A new study says a quarter of people interviewed in eastern DR Congo last year believe Ebola is not real.

One in four people interviewed in eastern Democratic Republic of the Congo (DRC) last year believed Ebola wasn’t real, according to a new study, underscoring the enormous challenges healthcare workers are now facing.

Health workers said public mistrust is now the biggest obstacle to stopping the epidemic, with many refusing vaccines, resisting treatment and concealing symptoms, as the world’s second-biggest Ebola outbreak spreads.

This mistrust resulted in people being 15 times less likely to seek medical treatment at an Ebola health centre, according to the study published in the Lancet Infectious Diseases journal.

The study, released on Wednesday, was based on interviews conducted last September, about a month after the outbreak began. It comes as the number of probable and confirmed cases exceeds 1,000.

At least 639 people have died from Ebola in eastern DRC since August in what is now the second-deadliest outbreak in history, according to the World Health Organization.

In recent weeks, there have been, on average, eight new cases a day, said the country’s health ministry.

The response to the outbreak has been hampered by a series of deadly attacks on Ebola health centres since the study was completed. As a result, Doctors Without Borders has stopped staffing two health centres at the outbreak’s epicentre after violent attacks.

Researchers found that trust in public authorities had already fallen in the cities of Beni and Butembo before Ebola hit, due to decades of conflict and poor governance.

Accelerated distrust

“It’s been three years now that we saw a declining level of trust in those actors, and the Ebola crisis comes on top of that and accelerates the distrust,” said Patrick Vinck of Harvard University, who led the research.

“In some ways, we are now paying the consequences of many years of lack of interest and focus on this issue.”

Eva Erlach, the community engagement and accountability delegate for the International Federation of Red Cross and Red Crescent Societies (IFRC), said the findings show how the level of trust correlates with preventive behaviours.

The organisation has had more than 800 trained volunteers working to get prevention messages out amid the region’s security challenges.

“There is still a part of the community who do not believe that Ebola is real and we definitely still need to continue focusing on community engagement,” said Erlach, who was not part of the study. “And this is why this report is so helpful, even if it’s from September.”

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WHO Director-General Tedros Adhanom Ghebreyesus said earlier this month he was encouraged “to see the communities accepting the response more and more”.

The study highlights just how pervasive misinformation has been in places in eastern DRC like Beni and Butembo, where in-person interviews were conducted with 961 people.

Some 25.5 percent of those interviewed did not believe Ebola was real. In addition, nearly 45.9 percent of people thought the Ebola outbreak was being fabricated to destabilise the region or for financial gain.

Additionally, 18.2 percent believed all three of those statements, the study found.

Volatile security situation

Those who didn’t believe Ebola was real were far less likely to agree to take the Ebola vaccine or go to a treatment centre. Ebola is spread through the bodily fluids of those infected, and isolating them is key to stopping transmission.

Attacks on Ebola treatment centres in eastern DRC also hamper the health response [John Wessels/AFP]

This outbreak has been uniquely challenging because of the volatile security situation in the region. Eastern DRC is home to numerous armed groups and the Ebola epidemic has deepened the political and economic grievances of many in the area. The fact that people in Ebola-affected areas were excluded from voting in the December presidential election has only heightened conspiracy theories.

Tariq Riebl of the International Rescue Committee, who is currently working in eastern DRC, said the findings released Wednesday mirror what he and his colleagues are seeing on the ground. Concern remains about how Ebola prevention efforts are going because new cases are still emerging.

“Once you reach a wider outbreak zone, especially urban zones, the community engagement and prevention side of things is almost more important than the treatment side,” Riebl said.

“If you can’t have those messages out successfully, it doesn’t matter if you have all the treatment options available because no one is ever arriving to take advantage of that,” he said.

The world’s worst epidemic of Ebola, a haemorrhagic fever, killed more than 11,300 people in West Africa from 2013 to 2016.