DRC Ebola Outbreaks

Where are most Ebola cases concentrated in the current outbreak?

The outbreak keeps spreading at an alarming rate. It is currently spreading across Ituri, North Kivu, South Kivu, Tshopo and Haut-Uélé provinces in eastern DRC, with Ituri accounting for more than 90 per cent of cases and latest official data showing an increased number of confirmed cases in North Kivu. 

What are the latest case figures?

Based on the latest from the Ministry of Health there are 3,262 confirmed cases and 1437 confirmed deaths in the affected provinces, as of 26 July  link. 

How is the outbreak expanding in the Eastern part of DRC?  

On 9 July, two new provinces were declared as part of the current outbreak: Haut Uélé (Wamba) and Tshopo (Kisangani). An MSF emergency team is present in Kisangi to support local health structures with training for Ebola management and IPC. We have also set up a 12-bed isolation unit in one hospital and will set up an Ebola Treatment Centre (ETC) in an additional location in Kisangani. In Ituri, cases have increased in the Nia-Nia and Nizi health zones. This area is located along the road leading northwest to Isiro and Kisangani, which is highly concerning.   

10 weeks on, what is MSF’s position on the situation and the response?

We are facing a large outbreak in a highly complex and challenging environment. In just 10 weeks, the current Ebola diseases outbreak, caused by the Bundibugyo virus, has become the third largest outbreak and the fastest growing on record, and over the past month the number of cases has tripled while reported deaths have increased more than fivefold. Undeniable progress has been made in several areas, including laboratory capacity-building. However, major challenges remain that jeopardise the control of the outbreak, whether in diagnostics, surveillance, contact tracing, or community engagement. These are real and must be addressed as quickly as possible by all response partners in support of the health authorities, including an urgent scale up in areas outside of the urban centres.  

The outbreak continues to spread, including in parts of Ituri and North Kivu where it likely remains undetected, as access surveillance and testing are still major constraints. 

Facilitating movement and access to affected areas will also be essential if the outbreak is to be brought under control. 

What is MSF doing in the DRC and Uganda?

In collaboration with the relevant health authorities, MSF teams work on case management and clinical care, surveillance support, community engagement, IPC, safe burial support, supply and equipment donations, trainings (IPC, isolation, case definition, etc.), and non-Ebola primary healthcare support. In DRC, MSF operates several ETCs and isolation units across Ituri, North Kivu and South Kivu provinces. In Uganda, MSF has rehabilitated an ETC near Kampala and also renovated an isolation centre located in south-western Uganda, bordering DRC. On 28 July, the Ugandan Ministry of Health declared the end of the Ebola outbreak, however the WHO has not yet confirmed it.  

Have any patients been cured under MSF care?

Yes. Since MSF began providing care in Ituri, North Kivu and South Kivu up to 25 July, 282 patients have survived and been discharged from its ETCs. There have also been some deaths, mostly among patients who arrived late at the treatment facility, when the disease is more advanced and more difficult to treat.  

How many staff have you mobilised for this response?

Over 1,400 MSF staff are directly responding to the Ebola disease outbreak in DRC, working alongside Ministry of Health (MoH) teams. They are supported by more than 2,700 MSF staff, and nearly 4,500 incentivised MoH staff already working in the country on existing health programmes, helping ensure that other essential health services continue. In Uganda, MSF has 20 staff responding to the outbreak. 

What are the current challenges that are affecting the Ebola response more than two months on? 

The Ebola response is facing a dangerous combination of operational, epidemiological, and contextual challenges. An urgent scale-up of the international medical response is urgently needed, in particular outside of urban areas. 

The situation remains unclear and rapidly evolving, with new suspected cases reported in additional health zones almost daily, highlighting gaps in surveillance and diagnostic capacity. Although diagnostic capacity and case reporting have improved since 15 May, testing and surveillance remain highly centralised and is still not reaching remote areas, delaying detection and confirmation of cases. These gaps make it difficult to fully understand the outbreak and respond quickly enough to contain transmission. 
 
