Swarms of motorcycle taxis overloaded with passengers and goods weave their way through traffic in the eastern Congolese city of Butembo. Motorbikes far outnumber four-wheeled vehicles on the dusty roads of the regional trading hub, especially downtown, where drivers laden with cargo carve their way through crowded street markets.

A taxi driver pushes his motorbike through a crowded market in the city of Butembo

These “taxi-motos,” as they are known, are the lifeblood coursing through Butembo’s arteries. With local unions representing around 10,000 taxi-motos, they are also a political force that has at times hampered efforts to contain the Ebola epidemic rampaging through North Kivu and Ituri provinces in eastern Democratic Republic of Congo (DRC).

An aerial view of the city of Butembo in Eastern DRC, currently at the centre of the Ebola outbreak

Without the taxi-motos, Butembo grinds to a halt, as it did in May when an accident involving a taxi-moto and a suspected Ebola response vehicle sparked clashes embroiling taxi-moto drivers, armed militia and security forces. Nine people were killed in the violence. The Ebola response was suspended for a fourth consecutive day due to general insecurity. The clash was just one of more than 200 attacks and violent incidents involving Ebola responders so far this year, with some involving taxi-moto drivers. The most recent in the string of assaults that have injured or killed dozens of responders was the murder by unknown assailants of two Congolese Ebola awareness workers near Butembo. But with outbreak declared an international emergency last week by the World Health Organisation (WHO) and the subsequent resignation of the country’s health minister, the DRC must urgently address its response to the epidemic.

A crowded market in the city of Butembo. The effort to stamp out this Ebola outbreak in eastern Congo – already the second largest in recorded history – is going poorly, as front-line health workers struggle against rising hostility, insecurity, and distrust

Eastern Congo is awash in armed groups vying for local influence and control. Across Ituri and North Kivu, community self-defence militias known as Mai Mai have been behind many of the attacks on health workers. The Mai Mai and moto-taxi drivers are drawn from the same demographic of young men in each community. Often there is overlap.

Quick guide Ebola in the Democratic Republic of the Congo Show Hide How bad is the current outbreak? With more than 2,577 confirmed cases and more than 1,803 confirmed deaths, the outbreak in the eastern DRC is the second largest in history. It has a 67% fatality rate and 11 months after it began, the case numbers are still escalating. It is disproportionately affecting women (55% of cases) and children (28%). The WHO declared the outbreak an international public health emergency in July 2019. The same month saw the the first diagnosis of a case in Goma, a city of 2 million people, which is a transport hub on the border with Rwanda. In early August Rwanda announced that it was closing its border with DRC. The WHO has long said that the national and regional risk levels are very high and containment of the spread to North Kivu and Ituri provinces was unlikely, unless a break in the fighting made it safe for health workers. What is Ebola and how do you treat it? Ebola hemorrhagic fever is caused by a virus that has a reservoir among forest animals, including monkeys and bats. It is spread through body fluids, which is why carers – mostly female relatives and nursing staff – are particularly at risk. It causes fever, aches and diarrhoea and attacks the immune system, causing blood clotting cells to malfunction so that victims bleed extensively and die if their immune system cannot fight off the viral infection. Drugs are still experimental. Patients are isolated and treated by nurses wearing full protective body suits and masks who try to boost their immune response. Friends and relatives are quarantined for 21 days. Prevention measures include washing hands at every opportunity and safe burial practices, with no touching or washing of the body, as is traditional in some cultures. How does this compare with other outbreaks? The 2013 and 2016 outbreak in Sierra Leone, Liberia and Guinea spread for months through forest regions in west Africa where Ebola was unknown before the emergency was recognised. It escalated when it emerged in towns and cities, with 28,600 cases and 11,300 deaths. DRC successfully stamped out nine previous Ebola outbreaks in rural areas within a matter of a few months. Aid agencies, infectious disease experts and the WHO say it will be very hard to bring this outbreak under control, even though they have had vaccines and experimental drugs from the outset. What are the contributing factors to this outbreak? There is almost no functioning state in much of eastern DRC. There is an almost total lack of basic services such as power, education, roads, healthcare, and the authority of the government only extends to the edges of urban areas. Police are corrupt, predatory and violent. In rural zones, militia and armed bands provide security and employment opportunities but also steal, rape and kill at will. It is one of the most hostile environments faced by aid and health workers anywhere in the world. Mistrust of officials and foreigners is harming efforts to tackle the disease and conspiracy theories are rampant. Some believe the outbreak is fake news spread by rapacious NGOs and the UN to justify their presence in the country and allow the extraction of valuable mineral resources. Sarah Boseley and Jason Burke

Those who can’t afford motorcycles transport cargo on wooden chukudus in the busy street markets of Butembo

The attacks are driven by a deep resistance to outside influence in an area with a long history of ethnic killings. Many residents in this opposition stronghold blame ethnic violence on the central government, which blocked Ebola-stricken regions from voting in last year’s presidential elections.

