Dr. Marie-Roseline Bélizaire had just gathered the members of her Ebola response team for a morning meeting when they heard the rat-a-tat of gunfire.
"It was just in front of our door – very close," she recalls. "We all got on the floor to protect ourselves." They lay there for the next 20 minutes, listening as police fired into the surrounding jungle to drive off a group of armed men who had been spotted trying to make their way toward the compound – an encampment of tents and low-rise buildings near the town of Mangina that serves as living quarters for the team.
The Nov. 28 attack was merely the latest in a series of violent incidents that Bélizaire, who is originally from Haiti and is 40 years old, has survived while working as a field coordinator for the World Health Organization over this 16-month long outbreak. Indeed, Bélizaire had called that morning meeting to plan next steps in the wake of two even more serious attacks hours earlier: The first was an hour-long, midnight assault by gunmen on her team's offices a mile away. The second was more devastating: Four Congolese Ebola responders were killed in a nearly simultaneous attack on the living quarters of another team located a 2-hour drive away.
In total this year, WHO has documented about 390 attacks on health facilities involved with the Ebola response, with 11 Ebola responders killed and more than 80 injured. Globally, according to a United Nations report released this week, so far in 2019 there have been 825 attacks on health-care workers and their facilities, resulting in 171 deaths.
That makes this Ebola episode the most violent on record. NPR reached Bélizaire by phone to find out what it's like to be – quite literally — on the front lines.
(This conversation has been lightly edited for length and clarity.)
What does your job entail? In other words, what does it mean to be a field coordinator for the World Health Organization?
It means I'm in charge of making the Ebola response work at the operational level – making sure the response teams have everything they need logistically to fight Ebola. We have divided the coordination area into zones. [Over the course of the outbreak] I've been moving according to where the hot spots are. Right now I'm responsible for two health zones — with a population of more or less 500,000 — around the town of Mangina.
The response is a chain. I make sure all parts of the chain in my zones are in the right place. It starts with investigating possible cases, making sure there are ambulances [to take people to Ebola treatment units] and that the Ebola treatment units are working well. Then making sure the infection prevention and control teams [who decontaminate homes and health facilities] have all the technical materials they need. Then mapping the cases — finding the places where [an infected person] has been, who they've been in contact with and vaccinating them. Now we can do that within 24 hours. I supervise that surveillance and vaccination.
This outbreak has been taking place in a part of Congo with a long history of conflict between the government and multiple armed groups. Ebola responders have often found themselves in the crossfire – targeted by militants as well as some members of the population who consider health workers an extension of government authority. How many of these violent episodes have you personally experienced during this outbreak?
There have been a lot of times I have been personally worried by gunshots around our coordination offices. Sometimes it's the police trying to break up a demonstration. Sometimes it's a confrontation between police and militias.
Last April when our colleague Dr. Richard Valery Mouzoko Kiboung was killed [by gunmen who stormed into a meeting he was leading in the city of Butembo] my team was based in Katwa. It's a locality right next to Butembo. And that same day Katwa was attacked on multiple sides by militias.
So we were hearing all these gunshots. And we had to get on the floor, put on bullet proof vests to protect ourselves.
Then that night our team's offices in Katwa were attacked. The bullets left marks in the wall of my office.
But the worst experience were those attacks in the early hours of Nov. 28.
Tell us more about how that night unfolded.
It began about 15 minutes after midnight. I was still up – meeting with my counterparts with Congo's ministry of health, because we often have to work late at night – when we heard gunfire in the distance. I called the security officer to find out what was happening. He said, "Let me call the police." The police told him, "There's an attack going on, we'll have to call you back." An hour later they called us to let us know that about 20 armed men had tried to reach our offices, about a mile away from our living compound. But the police disbursed them, killing one of the bandits.
A few minutes after that attack had started I got a call from a colleague with a team based at Biakato mines [about a 2-hour drive away] to tell me "we are under fire, we are under attack." The difference was [in their case] the gunmen were attacking the compound where [the health workers] were living.
I stayed on the phone with them through to the end – more than 3 hours – calling around to find out where everyone was, telling them, 'Try to stay calm, we are supporting you, rescuers are coming.' I could hear the bullets flying on the phone line. Some of them were telling us, "Please, help!" And it was heartbreaking because you know in that moment you can't help. A policeman and two drivers for that team were killed, and a colleague who did vaccinations. She was sexually abused and then killed with four bullets. Seven of our colleagues were also severely injured.
Where are you now?
My team has been evacuated to Goma [a city 200 miles south of the outbreak zone]. But we are already preparing to go back. Our Mangina compound has received too many threats. It's not safe for us to stay there. So we'll be operating from Beni [a city about 16 miles from Mangina]. And we'll be proposing just essential staff to go there so we can shorten their exposure time in the field.
How confident are you that the new arrangement will keep you safe?
After the [killing of Dr. Richard Mouzoko] in April the United Nations system created a committee to take charge of security in the response — to make plans to ensure those of us in the field are protected in coordination with [the U.N.'s peacekeeping force in Congo.] This committee has totally failed us.
What should U.N. peacekeepers be doing that they are not?
They don't react quickly – this last incident it took more than 5 or 6 hours. And we [field workers] are moving with the evolution of the epidemic. Yesterday we can be there, tomorrow we will be there because that's where the Ebola virus has moved. So even before we go somewhere into the field, into a "red" zone, [the U.N. security committee] should be ensuring it's safe for us to go: Negotiating access, having a contingency plan [if something goes wrong] and providing not just personal security for us but security for the area.
They have no real plan. This is one of the biggest pillars of this response and they received a lot of money. But unfortunately there is still no good security plan. We are still exposed.
How do you cope with that? How often are you overcome by fear.
Normally I'm not anxious about myself. But I should say that on that night of Nov. 28 I was anxious about my family. My son is 15 years old. He lives in Spain. I was thinking, "If I die tonight what will happen to my son? How he will it be for him to live without me?" Mostly I'm anxious for my team. Not just their immediate safety but their mental health. We're putting in place stress counselors to help with that.
Why have you stuck with this job? Especially given that the outbreak is now nearly contained. Although more than 3,300 people have been infected, lately new infections have dropped to less than 10 per week?
People are still dying of Ebola. Yesterday we had four new cases. We know that for every minute we don't intervene this virus is spreading and wiping out communities. And as doctors we have committed ourselves to saving lives. This is what we do. We cannot leave people to die.