The response is also taking place in a highly insecure environment, where armed conflict and logistical constraints restrict access - both for MSF teams trying to reach communities and for communities trying to access care – and complicate the transport of staff, patients, and supplies. At the same time, chronically under-resourced health facilities and weak infection prevention and control measures limit the ability to safely manage cases.  

Community mistrust and misinformation further affect engagement with response efforts, while broader challenges - including funding constraints and movement restrictions - add complexity and slow response operations. Together, these factors make it more difficult to rapidly contain transmission and deliver an effective, timely response. 

What are the challenges ahead. What must be urgently addressed?

1. Response coverage, case management and care
2. Surveillance and contact tracing
3. Diagnostics
4. Community engagement
5. Maintaining access to essential healthcare services

Finding treatments and vaccines

1. Response coverage, case management and care

   The outbreak is currently centered in Ituri, with the main epicenter around Bunia-Rwampara, Mongbwalu and Nyankunde health zones. However, other areas – outside of urban ones – show either none or little support by humanitarian actors for the provision of Ebola care. This evolving epidemiological situation, coupled with people’s reticence to seek Ebola care far from their homes, means Ebola care must be decentralised outside of main urban centres.

2. Surveillance and contact tracing

   Surveillance and contact tracing remain limited overall. There is a clear urgency to strengthen surveillance and early detection systems, which includes:

Rapid and transparent reporting of suspected cases and alerts through community leaders and health agents;

Timely sharing of data to guide response efforts; and

Efficient contact tracing and follow-up, including training of community leaders and local health agents.

After two months, surveillance remains challenging, notably outside urban areas. Delays in detection, testing, and referrals fuel the ongoing transmission and the spread of the outbreak.

In North Kivu, while the region has experience responding to Ebola disease outbreaks, the current surveillance system relies heavily on volunteers and is under-resourced. Urgent support is needed to strengthen capacity and get ahead of the outbreak.

3. Diagnostics

As we speak, significant efforts by the MOH to scale up the laboratory capacity have been made in the last month and are ongoing. Despite this, results are still significantly delayed overall and timely access to diagnostic capacity remains critical in certain areas, such as Beni and Kisangani, as well as in remote and newly affected health zones, especially in areas affected by insecurity, increasing the risk of ongoing transmission, delaying access to care, and prolonging the outbreak. Diagnosing relies on virus-specific PCR testing, but capacity for the current Bundibugyo virus remains limited. Only a small number of laboratories in eastern DRC have the equipment, supplies, and trained personnel to conduct tests safely. Although hundreds of testing kits have been delivered from abroad, their distribution and effective use are constrained by limited local capacity, including shortages of trained staff and operational resources.

There are consequences of limited access to testing:

Delays in confirming cases;

Slower isolation and treatment of patients; and

Challenges in safely discharging patients, leading to overcrowding in ETCs.

This is particularly concerning because rapid detection and isolation are essential to breaking chains of transmission, especially in the absence of a vaccine or specific treatment for Bundibugyo virus.

The availability of diagnostic tests and other essential response tools must continue to expand, together with support to new laboratories such as the one in Beni which also covers Butembo (North Kivu), to ensure they continue running for Ebola diagnostics and other tests needed by patients. There is an urgent need to strengthen testing capacity, including increased investment in laboratories – including in infrastructure, diagnostic equipment, and trained personnel.

More information on diagnostics in the current outbreak, see MSF Access briefer from 24 June.

How can testing capacity be strengthened effectively?

Efforts should focus on both expanding permanent laboratory infrastructure and adaptable solutions, such as mobile and portable laboratories, to reach remote and underserved communities. A few mobile labs have arrived in some areas, but these efforts need to be rapidly scaled up to meet current needs.

