognize myself,” Mangembo said afterward. “I feel stressed.” She said she contracted Ebola after helping her sister, whom she found collapsed and vomiting in a field. She persuaded her family to call an ambulance, but her sister died two days later. Relatives then blamed Mangembo for the death, reflecting continued confusion about the disease. “The virus is real,” Mangembo said. “Luckily, I emerged victorious.”