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BUNIA, Congo — Esther Lutula stopped going for prenatal checkups shortly after the current Ebola outbreak was declared in eastern Congo. Midway into her pregnancy, the 26-year-old feared being put into isolation simply for having a fever, a common misconception.

“That’s why I’m waiting until the disease is no longer widespread,” she told the Associated Press from her home in Bunia, the capital of Ituri province and epicenter of the outbreak declared on May 15.

But that could be a deadly mistake.

Maternal mortality across Ituri soon doubled as news of the outbreak spread, with an average of about six women dying per week due to childbirth complication, according to Noemi Dalmonte, deputy country representative of the United Nations Population Fund in Congo.

While there was an average of 3.1 maternal deaths weekly this year before the outbreak, that jumped to 5.8 deaths from May 25 to July 19. Among those, the deaths outside health centers have also jumped from 9.1% to 17.4% within the same period, UNFPA data shows.

As Congo battles the fastest-growing Ebola outbreak on record, with more than 1,600 confirmed deaths, health and aid workers are warning of a shadow crisis as pregnant women avoid hospitals and the country’s already high maternal mortality rate climbs even more.

While it’s common for Africans to avoid health centers during public health emergencies because of safety concerns, “with Ebola, it is stronger because Ebola has a lot of rumors,” Dalmonte said in an interview.

With some wary residents questioning whether Ebola even exists, and health workers in one of Congo’s most remote and volatile regions struggling to respond to the outbreak with few supplies, pregnant women have less care than ever.

Congo is one of the world’s most dangerous places to give birth

Congo has among the world’s highest rates of both childbirths per woman and deaths around childbirth.

Women in the vast central African nation have almost six children on average. At least 19,000 women died from pregnancy complications in Congo in 2023, according to the latest U.N. data, tied with India and second only to Nigeria globally.

Now health workers in Ituri say they are seeing a decline in hospital visits as people worry about the risk of infection. This type of Ebola has no approved treatment or vaccine.

Women in need of care also fear being caught up in violence. Ebola treatment centers have been attacked by residents fueled by misinformation or anger over strict outbreak measures.

At the Bénédicte Clinic in Bunia, the number of women registered for prenatal care has dropped from 60 each month to around 10, said Sonny Mwembo, the medical director.

Even now, weeks into efforts to battle misinformation, some residents hold mistaken views of the outbreak.

“Right now, if you feel sick and go to the hospital, they say it’s Ebola and they put you in quarantine right away. That’s what scares people,” said Elodie Yabiri, a Bunia resident who is heavily pregnant.

Yabiri said she’s avoiding hospitals as much as she can.

As long as she still feels her unborn child moving, she believes everything is still OK.

Limited healthcare pivots to Ebola instead

The outbreak has strained Congo’s already overstretched healthcare system, complicating access for the pregnant women who still come for prenatal care or birth.

Health facilities in the five affected provinces are redirecting staff and supplies to the response, reducing access to essential maternal care services, according to aid groups.

At least 44 health infected workers have died. Many other health workers have walked off their jobs, protesting a lack of payment. At least 12 attacks have been recorded against health facilities and teams since the outbreak was declared in mid-May.

“We are doing everything we can to make the public understand how dangerous this disease is. We are working day and night without being paid,” said Ghislain Maneba, an epidemiologist and community investigator in Ituri’s Rwampara health zone.

All women are at higher risk in this outbreak

Ebola is rare but highly contagious and severe, often fatal. It spreads in the human population through contact with bodily fluids such as vomit, blood, or semen, and with contaminated surfaces and materials such as bedding and clothing.

Women are usually the primary caregivers when a loved one becomes ill. Many are among frontline health workers in this outbreak as well.

Associated Press journalists covering the outbreak have seen pregnant health workers among the responders.

“It is very important that they know how to protect themselves, that they have the right information,” Dalmonte said.

Pregnant women with Ebola are at an increased risk of problems including miscarriage, the U.S. Centers for Disease Control and Prevention has said in its clinical guidance.

Meanwhile, pregnant women who delay care and avoid health facilities “could die not from Ebola itself but because the care that would have saved them was no longer accessible, trusted, or safe,” Dalmonte said.

WASHINGTON — A federal judge is allowing the Department of Homeland Security to go ahead for now with plans to build a border wall through a levee system protecting a small Texas town on the border with Mexico, rejecting arguments by the town that the wall could lead to flooding.

The decision late Sunday marks a victory for the Trump administration as it races ahead with efforts to build a $46 billion wall along the U.S.-Mexico border from the Pacific Ocean to the Gulf of Mexico.

The town of Presidio, with a population of about 3,200 people, argued the wall could cause flooding and that the administration isn’t following the law as it rushes forward with its plans. The town’s development district sued earlier this year to stop the department from going forward with construction.

But the judge said in his ruling Sunday that they were unlikely to succeed on the merits of the case.

“For the foregoing reasons, despite the understandable concerns expressed by the plaintiff regarding the harms it and the plaintiff’s residents might sustain by the potential construction of the Smart Wall, the Court is compelled to deny the plaintiff’s motion for a stay,” wrote Judge Reggie B. Walton.