4. Health workers strikes

Health workers involved in the Ebola response in eastern DRC have gone on strike on several occasions over payment issues, including at MSF Elikiya Ebola Treatment Centre (ETC) in Bunia. These strikes are not related to MSF's human resources management or employment practices. Rather, they reflect concerns raised directly with the Congolese authorities regarding the payment of staff engaged in the outbreak response. MSF has no comments on such protests, as they relate to governmental and administrative decisions beyond our mandate. However, health workers play an irreplaceable role in responding to this outbreak and it is important they are compensated in a timely manner for their work under extremely challenging conditions.

5. Community engagement

   Community engagement is critical now and in the coming months. It is fundamental to building trust and ensuring people seek care early and follow public health measures.

   Community acceptance cannot be assumed. Many communities in the DRC have experienced previous Ebola disease outbreaks, often with difficult and traumatic consequences that continue to shape perceptions of the current response. Ebola is a frightening disease that disrupts families and communities, particularly in a context already marked by conflict, displacement, food insecurity, and limited access to healthcare.

   In addition, many communities face a long-standing lack of access to basic health services and trained personnel. In this outbreak, it is entirely legitimate that some question the sudden surge of resources and international attention for Ebola, when other pressing health needs have gone unmet for years.

   Our teams have witnessed firsthand that fear and uncertainty, combined with past experiences, can fuel misinformation. Misperceptions reported in some areas include doubts about whether Ebola exists, beliefs that it was introduced deliberately, fears about treatment centres, and suspicions that humanitarian actors are profiting from the outbreak.

   Listening, providing clear and transparent information, and working with communities on their own terms will be essential over the coming months to protecting lives and controlling the outbreak.

6. Maintaining access to essential healthcare services

Ebola is not the only public health emergency facing communities in the DRC. The outbreak is aggravating an already existing humanitarian crisis. One of the key lessons from previous Ebola disease outbreaks is the importance of maintaining access to, and funding for, other essential healthcare services. This should include free access to health facilities for people in Ebola-affected areas together with the reinforcement of IPC measures, systematic triage mechanisms, isolation capacity to avoid the disruption of essential services and exposure of non-Ebola patients.

Malaria, measles, cholera, malnutrition, and other preventable and treatable conditions continue to cause significant illness and death. Ensuring that people can continue to access essential healthcare - including treatment for common illnesses, malaria, vaccinations, maternal healthcare, and emergency medical services - remains a critical priority.

7. Finding treatments and vaccines

   This outbreak is caused by the Bundibugyo virus, for which there is currently no approved vaccine or specific treatment. Vaccines and therapies that have been successfully used in previous Ebola outbreaks in the Democratic Republic of Congo (DRC) were developed for a different Ebola virus species (Ebola virus) and are not approved for use against the Bundibugyo virus.

WHO, the Ministry of Health of the DRC, researchers, and partners are exploring potential vaccine and treatment candidates to be evaluated during this outbreak. Similar research conducted during past Ebola disease outbreaks contributed to the development and approval of vaccines and treatments that are available today.

On treatments, on 02/07 a therapeutics trial has been launched in the DRC under the WHO-sponsored “PARTNERS Trial Initiative”, a collaborative platform involving Congolese health authorities and the Congolese National Institute of Biomedical Research (INRB); foreign research institutions like the University of Oxford and the Antwerp Institute of Tropical Medicine; outbreak response partners and international organisations. During this trial, investigational therapies will be evaluated among patients with confirmed Ebola diagnostics in different ETCs. This study will help identify the most effective type of treatment for patients affected by Bundibugyo virus disease.

MSF, along with other medical organisations involved in the outbreak response, has agreed to participate in this initiative as similar treatment trials conducted in the DRC proved instrumental in identifying effective treatments for Ebola virus disease. MSF is actively supporting this trial which evaluates the safety and efficacy of the therapies remdesivir and MBP134 for this virus. On 23 July, it started in our Elikiya ETC, in Bunia, where the first patients were enrolled. Transparent and enforceable access conditions need to be deliberately included into how these products are funded, licensed, priced and supplied.

