Politicized health emergencies and violent resistance against healthcare responders

2019 has been the most violent year on record for health workers in the Democratic Republic of the Congo. Attacks on healthcare coincided with the first-ever Ebola outbreak in an active conflict zone. Many of the attacks on the Ebola response were perpetrated by civilians who intended to disrupt the response, which in turn contributed to the spread of the virus. Why would communities attack the very people trying to protect them from disease? This mixed-method study examines the case of violence against Ebola responders during the Democratic Republic of the Congo’s tenth Ebola outbreak from 2018 to 2020. First, an ‘explaining-outcome’ process tracing reconstructs key events that led to the violent resistance of the population. I find that – contrary to popular belief – distrust alone was not the main driver. Rather, I argue that the politicization of the response provoked violent popular resistance. Second, an interrupted time-series model shows that the exclusion of three regions from the presidential election due to Ebola led to a significant increase in attacks on Ebola responders. The analysis demonstrates that the behavior of healthcare responders has limited ability to build trust when other political dynamics are at work. The article illustrates how combining process tracing with quantitative causal inference methods enables the simultaneous inquiry of cause, mechanism, and effect.