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Health-care workers in the Democratic Republic of the Congo are fighting the third-largest outbreak in history—and trying not to get infected themselves.

On May 17th, the director general of the World Health Organization declared the current Ebola outbreak a public-health emergency of international concern in the Democratic Republic of the Congo and in Uganda. More than twenty-four hundred people have tested positive and more than nine hundred and ninety have died, in the third-largest outbreak ever recorded. “It’s like a big fire,” Chikwe Ihekweazu, the executive director of the W.H.O. Health Emergencies Programme, told me. “The center of it is still hot, and it’s also spreading.” Many factors are fanning the flames: the area has been wracked by conflict, global funding cuts have weakened the health system, and an exodus of health-care staff has deprived hospitals of experience from previous outbreaks. The early phases of Ebola can be indistinguishable from those of infections such as malaria and typhoid fever, but the virus eventually causes fluid losses that can lead to shock, multi-organ failure, and a mortality rate that often exceeds fifty per cent. The most profound complication is hemorrhagic fever, in which platelet counts drop and the blood loses its ability to clot normally, leading to bleeding throughout the body.

On July 19th, I spoke with Abdou Sebushishe, a physician and a senior global-health adviser with the International Medical Corps, who hails from Goma, in eastern D.R.C., about what it’s like to care for patients with Ebola right now. Sebushishe previously worked on the Ebola response in Liberia, Sierra Leone, and South Sudan. The D.R.C. has experienced sixteen previous Ebola outbreaks—just last year, Sebushishe responded to one of them in the Kasai province—but this one is different. Some early patients were tested for the wrong strain of Ebola, so infections initially went undetected. “Modelling has suggested that the outbreak might have started in February,” Sebushishe told me. “We missed the critical window of detecting, isolating, and tracking cases early.” A major 2018 outbreak in the D.R.C. took nearly eight months to grow beyond a thousand cases. This time, a thousand people were confirmed positive within the first forty days of the emergency response. Experts continue to worry that the outbreak could spread to neighboring countries. (The risk to the U.S. remains low.)

Bunia General Hospital, where Sebushishe spends much of his time, comprises an aging cluster of buildings and employs about a hundred and fifty health-care workers. Arriving patients wash their hands, have their temperatures taken, and are assessed in a triage area. Anyone with Ebola symptoms is sent to the Ebola Treatment Center (E.T.C.), a semipermanent wood structure surrounded by barbed wire. “Non-Ebola patients cannot cross to the treatment center,” Sebushishe told me. “That could cause them a problem.” His day usually begins at 5 or 5:30 A.M. He showers, drinks coffee, and sends e-mails to help coördinate teams across the D.R.C. Then he goes to the hospital and prepares to treat patients. His account has been edited for length and clarity.

“At 8 A.M. every day, the team that was on the night shift hands over patients, starting with the critical ones. They describe their symptoms and what patients they suggest the day team focus on. Then we go inside. We put on personal protective equipment, following a checklist. We have a buddy system, and we have a third person who is monitoring what we are doing. Once we are in boots and scrub suits, we wash our hands and then put on the first layer of gloves. We put on coveralls. A supervisor comes and zips them for us, to insure that the zipper reaches the neck. After the coveralls, we put on a surgical mask or N95, and then we put goggles on top. When we speak, the supervisor sees if it creates any fog on the goggles, and he adjusts or replaces them before we enter. Then we put on a second pair of gloves on top of the coveralls, up to the mid-arm.

“After that, we put on a hood, and then an apron. We are checked for any leaks of air, and they write our names on a piece of tape on the apron. This way we know each other when we are inside, and the patient knows whom he is talking to. They write, also, the time when we finish putting on the full P.P.E. If I finish before my buddy, my time is written first. We monitor who reaches a maximum of one hour inside the P.P.E. so that the buddy can tell him to go out.

“Most of the time, when doctors enter, the nurses go through the vital signs, but for critical patients we have to take vitals again and do a quick A.B.C.D. (airway, breathing, circulation, disability) assessment. If there are not many critical patients, we can see up to six patients in one hour. But when there are more critical patients we sometimes see only two. We go out, refresh, and then go back after one or two hours of rest.

“Before we leave the red zone, we write the status of the patient. In Bunia, we have a Plexiglas divider where we hang what we’ve written. The clinician on the other side can quickly copy the notes before we discard them in the red zone. (In Beni, we go to a designated area within the E.T.C. where we can talk to clinicians who are on the other side—the green side. We dictate to them each patient’s instructions.) Once we finish that, we doff our P.P.E. under supervision. Someone receives us with a bottle of water and biscuits. And then we go sit down, recover for a few minutes, and we start discussing each patient again.

