First came the war, which developed into a brutal, bloody tussle between militias who abused civilians or killed them.
Now Ebola, a name almost as dreaded as death itself, has come.
In the Beni region, in the Democratic Republic of Congo’s eastern province of Kivu, the twin peril has bred fear and despair.
The region is haunted in particular by the Allied Defence Forces (ADF), a Ugandan Islamist rebel group blamed for hundreds of civilian deaths over the past four years.
On August 1, Beni declared an outbreak of Ebola epicentered in Mangina — a small town that had been a relative haven from the fighting — where six members of the same family died of the disease.
“I fled here from Kokola, where the ADF were committing atrocities,” said Pascaline Fitina, a 36-year-old woman, sitting alone, her head in her hands.
“I went to my elder sister, but she has died of Ebola and her husband is being quarantined at the treatment centre. I don’t what to do.”
Pascal Lukula, a 38-year-old farmer with five children, said he was stuck in Mangina, unable to get to other members of his family, because of the encroaching militia.
“We are caught between the hammer and the anvil,” he sighed. “The ADF’s on one side, and Ebola on the other.”
The Congolese health ministry said Wednesday the death toll in the east had reached 42 out of 66 probable and confirmed cases.
The outbreak — the country’s 10th since the disease was discovered in then-Zaire in 1976 — was announced just a week after the end of an Ebola flareup in northwestern Equateur province that claimed 33 lives.
– Chlorinated water –
Ebola causes serious illness including vomiting, diarrhoea and in some cases internal and external bleeding. It is often fatal if untreated.
The disease is caused by a virus that is transmitted to people from wild animals and spreads among humans through close contact with the blood, body fluids, secretions or organs of an infected person.
In Mangina, located 30 kilometres (18 miles) southwest of the city of Beni, suspicion and rumour seem to have spread across the population.
Containers of chlorinated water have been installed in front of all shops and in the markets to provide rudimentary hand protection.
“I wear gloves to protect me from the epidemic,” said Jonas Mumbere, 26, who drives a motorcycle taxi.
“Customers have started to think twice about getting on the motorbike for fear of contamination.”
Elodie Zena, a 28-year-old sex worker, said, “Business has dropped off — customers are afraid. I’ve heard that even the sweat of someone who is infected can contaminate us. I’ve got two children and I don’t how I can feed them.”
Health experts have long fretted about the problems of combating Ebola in the DRC, a vast country that is poor and unstable and shares boundaries with nine countries.
On Tuesday, the World Health Organization (WHO) chief, Tedros Adhanom Ghebreyesus, also warned that conflict had helped create “a conducive environment for the transmission” of Ebola.
Hanna Leskinen of the International Committee of the Red Cross (ICRC) said the grassroots work in combating Ebola lies in locating and treating patients and isolating people who have been in contact with them.
In North Kivu, “people are moving around all the time, fleeing the latest wave of violence,” she said. “It enormously complicates search and followup of infected people.”
Another worry is for the safety of health workers — “the police and army are providing night-and-day security” for them, said North Kivu’s governor, Ephrem Kasereka.