NAIROBI – The medical anthropologist was in the shower when she heard the first pops of gunfire. Initially, she thought it might be the action movie she'd be left playing on high volume. Then the wall shook.
The violence in eastern Congo, which has stumbled on a growing Ebola outbreak in the region, had arrived at the guesthouse used by many of those working to prevent the disease's spread.
Terrified, Julienne Anoko dropped to the floor and crawled into the corridor outside her room. She and five others from U.N. agencies, Congo's health ministry and the World Health Organization, which she works for, hides in a U.N.
"It was like a horror movie," Anoko said of the Nov. 16 attack in the city of Beni, the epicenter of the outbreak.
Congo's North Kivu province, where the Ebola virus has been spreading since August, infecting almost 500 people and killing more than 270. It is now the second-biggest outbreak, after the vast epidemic that swept through Guinea, Sierra Leone and Liberia between 2014 and 2016.
The constant insecurity in North Kivu has proved an enormous obstacle, thwarting attempts to contain the virus. By WHO's estimate, the outbreak will be for at least another six months.
"Said Abdourahmane Diallo, a Phinean doctor who coordinates the administration of an experimental Ebola vaccine. He was at a different compound in Beni that was attacked the same day as Anoko's.
"We know that violence is a constant risk. But that's why I was ready to go to work, "Diallo said. "We just can not stop our response if we hope to overcome this outbreak."
This is the first Ebola outbreak during which health workers have had to donate bulletproof helmets and vests. To reach at least 20 percent of Ebola-affected areas, said police chief, said Michel Yao, WHO's response coordinator in Beni.
The U.S. government withdrew its only staff in the region in late August and has no plans to redeploy them. The WHO has 300 specialists from around the world in North Kivu. Those on the ground describe a chaotic effort to negotiate with or simply avoid the region's various militias.
"It turns into a cat-and-mouse game – we are trying to evade the armed groups," said Anoko, who is from Cameroon. Anoko goal, whose job entails extensive interviewing with locals, who are in charge of their work. "There's been decades of war, it can not be so understood," she said.
A quarter-century of vicious conflict, triggered by spillover from the Rwandan genocide in 1994, has been accompanied by deprivations of food, medicine and shelter that have shattered North Kivu's society. Amid the widespread trauma and desperation. The U.N. Peacekeeping Mission – established in 1999 and now the most expensive in the world – has been the target of violent protests due to its perceived ineffectiveness. Suspicion of outsiders is common and rooted in history.
To protect themselves, many communities have taken up arms. The resulting militias, which vary greatly in size, are collectively known as May-May. Other groups, such as Allied Democratic Forces (ADF), at Ugandan-origin extremist group infamous for its child soldiers, routinely skirmish with Congolese The brunt of their vengeance falls on civilians.
An effective Ebola response relies on persuading people in the affected area. Yao, the WHO coordinator in Beni, said not a week ago in which his teams are not attacked by skeptical locals.
"Even yesterday," said Yao, who is Ivorian Canadian.
Generating trust is the task of medical anthropologists like Anoko, and local politicians and traditional leaders. They are contending with Ebola's newness in North Kivu. But this is Congo's 10th Ebola outbreak, and knowledge of the virus is low.
Marie Roseline Belizaire, a Haitian doctor managing the WHO's response in Butembo, a city of 1.3 million south of Beni where the disease is also spreading, has tried to infuse money into the local economy as a way of buying trust. Recently, for instance, she bought 30 motorbikes for her team locally, even though she had to import them.
Aim Belizaire also takes a more hands-on approach. Ebola is being transmitted in large numbers in May-May-controlled suburbs of Butembo. She spends days negotiating with the militias for access.
"New Mai-Mai groups keep calling us and making their demands; it's like a new one every day, "she said. "But they are very hostile to outsiders coming in. In some cases, we have agreed to send them to us so we can train them instead of the other way around. "
While many Mai-Mai groups are open to such arrangements, the ADF will not engage. Local workers have taken over an ADF-controlled area between the towns of Mbau, Eringite and Kamango "the triangle of death" – the triangle of death. That's where many are worried Ebola transmission is happening out of sight of the responders.
Congo's health minister, Oly Ilunga Kalenga, said in an interview that he is "deeply disappointed in the international community" and "with the help of Congolese health workers," "thousands of cases and deaths have been avoided so far."
But with every attack comes a break in the health workers' response, and with each break in the number of cases.
"We can not give up these people in North Kivu," Anoko said. "They have suffered so much. We have great sympathy for them. "