When a schoolteacher in eastern Congo learned that five of her family members had been diagnosed with Ebola, she was “deeply shaken,” fearing the worst from a disease that carries stigma and is seen by some in her community as evil.
Two of her relatives — her brother and his wife — died of Ebola in July at a treatment center in Ituri province, the epicenter of the deadliest outbreak in Congo's history.
The 34-year-old teacher, who spoke to The Associated Press on condition of anonymity for fear of being stigmatized, said grief and stress over the loss of her relatives led her to seek treatment at a mental health clinic.
After two months at the clinic, the teacher said she was feeling better but worried about her future. “Will these people still be there for me?” she said of her relatives in Bunia, capital of Ituri.
Her experience highlights a burden rarely talked about in the fast-moving Ebola outbreak: the psychological toll on relatives coping with loss, fear and rejection in communities already scarred by years of rebel violence.
The outbreak is spreading at an unprecedented rate under some of the most challenging conditions imaginable, fueled by mass population movements, violence, mistrust and poor working conditions for frontline health workers. Caused by the rare Bundibugyo virus for which there's no approved vaccine or drug, the outbreak has killed at least 4,600 of the 9,500 people infected. The World Health Organization has said that it continues to outpace efforts to track and slow it.
Losing relatives to disease outbreaks is always difficult, but responders say grief can be especially severe with Ebola in a country where the disease is viewed by many as evil due to rumors and misconceptions. The risk of transmission also limits contact with the patients even after death, depriving families of closure and the opportunity to observe their preferred burial rites.
The psychological effects of past Ebola outbreaks can persist long after the immediate crisis, according to WHO, often taking the form of anxiety and mood disorders, exacerbated by prolonged grief and discrimination.
This is Congo’s 17th Ebola outbreak and has spread to eight provinces, coinciding with an escalation of decades-long conflict in the east between government forces and rebels.
Experts say the outbreak has compounded the trauma for many across the region. The medical response has focused largely on treating and containing the disease, with little to no attention to the mental health of those affected.
“There are so many areas (in eastern Congo) already devastated by war, crisis and severe malnutrition" and Ebola has worsened the condition of vulnerable populations and their mental health conditions, said Mirella Riccardi, a mental health specialist with Doctors Without Borders, known by its French name Médecins Sans Frontières.
The Congolese teacher recalled that her family felt abandoned by neighbors when her relatives began showing symptoms consistent with Ebola, including fever, vomiting, diarrhea and muscle pain.
Neighbors stayed away until Ebola responders came to take the sick to a clinic and disinfect their house afterward.
“It felt as though we were living all alone because of the illness,” said the teacher, who did not contract the disease. “It has caused severe trauma within our family.”
She also lost someone she had regarded as a father and said many others in their Bunia neighborhood have also died.
“Many people initially assumed that their symptoms were due to poisoning or malaria. Only later did they realize that they could be Ebola,” she said.
The Samelo mental health facility in Bunia, where she was admitted, said it had received up to 350 patients, a surge it attributed to the Ebola outbreak.
“Grief, fear of infection, social isolation and a succession of deaths can leave families and communities lastingly vulnerable,” said Katembo Vyaluva Anicet, the head nurse at the facility.
Five months into the outbreak, health authorities remain alarmed. More than 70% of new cases involved people who were not among known contacts, while at least 60% of deaths occurred outside treatment centers as of early October, government data showed.
The teacher has been discharged from the mental health facility but returns often for follow-up checks. Her three other infected relatives survived, and her husband said she feels much better.
But fear of Ebola persists within her family and among her neighbors.
“This has reignited fear and tension within the community,” she said. “Now, everyone is wondering how this disease will end.”