“The first obvious thing you feel in P.P.E. is the heat. It’s really hot. You are putting everything on top of the scrubs that you are wearing. I come out of the red zone and I’m totally wet with sweat. I’ve seen in past outbreaks, like in Liberia, colleagues falling inside P.P.E. The second thing is breathing. When you have everything on, there is a barrier for airflow. Often, if the supervisor did not pay attention, we have to say, ‘O.K., let’s go out, because your goggles are fogging.’ If you don’t see well, you can easily stumble on something and fall.

“In the red zone, I know I’m going to see patients who are confirmed to have Ebola. If I make any mistake, I will also be in quarantine for twenty-one days—or I will also be infected. So we enter with that anxiety, knowing that this is a risk that I’m taking. I know that everybody has that level of fear. But I have to go. Because I’ve been in many other outbreaks, I trust that, if I respect the protocols, there is nothing that will happen to me. And that has helped me a lot in gaining confidence. I always tell my colleagues that, if we continue to respect the protocol, none of us will be affected.

“People need to be trained well to avoid being in a panic when they are removing the P.P.E., because that’s the critical moment. We have entered the red zone. We have touched patients. Our colleagues sometimes have to mop the blood of confirmed patients, or body fluids. I myself was taking care of a patient, and he sneezed and everything went on my apron. We have a mirror so that you can see what you are doing. We have, also, a huge banner showing each step. And then there is a person in the green zone, in light P.P.E., who is also giving instructions: ‘O.K., now you can wash your hands.’ And then we have a sprayer who is spraying us with disinfectant. If there is visible soiling on our P.P.E., he cannot spray, because he will spread those things. So he will just tell us what to do, like removing it carefully and dropping it in chlorine very quickly before we wash hands.

“Recently, a man in his forties was brought in. He had spent two weeks with symptoms. He had a light fever first, with vomiting and muscle pain, but it was mild enough for him to stay in the community. And then when symptoms started to worsen—especially when he started having profuse diarrhea and vomiting, ten days later—he was brought to us. He was already very weak. He was no longer fully conscious and was not able to listen. And he was still passing a lot of diarrhea. Because of vomiting, we put in a nasogastric tube. A moment later, he started bleeding everywhere.

“That is one of the things that I don’t wish anybody to see—a human being bleeding from wherever you have an opening. Nose, eyes, mouth. When he coughs, he spits blood. Even from his ears you see traces of blood. The urine is full of blood. So it’s quite a nightmare when you see a patient in the later stage. I’m sorry, I have that image in me. It makes me feel some emotion, as well. At that stage, it was quite difficult for the team to resuscitate him. He passed away that same day.

“There is not enough blood for transfusions. With the outbreak, they stopped collecting blood in the provinces that are affected, so blood has to come from other locations. And Congo is too big, so it has to come by flight—it has to be scheduled. So when someone reaches that level, as a doctor, you sometimes don’t have anything else to do. And I can tell you seeing a patient for whom you can’t do anything is almost a torture.

“We have a team of psychosocial workers—mental-health specialists—who are part of our team. They bring relatives of patients to a dedicated visit space. There are Plexiglas screens that allow visits without physical contact. The psychosocial workers have to be careful to make sure that they sit at least one metre away from the relatives. They explain what will happen inside, including the reason for isolation. If the relative is required to stay in quarantine for twenty-one days, we give them options like phone calls to help them talk to the person inside. We always welcome visitors. When we don’t, rumors start to spread: ‘Doctors are removing organs to sell them. That’s why they bury patients themselves.’ In reality, with Ebola, we have to do a safe burial to prevent it from spreading.

“In Bunia, I can feel a mix of fear and frustration. Everyone can see buckets of water everywhere to wash their hands before they access any public space. It’s a reminder that something is happening in this city. And then seeing the funerals being organized here creates fear among the people. Frustration because no one knows when it will end. If I meet colleagues who are not working on Ebola, at a restaurant, they ask me, ‘When are we going back to our normal life?’ And I keep telling them I don’t know—maybe six months, maybe a year. And that causes more frustration.

“When I was a kid, I witnessed what was probably the worst cholera outbreak in my city of Goma, D.R.C. It left a kind of trauma, seeing suffering all around. One of the things that helps me overcome this is when we see results. When we see someone who came in very, very sick, and then is able to walk after one week or ten days or two weeks—able to recover and go out happily, reunite with their family. Those moments, they are not every day. But, when they happen, it’s so rewarding. That’s one of the things that make it worth it.

“The second thing is the team. I manage a team that is close to a thousand people. Sometimes I’ll see a logistician working until 10 or 11 P.M., just to make sure everything is done. When I see that around me, it’s an additional motivation for me. If the people I’m working with are behaving like this, I also need to maintain that courage. We are seeing interest from journalists, from donors, from colleagues. They are asking us, ‘How are you doing? How is the situation there?’ They will support the team here to stop this outbreak. That helps us not to feel alone.”