Vianney Kambale Kombi carries the weight of memory each time the word "Ebola" surfaces in conversation. The resident of Beni, a commercial crossroads in eastern Democratic Republic of Congo near the borders with Uganda and Rwanda, lived through one of history's most devastating viral outbreaks. Between 2018 and 2020, the disease claimed over 2,200 lives from more than 3,400 reported cases, making it the second-largest Ebola epidemic ever recorded. Yet as a new outbreak linked to the rare Bundibugyo virus spreads through the region—with 550 confirmed cases, 101 deaths, and 19 recoveries as of early June—Kombi and other survivors are raising urgent warnings about patterns of denial and distrust that could derail containment efforts.
The psychological scars run deep in Beni and surrounding communities. Kombi contracted Ebola after exposure to infected individuals, during a period when fundamental information about transmission and recovery remained scarce. The disease emerged not just as a medical crisis but as a collision of worldviews. Many residents, particularly in rural areas with limited health literacy, interpreted the outbreak through the lens of traditional belief systems rather than epidemiology. "We thought it was witchcraft," Kombi recalled, describing how the community's refusal to acknowledge the disease's reality and the possibility of survival became a significant barrier to both prevention and treatment-seeking behaviour.
This initial scepticism evolved into something more complex and destructive. As Bienfait Wanzire, another 2018 survivor, explained, the political context of the time amplified confusion. With election campaigns underway, some residents dismissed Ebola as a manufactured political crisis designed to influence voting patterns or secure international funding. Others viewed it as a spiritual affliction requiring traditional remedies rather than medical intervention. These competing narratives fragmented community response, discouraged people from seeking care at health facilities, and created an environment where the virus could spread with minimal resistance. The convergence of medical ignorance, political suspicion, and cultural frameworks hostile to Western medicine proved catastrophic.
Healthcare workers themselves bore witness to the devastating consequences of this denial. Dr Babah Mutuza Lusungu, a physician at "Dieu Est Grand" Medical Centre in Beni, lost his uncle and two professional colleagues whilst simultaneously battling profound community mistrust. Despite his medical credentials and direct experience of the outbreak, Dr Lusungu faced "very strong resistance" when attempting to convince people that Ebola was genuine and lethal. This mistrust extended across multiple stakeholders—between the population and authorities, between communities and international health partners, and most critically, between residents and healthcare workers themselves. Such fractures in social cohesion undermined every layer of outbreak response.
Dr Lusungu has identified a strategic gap in previous response efforts: the marginalisation of youth voices and leadership. Young people, who constitute a substantial demographic in Congo and hold considerable social influence within their communities, were largely excluded from official response activities. This oversight meant that critical bridges between formal health messaging and grassroots acceptance remained unbuilt. The physician now advocates for local authorities to develop deliberate partnerships with youth leaders, recognising them as essential channels for disseminating accurate information and building community buy-in. "If we wait until they have so many declared cases to start making an effective response, we will have totally missed the target," he warned, underscoring how early engagement matters far more than reactive measures.
The psychological toll extended beyond those who contracted the virus to caregivers and humanitarian workers. Esperance Masinda, who worked for UNICEF in Beni during the 2018 outbreak, found herself navigating impossible circumstances—providing care for children orphaned by Ebola whilst also contracting the disease herself whilst tending to her husband, a medical doctor. Both recovered, thanks in part to the experimental vaccine that ultimately contained the outbreak. Yet survival brought its own trauma. They faced cruel predictions from neighbours who insisted the medication would kill them within five years. The vaccine that saved their lives also isolated them socially, transforming recovery into a different kind of loss.
Stigma proved as damaging as the virus itself. Survivors encountered a society that simultaneously denied Ebola's existence and treated those who had contracted it as quasi-dead, as people infected with a permanent curse. The psychological impact of this paradoxical response—disbelief followed by shunning—cannot be underestimated. Masinda's recollection that neighbours now greet recovered Ebola survivors without stigma represents genuine social progress, yet it also highlights how fragile such acceptance remains and how easily it can fracture during new health emergencies.
The emergence of the current outbreak, caused by the Bundibugyo virus strain rather than the Zaire subtype that dominated 2018-2020, presents both challenges and opportunities. Unlike the previous crisis, this epidemic initially unfolded without an approved vaccine specifically designed for Bundibugyo, eliminating one tool that previous responders relied upon. However, the existence of survivors willing to publicly share their experiences and the documented lessons from the 2018-2020 outbreak provide a knowledge foundation that did not exist beforehand. The question now is whether authorities and international partners will effectively mobilise this institutional memory before the epidemic gains momentum.
Beni's geography compounds these challenges. As a regional commercial hub with significant cross-border movement to Uganda and Rwanda, it functions as a potential transmission corridor for disease spread into neighbouring territories. The city's connectivity that makes it economically vibrant also makes it epidemiologically dangerous. Communities in surrounding areas may carry the same scepticism and misinformation that fuelled the previous outbreak, particularly given limited access to reliable health information outside major urban centres and the persistence of traditional healing systems that compete with biomedicine.
The survivors' testimonies collectively point toward a reorientation of outbreak response strategy. Technical interventions—vaccines, treatments, diagnostic tests—remain essential but insufficient. Future efforts must prioritise community engagement from the outset, treating local populations not as passive recipients of health directives but as active participants in disease control. This requires investing in trusted community voices, youth leaders, religious authorities, and traditional healers who can credibly communicate why vaccination and early care-seeking save lives. It demands humility from health authorities and acknowledgment of past failures in building genuine partnerships with communities.
Moreover, the psychological and social dimensions of epidemic response deserve equivalent attention to epidemiological data. Survivors carry knowledge about how fear manifests, how misinformation takes root, and how people make sense of catastrophe when official narratives seem disconnected from their lived reality. Their warnings about the dangers of political instrumentalisation, spiritual reinterpretation, and Western scepticism remain acutely relevant. As Kombi's reflection on reintegration suggests, recovery from epidemic requires not just medical intervention but profound restoration of community cohesion and mutual trust.
The current Bundibugyo outbreak will test whether Congo and its international partners have genuinely absorbed lessons from the 2018-2020 crisis or whether institutional memory will prove as fragile as past community resistance to health messaging. The survivors who lived through history's second-largest Ebola epidemic have offered a roadmap—one that prioritises listening over commanding, engagement over enforcement, and recognition that disease control depends ultimately on community acceptance. Whether decision-makers heed these hard-won insights will determine whether the new outbreak becomes a contained episode or repeats the trajectory of previous disasters.
