A special report from the Democratic Republic of Congo on the ongoing Ebola outbreak. News: The doctor who beat Ebola — and inspires other survivors to care for the sick; News: Meet the Ebola workers battling a virus in a war zone; News: World Health Organization resists declaring Ebola emergency — for third time.

Benjamin Thompson (Interviewer): Listeners, we’ve got something a bit different for the News Chat this week. Amy Maxmen, a senior reporter here at Nature, has been in the Democratic Republic of the Congo. She’s reporting on the ongoing Ebola outbreak in the country, with support from the Pulitzer Center on Crisis Reporting. It’s a complex situation as there have been multiple conflicts in the country unrelated to the outbreak. I spoke to Amy at the backend of last week on a slightly wobbly phone line when she’d just returned from Beni, a city in the east of DRC – the region where the outbreak is centred. I started our chat by asking her about the current situation there.

Amy Maxmen (Interviewee): So, as of June 19th, now we’re entering the tenth month of this outbreak. It’s in North Kivu and Ituri, two provinces in eastern DRC, and there have been just over 2,200 cases of Ebola so far and almost 1,500 deaths.

Benjamin Thompson: So, this is now the second biggest outbreak of Ebola on record, and the WHO Director-General has been in the country to assess the situation.

Amy Maxmen: Yes, right when I arrived, I met the Director-General of the WHO, Tedros Ghebreyesus – he likes to be called Dr Tedros – and when I first met up with him, he was in Kinshasa and he spent the day meeting with big leaders like the Prime Minister of the DRC. He actually met with opposition leaders because it’s important to sort of make this a bipartisan effort. He met with the Minister of Health. He was also warning them that later that day he was going to meet with an emergency committee of experts on a conference call, so he wanted to warn all of these different leaders that they might be declaring what’s called a Public Health Emergency of International Concern. So, after that morning of meetings, he then went into a conference room for a couple of hours to speak with this emergency committee. Now, I didn’t get to sit inside that – that was confidential – but I thought maybe they would declare this an outbreak because there had been a couple of confirmed cases in Uganda. It’s important to know that as far as anyone had seen, there was no spreading of the virus to Uganda. What had happened, was a mother from Uganda had gone to a funeral for someone who had died of Ebola in DRC and then returned with her baby to Uganda and that’s where they noticed the case.

Benjamin Thompson: And what did the committee decide?

Amy Maxmen: They decided to not declare it – this Public Health Emergency of International Concern. That made some people, I would say, upset because the World Health Organisation, right now, is lacking funds in order to fight Ebola, and so the thought is that if they made this declaration, finally funders would start pumping money into the response that’s required.

Benjamin Thompson: So, the experts didn’t announce a Public Health Emergency of International Concern – what does this mean then for the current outbreak and the response to it?

Amy Maxmen: No one knows if actually declaring it would in fact amplify funds and on the reverse, what could have happened is people – by that I mean lawmakers – could go against the advice of the World Health Organisation and shut down borders completely. Now, so many supplies coming into the region I was in – North Kivu and Ituri – are near the border of Uganda and all of the supplies going out would be cut off. Plus, right now, there’s a lot of conflict in Ituri especially. I think since June there’s been more than 300,000 people have fled murder, rape, violence, so that could put those people in danger as well, and they might just try and sneak through the forest at night and then we really have no idea how the virus moves. So, that was sort of the fears that I’ve heard from various people about declaring the outbreak. So, what the WHO did do and what also the governments of Uganda and DRC and Rwanda and surrounding places are doing is trying to make sure that they’re checking people’s temperatures, vaccinating people along the border, like health workers, to be as prepared as possible for the spread of the disease, without declaring this an emergency.

Benjamin Thompson: Amy, you’ve been out and about in DRC with healthcare workers and officials. Where have you been and what sort of things have you seen?

Amy Maxmen: I’ve managed to see quite a lot. I went with Dr Tedros from Butembo to Katwa, an area where there has been lots of attacks against the Ebola responders. There’s an Ebola treatment centre that had been shot out by assailants and it was later burnt, so he went to go visit that. Since these attacks, they now have snipers behind a barricade outside, there’s sort of sandbags within it for people to hide behind. These are things I’ve never seen before, and I should emphasise nobody likes that. These are really researchers, health workers – these are not military people. They don’t enjoy travelling with kind of rifles around them, but at the same time they want to guarantee the protection of patients and their own staff, so you can kind of see both sides of it.

Benjamin Thompson: And have your travels given you a sense of why it’s been so difficult to contain this Ebola outbreak?

Amy Maxmen: Well, the shortest answer is it’s the conflict that has been going on there for 25 years. There’s dozens, let’s say, of armed groups and whenever an attack happens, people run and they don’t exactly want to be followed. They’re not going to put their lives at risk to stay sitting in an Ebola treatment centre at the time of a conflict. And when people run, they might carry the virus with them somewhere else. The conflict also makes it really hard for Ebola responders to go and do their job. Already, the Ebola responders I’ve met, they’re far braver than I would ever be just to be there. So, you might train as an epidemiologist, but you really weren’t prepared to be on the other side of people throwing rocks.

Benjamin Thompson: So, you’ve been writing up some dispatches for Nature News about the things that you’ve seen in what is clearly a very serious outbreak that is affecting a lot of people, but in your reporting, have you seen any bright spots at all?

Amy Maxmen: Yeah, so, one thing that I found remarkable was the role of Ebola survivors right now. So, once they get the virus, they’re sort of immune to Ebola – at least based on data from the last outbreak and everything we’ve seen so far. So, I was really moved to see survivors going to see Ebola treatment centres and sitting by the bedside of patients, and this includes children who are isolated who only see their nurses or doctors wearing the whole protective gear, kind of like this astronaut suit. So, they have no one to comfort them and yet survivors are sitting by their bedside, telling them listen, like I lived, you can live, and that means a lot. The other thing survivors are doing, there’s not a lot of ambulances for one – there were never ambulances there before. Second, there’s also not roads ambulances can drive on and people are used to travelling by motorcycle taxis. So, survivors are in some cases going out on their motorbikes and offering to take people who have symptoms of Ebola to the treatment centres. Whereas a normal motorcycle taxi driver would be at risk, they’re sort of like these powerful agents right now.