Unpaid wages and deadly risk: Why health workers are threatening to abandon the Ebola response

By Nimi Princewill, CNN

(CNN) — Every morning, Micheline Kayimpa pulls on layers of protective gear before stepping into an Ebola isolation ward in eastern Democratic Republic of Congo (DRC), knowing that one small mistake could cost her life.

At the Elikya Ebola Treatment Center in Bunia, the nurse spends her days caring for patients infected with Ebola — one of the world’s deadliest viruses — administering medicine and assisting those too weak to feed themselves.

Because Ebola spreads through bodily fluids, even routine care exposes health workers to constant risk — from treating patients to cleaning contaminated spaces.

“I am very afraid for my safety,” Kayimpa told CNN. “Sometimes, a small detail we overlook can prove fatal.”

But as the outbreak grows at an alarming pace, health workers say they are battling more than the virus.

After months of treating Ebola patients, Kayimpa says she has yet to receive a single government paycheck. The mother-of-four is among dozens of health workers who have protested delayed wages and threatened to boycott work.

The timing couldn’t be worse.

Kayimpa is working on the front line of what the World Health Organization says is now “the largest Ebola outbreak ever reported” in the DRC. Since the virus emerged in mid-May, it has infected at least 3,874 people and killed 1,751, according to figures released Wednesday by the Congolese health ministry.

The outbreak was jointly detected in both the DRC and neighboring Uganda. While Uganda has since declared itself Ebola-free, transmission has continued to accelerate in eastern Congo.

The flare-up has reached that scale in just over two months, surpassing the country’s last major Ebola epidemic, which spanned nearly two years between August 2018 and June 2020. Only the 2014–16 Ebola epidemic in West Africa has been larger and deadlier, infecting more than 28,600 people and killing 11,325 across Guinea, Sierra Leone and Liberia.

Deep mistrust fuels hostility

Bunia, where Kayimpa works, is the capital of northeastern Ituri province, the epicenter of the outbreak, where more than 90% of confirmed cases have been recorded. The response is already struggling to keep pace even without the threat of healthcare workers walking out in protest.

Unlike previous Ebola outbreaks, this one is caused by the less common Bundibugyo strain, for which there are no proven vaccines and treatment options remain limited. Ongoing fighting in eastern DRC has also made it harder for health workers to reach affected communities.

“This outbreak took hold in communities already worn down by conflict and displacement, with weak health, water and sanitation systems to begin with,” said Lancelot Mermet, director of humanitarian programs at Mercy Corps.

“When people can’t get to care quickly, or don’t trust the system enough to come forward, the virus moves faster,” he told CNN, adding that health officials are still identifying cases that cannot be linked to known infections.

Aid agencies say mistrust, misinformation about Ebola, and resistance to restrictions on traditional burial practices have fueled hostility toward health workers and complicated efforts to contain the outbreak.

That hostility erupted into full view in late May, when demonstrators seeking the bodies of two relatives forced their way into an Ebola treatment facility. It was the third such attack since the outbreak began, forcing health workers to move patients to safety as gunfire erupted nearby.

The violence has continued. Similar attacks were reported in June and July, and the United Nations said last month that “at least a dozen facilities have been attacked, largely due to fear, misinformation and deep community mistrust of outside authorities.”

‘We’re sacrificing our lives’

Inside Bunia’s Elikya Ebola Treatment Center, the response is stretched thin.

The 90-bed isolation ward, run by international humanitarian organization Médecins Sans Frontières (Doctors Without Borders, or MSF), is already operating at full capacity, with many patients arriving only after they are critically ill.

“We do not have enough staff,” Kayimpa said. “There are just two or three of us nurses looking after patients with more than 10 different conditions.”

Even with protective equipment, the danger never disappears.

“Accidents can happen whilst I’m working here,” she said. “Some aggressive patients may attack you and infect you. We’re sacrificing our lives for the people.”

Health care workers already paid a heavy price in the early days of the outbreak, she said.

“When the disease first broke out, we didn’t know it was Ebola,” she recalled. “We were treating patients without any protection. Many of us became infected, and some died.”

Despite those risks, Kayimpa says it isn’t the virus that has pushed many health workers to breaking point.

MSF provides bonuses, she said, but those payments do not replace the government wages she relies on.

“I’ve been working here since June, but I haven’t received a single penny in wages,” she said, adding that her name was misspelled on payroll records. “I was told that processing my file would take a long time.”

She stopped work for three days in protest, she said, but has since resumed in the hope her case will be resolved. If there’s no progress, however, Kayimpa – who worked for a private health organization in Bunia before joining the Ebola effort – is ready to walk out again.

It remains unclear whether the delays are linked to broader funding pressures affecting the response.

DRC communications minister Patrick Muyaya Katembwe acknowledged that delayed payments had triggered staff protests at several Ebola treatment centers but told CNN the outstanding payments were now being processed.

He said the delays were largely caused by the administrative process of verifying which workers had been deployed to the Ebola response and ensuring payments reached the correct recipients.

“Anyone officially listed will be paid,” he said.

MSF, which runs several Ebola treatment and isolation facilities across the DRC, said the protests were related to government compensation rather than payments from the humanitarian organization.

“MSF is continuing to meet its obligations towards staff working in the response,” it said in a statement to CNN, adding that “health workers play an essential role in responding to this outbreak, and it is important that they receive compensation in a timely manner for their work under extremely challenging conditions.”

‘Chasing a wildfire from behind’

Aid workers say the success of the Ebola response depends on the people risking their lives to keep it running.

“These are the people carrying the greatest burden of the outbreak, caring for and treating patients, preventing infections and holding together public confidence in the health system, all while taking significant risks themselves,” an aid worker familiar with the response told CNN.

He said, “With this outbreak moving this fast and spreading further from the epicenter, frontline workers need the equipment, protection, timely payment and support required to do their jobs safely.

“Every interruption gives the virus more time to spread and leaves the response chasing a wildfire from behind,” the aid worker added.

Whether health workers like Kayimpa receive that support could determine how many remain on the front line, fighting to keep patients alive and contain the virus.

“As long as I don’t receive my wages, I will boycott work until I’m paid,” she said. “Better still, I will leave this job to try my hand at other activities that will bring me money.”

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