DHS has been charging forward with its wall-building plan, with senior administration officials saying a first layer of the structure will be done by next year. In its push, the Secretary of Homeland Security has waived numerous regulations designed to protect the environment, wildlife, and archaeological and Native American sites.

But the department has been running into opposition by landowners, environmental groups, Native American tribes, and others who argue that the government’s rapid construction endangers environmental and religious sites and a way of life along the border. Opponents also question the urgency to finish the wall when migrant crossings from Mexico are already at extreme lows.

Lawyers for Presidio’s development district argued in a court hearing that the government’s plans could compromise the levee system protecting the town from flash flooding and that the government flouted a key act that requires it to seek permission from the Army Corps of Engineers before building on or near the levees.

“We are very disappointed that the court will allow this potentially disastrous construction to continue, but we remain committed to protecting the Big Bend area and those who rely on the threatened levees,” said the town’s development district in a statement Monday.

Presidio is protected by a series of berms and levees built in the 1970s and 1980s along the Rio Grande and tributaries to combat flooding.

In court documents, Presidio’s development district said Customs and Border Protection plans to “replace the earthen slope of the existing levee with a concrete wall, with 30-foot steel bollard panels installed on top.” The district said it asked the agency for more details but was told they can’t be shared due to “national security.”

The government has argued that there is no final plan for where the border wall will go or how it will be built. And the administration has maintained that it has the authority given to it by Congress to waive a vast swath of regulations to build the wall as it seeks to get the number of people crossing the border every day to zero.

In his ruling, the judge bolstered that argument, saying that it was clear “that Congress did not intend to limit the Secretary of DHS’ waiver authority.”

The government is also facing another lawsuit in Texas where an environmental group and a church preservation group have teamed up to oppose DHS’s plans.

MOSCOW — The Russian Embassy in Rome on Monday blamed Ukraine for a deadly weekend bombing at a Moscow restaurant, describing it as an attempt to intimidate the Italian community in Russia.

The embassy said “Kyiv terrorists” wanted to “scare the Italians working in Russia and to show them that they too are in the crosshairs and could become the scoundrels’ next victims.”

It said the Saturday night attack on the Balzi Rossi restaurant killed five and injured 19, adding that its Italian chef and his staff were unhurt only thanks to a Russian security guard’s “vigilance and selfless dedication to his professional duty.”

There was no immediate comment from Ukrainian authorities.

The National Anti-Terrorism Committee, which coordinates various security agencies, initially reported a lower death toll in a statement issued shortly after the attack. It said the bomb killed three people, including a woman who carried the explosive device into the restaurant, a guard who stopped her, and a guest inside. It said 21 others were injured when the bomb detonated near the restaurant’s entrance.

The committee didn’t say who was the target or name the mastermind.

Moscow Mayor Sergei Sobyanin on Sunday described the bombing as a “brutal terrorist act,” but did not say who was responsible for the blast at the upscale restaurant, which is located on the ground floor of a high-rise apartment building that is one of seven skyscrapers in the city that date to the era of Soviet dictator Josef Stalin.

The Russian Foreign Ministry reposted the embassy statement without comment. It did not respond to a request for comment or explain the higher death toll.

Several Russian media outlets claimed the bombing targeted a Russian general who was celebrating his birthday at the restaurant. Some claimed that the general was Col.-Gen. Alexander Chaiko, who led the troops that made a botched attempt to storm the Ukrainian capital in 2022 and recently was appointed the chief of Russia’s aerospace forces. The claims could not be independently verified.

The business daily Kommersant reported that the bomb, hidden in a gift box, was probably detonated remotely and the woman carrying it could have been unaware of the content. Kommersant said the bomb contained about 2.2 pounds of explosives and contained metal balls for lethality.

Russia blamed Ukraine for past attacks on military officials

Russian authorities have blamed Kyiv for a series of bombings and other attacks against senior military officials after Moscow sent troops into Ukraine in February 2022. Earlier this year, Russia’s Federal Security Service said authorities would tighten security around senior military and government officials following the attacks.

In February, Lt. Gen. Vladimir Alexeyev, ​the deputy head of the GRU ‌military ⁠intelligence service, was shot three times at a Moscow apartment building, but survived. Ukraine denied its involvement.

In December, a car bomb killed Lt. Gen. Fanil Sarvarov, head of the Operational Training Directorate of the Russian Armed Forces’ General Staff, in southern Moscow. Ukraine refrained from comment.

In April 2025, another car bomb that Moscow blamed on Kyiv killed Lt. Gen. Yaroslav Moskalik, a deputy head of the main operational department in Russia’s General Staff. Ukraine didn’t claim the attack but hinted at its involvement.

And in December 2024, a bomb hidden in a scooter killed Lt. Gen. Igor Kirillov, who headed the Russian military’s nuclear, biological,Z and chemical protection forces, one of the few attacks Ukraine openly acknowledged.

Among other prominent victims of bombing attacks in Russia were Daria Dugina, the daughter of influential nationalist thinker Aleksandr Dugin, and Vladlen Tatarsky, a well-known pro-Kremlin military blogger. Kyiv denied involvement in the attack on Dugina, and remained coy about the attack on Tatarsky.