The 2018-2020 Ebola outbreak in eastern Congo claimed more than 2,200 lives across 3,400 reported cases, making it the second-largest epidemic in history. Now, as a new outbreak emerges caused by the rare Bundibugyo virus with 550 confirmed cases and 101 deaths as of early June, survivors are stepping forward to illuminate the obstacles that prolonged the previous crisis. Their testimonies paint a troubling portrait of how deeply ingrained cultural beliefs, political suspicion, and vaccine resistance undermined public health responses in the conflict-affected region, raising urgent questions about whether the same pitfalls might repeat.

Vianney Kambale Kombi, who contracted and survived Ebola during the 2018 outbreak in the eastern city of Beni, recalls the pervasive denial that gripped his community. Rather than accepting the disease as a medical reality, residents attributed the mysterious illness to witchcraft or supernatural forces beyond the reach of modern medicine. This fundamental rejection of the outbreak's existence proved catastrophic. Families refused to isolate infected relatives, communities resisted health worker interventions, and patients delayed seeking treatment until symptoms became severe. For Kombi, the personal toll was compounded by the psychological burden of being shunned even after recovery, a consequence of the stigma that accompanied survival itself.

The intersection of disease and politics further complicated outbreak response in Beni, a commercial crossroads near the borders with Uganda and Rwanda. Bienfait Wanzire, another survivor, describes how election campaigns and political turbulence created fertile ground for conspiracy theories. When health authorities announced cases, some segments of the population interpreted the outbreak as a manufactured crisis designed to advance political agendas or secure international funding. This weaponisation of the epidemic for political purposes deepened the chasm between communities and the health system, making it exponentially harder for officials to implement isolation protocols, contact tracing, or vaccination campaigns.

The burden on frontline health workers became almost unbearable under these conditions. Dr Babah Mutuza Lusungu, a physician at Dieu Est Grand Medical Centre in Beni, lost his uncle and two colleagues while simultaneously fighting against widespread community rejection of the outbreak's reality. He describes an atmosphere of profound mistrust that poisoned relationships between the population, local authorities, international partners, and health workers themselves. Rather than being viewed as allies in a public health emergency, medical staff became targets of suspicion and, in some cases, violence. This erosion of institutional credibility left the health response severely hampered, unable to mobilise communities or secure cooperation for basic containment measures.

Youth populations, who typically serve as crucial bridges between authorities and communities, were largely excluded from decision-making and communication efforts during the 2018 crisis. Dr Lusungu emphasises that younger leaders possess legitimate influence within peer networks and could have been mobilised early to counter misinformation and build acceptance for outbreak response measures. The failure to engage youth leaders represents a strategic oversight with lasting consequences for public trust. As new outbreaks emerge, authorities must recognise that waiting until cases spike before launching educational campaigns guarantees failure. Prevention and community engagement must precede rather than follow the explosion of documented infections.

Women and caregivers faced uniquely painful ordeals during the epidemic. Esperance Masinda, who worked for the UN children's agency in Beni during the outbreak, contracted Ebola while caring for her husband, a medical doctor. Both survived thanks to vaccination, yet their recovery sparked new forms of cruelty. Neighbours and family members warned them that the vaccines would kill them within five years, suggesting that Ebola survivors were living on borrowed time and should be avoided. The psychological warfare extended beyond the outbreak itself, casting long shadows over survivors' reintegration into normal social and economic life.

The particular challenge of children orphaned by Ebola added another layer of complexity to the humanitarian crisis. Masinda witnessed firsthand how young people lost their parents and faced compounded trauma, not only from bereavement but also from community rejection of their Ebola-affected status. The absence of coordinated psychosocial support systems meant that these vulnerable children bore their grief in isolation, their suffering invisible to authorities focused on containing case numbers. For Malaysia and Southeast Asian nations with weaker health infrastructure, this gap in psychosocial care during epidemics represents a cautionary example of what neglecting the human dimensions of crisis response produces.

Vaccines, though ultimately effective in halting the 2018-2020 outbreak, became objects of profound suspicion rather than salvation. The very tool that saved lives faced resistance rooted in decades of medical mistrust and historical experience with exploitative health interventions. For those who survived with vaccine assistance, the irony was bitter: they were simultaneously saved and stigmatised, their recovery seen as evidence of participation in something mysterious and threatening rather than as triumph over disease. This paradox reveals the depth of the trust deficit between global health institutions and affected populations in conflict zones.

The current outbreak, caused by the rarer Bundibugyo virus, unfolds without an approved vaccine currently available, a factor that heightens anxiety among both survivors and health authorities. Beni's experience during 2018-2020 has left institutional memory of successful vaccination campaigns, yet also wariness about how the public might react if vaccines are again deployed without sustained community engagement. The commercial importance of Beni as a regional trade hub means that disease containment depends critically on the voluntary cooperation of merchants, travellers, and workers who move goods across borders into Rwanda and Uganda. Failure to rebuild trust could allow undetected spread across the fragile epidemiological landscape of the Great Lakes region.

Survivors are now positioning themselves as witnesses and educators, attempting to rebuild the credibility that health systems squandered during previous crises. Kombi and Wanzire represent a human bridge between communities and authorities, their very existence as healthy, functioning members of society contradicting narratives of doom and witchcraft. Yet their efforts, though valuable, cannot substitute for systemic change in how authorities engage with affected populations. True progress requires health workers to listen to community concerns, political leaders to cease exploiting epidemics for advantage, and international partners to support long-term relationship building rather than merely deploying resources once outbreaks explode.

For Southeast Asian policymakers and health officials, the Congo experience offers urgent lessons. Regional outbreaks of dengue, chikungunya, and other emerging pathogens will inevitably encounter pockets of vaccine hesitancy, medical mistrust, and misinformation. Building resilient outbreak response capacity demands investing in community trust during periods of health stability, not attempting to manufacture cooperation once crisis arrives. Training youth leaders, engaging traditional healers rather than dismissing them, and creating transparent communication channels represent foundational elements of preparedness that cost far less than the damage caused by delayed response. As new threats emerge in Congo and elsewhere, the question becomes whether the global health community will finally prioritise the social and political dimensions of epidemiology that survivors know from painful experience are just as critical as medical interventions.