[PLEASE NOTE: We have MSF experts involved in the organisation of the PARTNERS Trial. Yet, as MSF has not started its participation in the trial at this stage, we recommend that journos interested in this topic reach out to Lucy Pritchard, Head of Communications at the Nuffield Department of Medicine (NDM) within the University of Oxford: [email protected]]

On vaccines, discussions are underway between WHO, health authorities, and partners to determine which vaccine candidates could be evaluated through emergency clinical trials against the Bundibugyo virus. MSF is ready to contribute to this research, as it did during vaccine trials conducted in the DRC in 2019-2020. Those trials ultimately led to the approval and deployment of two Ebola vaccines.

How has the conflict/insecurity affected the response?

Conflict and insecurity have had a major impact on the Ebola response, as the outbreak is unfolding in parts of eastern DRC that have been affected by decades of armed violence and displacement. In recent weeks, most newly affected health zones have been located in insecure areas, particularly in northern North Kivu, raising serious concerns about the ability to rapidly deploy an effective response and save lives.

Insecurity has significantly restricted access for both MSF teams trying to reach communities and for communities trying to access care. Armed conflict, poor roads, checkpoints, shifting front lines and the presence of multiple armed groups make it very difficult to carry out surveillance, contact tracing, follow‑up, and community engagement, especially in remote areas. The armed conflict and logistical constraints restrict access and complicate the transport of staff, patients, and supplies. Additionally, the displacement of people linked to ongoing violence further complicates early detection and outbreak control.

While authorities have scaled up laboratory capacity and reduced testing delays in some urban centres, timely access to diagnostics remains a major bottleneck, especially in insecure areas. Dispatching and transporting samples, decentralising testing, and running laboratories are particularly challenging where access is limited. As a result, test results are still significantly delayed overall, including around Beni and Butembo in North Kivu.

Logistical constraints linked to insecurity, travel restrictions and airport closures further complicate the response. The closure of Goma airport, ongoing flight restrictions, border controls, and blocked or unsafe supply routes have slowed operations and increased costs, forcing teams to rely on longer and more complex transport routes through neighbouring countries.

Travel Restrictions and Border Control

How are travel restrictions affecting movement. Are you able to move in and out of the DRC?

Several neighbouring countries, including Rwanda and Uganda, have introduced travel restrictions in response to the outbreak. While humanitarian and medical personnel, as well as essential supplies, are generally exempt, allowing MSF to continue operating, these measures still create significant logistical challenges. Movement of staff and equipment has become slower, more complex, and more costly, particularly in eastern DRC where access was already constrained by insecurity, poor infrastructure, and remoteness.

Travel restrictions, border closures and other measures may instead hinder response efforts and create additional challenges for the deployment and rotation of specialised Ebola staff. MSF remains in close dialogue with authorities, neighbouring countries, and partners to find practical solutions that maintain access to an effective public health response.

North Kivu: Did the closure of Goma Airport affect the Ebola response?

The Goma Airport has been closed since late January 2025 following the escalation of armed conflict between the armed AFC/M23 and Congolese army. Since then, it has continued to disrupt humanitarian access, including for this Ebola disease response. MSF teams must travel via Rwanda and continue by road, while supplies are routed through Rwanda or Uganda, slowing operations and increasing costs. Reopening the airport would save weeks and allow for a faster, more effective response.

Uganda: Did the border closure impact the Ebola response, including MSF operations?

Since 27 May, Uganda has introduced targeted border restrictions with exemptions for authorised Ebola response teams, humanitarian activities, food and cargo transportation, and security personnel—all under strict health screening and monitoring protocols. While these measures caused some disruptions the first weeks, MSF is currently able to operate without major constraints in both Uganda or the DRC and continues its response activities.

What do you think of Uganda’s decision to close its border with DRC?

Since 27 May, Uganda has applied targeted restrictions, with exemptions for Ebola response teams, humanitarian activities, cargo, and security personnel under strict health screening. MSF has not experienced major operational constraints linked to these measures in either Uganda or DRC.

Movements from DRC are not fully blocked but subject to additional health controls. This is important, as experience shows that full border closures are ineffective, while well-managed measures can help support the response.