Women sift gold-bearing sediment in search of gold at the Maidede mine in the Democratic Republic of Congo’s Ituri province on June 16.
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MONGBWALU, Democratic Republic of Congo — Joseph Mute witnessed a string of mysterious deaths in Mongbwalu long before the Congolese government declared an Ebola outbreak.
A neighborhood leader in the town, Mute said that the characteristic feature of these deaths was the presence of blood.
“They had blood in the nose, blood in the mouth,” he said, standing on an unpaved road in the Shuni neighborhood.
A gold-mining town of about 130,000 people located in Ituri province, Mongbwalu is one of the epicenters of eastern Congo’s Ebola outbreak. The outbreak is believed to have started here, according to the World Health Organization, but this has yet to be fully confirmed.
From Mongbwalu, Ebola likely spread across Ituri, including to 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.
A cemetery in Mongbwalu, in Ituri province, in eastern Democratic Republic of Congo. The gold-mining town is one of the hot spots of Congo’s Ebola outbreak. Frequent burials have become part of daily life as the virus continues to spread and take lives.
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At first, it wasn’t clear what was causing the deaths. Mongbwalu’s population is made up largely of poor gold panners, and diseases are common among this marginalized group. Some, Mute said, suggested that the spreading sickness was tuberculosis, AIDS or even mercury poisoning — from the chemical that miners use to extract gold from ore.
Others offered a supernatural explanation, which gained wide belief.
A woman carrying a funeral cross rides on a motorcycle taxi through Bunia, the capital of Ituri province, in the Democratic Republic of Congo, on June 18. Funeral processions and other signs of mourning have become increasingly common as eastern Congo battles an Ebola outbreak.
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“Flames of the coffin”
In February, mourners traveled from Bunia to Mongbwalu in a car, carrying a coffin that was damaged en route.
Family members of the deceased decided to get a new coffin when they got to Mongbwalu. They 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,” said Mute, referring to the then-unidentified disease. “But that’s not true.”
Congo’s government eventually identified the illness as Ebola, but only after a significant delay.
A view of the morgue at the Ebola treatment center of the Evangelical Medical Center in Bunia on June 18, as staff prepare the body of a person who died from Ebola. The facility is part of the region’s response to the outbreak spreading through eastern Congo.
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The first-known suspected case was of a nurse who developed fever and vomiting on April 24, according to the country’s health ministry. The nurse died in Bunia but was buried in Mongbwalu.
Both fever and vomiting are hallmark symptoms of Ebola. Bleeding, though less common, is also a symptom of severe infection.
In early May, four health workers in Mongbwalu died within four days, sparking more alarm. But testing for Ebola 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 in the neighborhood that now lie empty because the former occupants had died or fled.
Serge Ugena of Mongbwalu lost his wife and five family members to Ebola as the outbreak swept through the Shuni neighborhood, one of the hardest-hit areas of the town.
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Gold mining is a factor in the spread
Ebola infections are still spreading widely in Mongbwalu over one month after the outbreak was declared. The town and surrounding area have 220 out of the 1,003 confirmed cases in the country as of June 20, according to the health ministry.
However, aid workers believe that the official numbers vastly understate the scale of the crisis. Many people avoid seeking medical care if they get ill. Superstition and fear run deep. Testing delays have also meant that some probable Ebola victims died without being confirmed as having the disease.
A view of the Shuni neighborhood in Mongbwalu. The neighborhood is one of the epicenters of the Ebola outbreak in eastern Congo. Death tolls here are among the town’s highest.
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In some parts of Mongbwalu, locals have fiercely resisted health responders too. Rumors are rife: Some believe that aid groups are spreading the disease to enrich themselves.
Funerals are also a flash point. This month, police in the town fired warning shots and tear gas to try to disperse a crowd that had come to seize a coffin of a suspected Ebola victim. Many families still wish to bury their dead themselves, despite the risks.
The rapid spread of Ebola over a large range reflects the nature of gold mining, the bedrock of Mongbwalu’s economy. Muddy pits filled with miners surround the town. They work closely, digging, pumping water through sluices and sifting for gold ore. The miners, who come from across eastern Congo, are highly mobile — yet another reason that Ebola has proliferated so quickly.
Women sift gold-bearing sediments at the Maidede mine in Mongbwalu on June 16. Gold mining drives the local economy and draws a highly mobile workforce, a factor that health officials say has complicated efforts to contain the Ebola outbreak.
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A portrait of Léon Gina at the Maidede mine, which is an artisanal gold-mining site. The mine is part of the informal gold economy that continues to draw workers to the area amid the Ebola outbreak.
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Bisimwa Biragi, from South Kivu province, about 300 miles south, said that he had arrived in Mongbwalu after being displaced by the conflict with M23 rebels, who are backed by Rwanda.
“We’re scared,” he said, with a team of two others, 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, with more than 900,000 people living in displacement camps in Ituri alone.
“The virus is real”
There were no visible health measures in the gold pits: 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.
The town’s hospital hums with constant activity, marking the scale of the outbreak in the town. Doctors Without Borders has established an Ebola treatment center here. Ambulances arrive regularly with suspected Ebola patients, as disinfection teams spray down each vehicle.
Coffins are a common sight here — as are mourners, who weep over deceased loved ones in the hospital’s courtyard.
The Mongbwalu General Referral Hospital is a key site in efforts to contain the Ebola outbreak in eastern Congo.
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But despite a perception that Ebola is a death sentence, some people survive.
On June 16, the hospital’s bookkeeper — who had contracted Ebola — was discharged at the same time as a 3-year-old girl. Hospital staff lined up to sing and dance, celebrating their good fortune, as the pair looked on in a daze.
Healthcare workers celebrate the recovery and discharge of Ebola survivor Florence Mangembo, in blue jeans, at the Mongbwalu General Referral Hospital. She is the hospital’s bookkeeper.
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“I don’t recognize myself,” said Florence Mangembo, the bookkeeper, afterward. “I feel stressed.” She contracted Ebola, she said, after helping her sister, whom she’d found collapsed and vomiting in a field. Mangembo persuaded her family to call an ambulance, but her sister died in the hospital two days later. Relatives then blamed Mangembo for the death, accusing her of provoking it by insisting her sister go to the hospital — reflecting continued confusion surrounding Ebola in Mongbwalu.
“The virus is real,” Mangembo said. “Luckily, I emerged victorious.”
