Why Epidemics Breed Rage at Health Workers
Some people have fought Ebola containment measures in the Democratic Republic of Congo. Scholars have seen similar responses across societies and throughout history.
During the 2014-16 Ebola outbreak in West Africa, Sheri Fink reported from Liberia, Sierra Leone and Guinea. She also reported from Covid hospital wards in several countries and is at work on a book about the pandemic’s global impact.
Efforts to contain Ebola in the Democratic Republic of Congo did not begin well. Patients fled a treatment unit in Mongbwalu, a mining town, after community members set it on fire . Residents assaulted a burial team in the town of Katana and forced the crew to turn over a coffin. People living in the Kpangba displacement camp drove out health workers searching for Ebola contacts; the assailants insisted that the victims had not died of the disease. Similar antagonism hampered Ebola responses in 2014-16 and again in 2018.
Reactions like this would be easy to chalk up to poor education and anachronistic rituals: “Fear and ignorance as ebola ‘out of control’ in parts of west Africa,” as one Guardian headline put it in 2014 . But unrest during epidemics is not about Ebola, Africa or education. It is something societies have struggled with for centuries, and it is evident in rich countries as well as poor ones, in modern times and medieval ones. During the Covid pandemic, Western doctors, nurses and health officials received not only applause and gratitude but also death threats. Patients denied that Covid existed as they died of the disease. Protesters carrying guns occupied sidewalks outside hospitals. Multitudes embraced treatments, such as ivermectin, that study after study showed to be ineffective . Vaccinators in Italy were assaulted. A German gas station attendant and a Michigan Family Dollar security guard were killed after asking customers to wear masks.
It can be difficult to imagine why those menaced by a deadly disease would threaten the people who are trying to protect them. But outbreaks elicit a contradictory mix of responses. They often unfold in three acts, wrote Charles E. Rosenberg , a medical historian: First, people deny reality and put off behavioral changes that might slow the spread. Then they demand explanations, often blaming “individual and community sins” or, in some cases, doctors. Finally, they take action. Then they have to contend with the aftermath of both the infections and the finger-pointing — the life-and-death consequences for themselves and their neighbors.
When armed community members remove a child from an Ebola treatment unit, “we may view that as irrational, illogical, kind of anti-science,” says Megan Schmidt-Sane, an American medical anthropologist who has briefed humanitarian groups fighting the current Ebola outbreak on ways to adapt public health advice to people’s realities. “We know that this is about so much more than that. It’s about history and culture and politics and even just about how people love and care for others in their family who are sick. And to reduce it to something like ‘resistance’ that needs stamping out in a really militaristic, heavy-handed response — that’s the exact wrong way to go.” Only when we understand these tendencies, she and other scholars say, can we navigate them.