Taxi-moto drivers wait to transport mourners to the funeral of Angela Masika, 31, who died the day before this picture was taken, in the town of Biakato in Eastern DRC’s Ituri province. Test results had not yet revealed whether Masika died from Ebola

The insular Nande ethnic group dominates the commercial towns of Beni and Butmebo at the centre of the outbreak. Butembo is one of the few major trading hubs in Congo with no visible presence of Indian or Lebanese businesses.

Travellers on the road toward the town of Beni wash their hands in chlorinated water at a health roadblock to prevent the spread of the Ebola virus in eastern DRC

“Even me, I am Nande from Beni,” said one taxi driver who gave his name as Adolphe. “But if I go to Butembo, they will know I am not from there just by the way I speak and they cannot accept me.”

A vendor selling motorcycle tyres waits by the roadside at a market in Butembo

The international Ebola response has brought money and convoys of gleaming 4x4 vehicles into this impoverished region, upending the local balance of economic power and exacerbating political rivalries. Misled by local politicians and leaders spreading false rumours by radio and social media, many residents don’t believe Ebola is real. They echo accusations that the response is a deadly money-spinning trick being played at their expense while outsiders – including Congolese from other parts of the country – grow rich. Local health workers have complained that Congolese nurses and doctors from other parts of the country are paid $150 (£120) per month while they can earn as little as $20, exacerbating existing resentment.

The crowded market in the city of Butembo

Many taxi-moto drivers believe the conspiracy theories about Ebola while also being aware that they are dangerously exposed to a virus spread by the kind of close physical contact unavoidable in crowded markets. With few cars in Butembo, most people rely on moto-taxis for transport. And when people fall ill they call moto-taxis to take them to hospital, increasing the risk of transmitting the virus. Taxi drivers transporting the sick have succumbed to Ebola during previous outbreaks, but even if they don’t get sick themselves, they facilitate the movement of people carrying the virus.

Sarah Kavuo, 15, plays the trumpet in a church yard in Beni in Eastern DRC, along with her sister Milka, 14 (second right), Esther Kahindu, 16, (right), and Nema Kavira, 16

In mid-July, a pastor who travelled by road from Butembo became the first confirmed Ebola case in Goma – an even bigger city with an international airport on Rwanda’s border – escalating fears that the virus could spread abroad. He died shortly afterward. One preventive measure involves moto-taxi drivers not sharing helmets.

Soldiers ride on the back of a motorcycle taxi in Butembo

There have been at least 2,500 confirmed cases of Ebola since the start of Congo’s outbreak last August, and over 1,655 deaths, though the WHO has warned that a quarter of all cases in may be going undetected. Two fatal Ebola cases were confirmed last month in neighbouring Uganda, where authorities closed local markets in an effort to limit contamination. If Ebola takes root in Goma, or jumps across another nearby border into the sprawling refugee camps in South Sudan, the repercussions could be catastrophic.

During a recent visit to the hilltop village of Mabuku, about 25 km north of Butembo, Dr Deby Mukendi, a Congolese epidemiologist working for the WHO, was following up on seven Ebola cases in the village, including three deaths and 170 people who had direct contact with those who died. Five Congolese army soldiers escorted Mukendi and his two colleagues. As they prepared to leave a health clinic, two moto-taxis zoomed up the driveway carrying half a dozen youths with AK-47s perched on their hips. The bikes skidded to a halt; the Mai Mai militia fighters dismounted, levelled their weapons, and spread out around the Ebola responders. Mukendi stepped forward and walked toward the one unarmed militia member.

Soldiers stand by the roadside while escorting a pair of Ebola response vehicles heading to the village of Mabuku

“Bonjour commandant,” he said, offering the fist bump that has replaced the handshake amid the outbreak. The commandant returned the greeting.

“Welcome,” he said in Swahili.

While Mai Mai have been behind many of the attacks on health workers, this group had granted Mukendi access after tense negotiations. He had arrived two weeks previously with 12 lightly armed soldiers and 60 heavily armed Mai Mai fighters quickly surrounded them.

Traditional Mai Mai militiamen ride on a motorcycle in Mabuku, an area beset by armed groups

“The soldiers were very twitchy,” Mukendi said. “They were outnumbered and this is not their terrain. You’ll find no state infrastructure out here, not even the Congolese flag. This area is controlled entirely by the local population and the Mai Mai. The members of our team were terrified and wanted to turn back. This is the situation we are facing here. Members of the response are always working under great pressure and strain because of the insecurity.”

Mukendi negotiated with the Mai Mai commanders, who eventually allowed his team to work.

“They used to be against the response, but because of the awareness campaign we’ve been doing, they’ve accepted us,” Mukendi said. “The Mai Mai here believe Ebola is real. They’ve seen it.”

All words and photography by Finbarr O’Reilly

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