The Ebola outbreak declared in mid-May in the Democratic Republic of the Congo (DRC) reaches this Sunday the threshold of six months, becoming the deadliest recorded in the country and the second most lethal in the world, with around 5,500 deaths, as international alerts grow over its expansion and the lack of sufficient resources to contain the crisis.
The authorities officially announced the outbreak on May 15 in the province of Ituri, in the northeast of the country, after detecting the Bundibugyo strain, for which there is neither a vaccine nor an approved treatment. Since then, the disease has spread to seven other Congolese provinces and has led to cases linked in Uganda, Kenya and Nigeria.
The situation led the World Health Organization (WHO) to declare, just two days later, that the outbreak—initially including eight laboratory-confirmed cases, 246 suspected cases and 80 suspected deaths in Ituri, as well as two infections and one death in Uganda—constituted a Public Health Emergency of International Concern (PHEIC), urging countries to adopt extraordinary measures.
Six months later, the National Institute of Public Health (INSP) has verified around 11,200 infections and 5,500 deaths. The speed of transmission was evident in that the 1,000-case threshold was exceeded in the first 40 days, compared with the more than 230 days that were needed in the 2018 outbreak, which concluded in 2020 with 3,470 infections and 2,280 deaths.
Current projections indicate that this episode—despite being a less deadly variant than the Zaire, with mortality close to 40%—could reach or even surpass the largest Ebola outbreak recorded so far at the global level, the one in West Africa between 2014 and 2012016, which left 28,616 cases and 11,325 deaths in Guinea, Liberia and Sierra Leone.
The executive director of the WHO Health Emergencies Programme, Chikwe Ihekweazu, has acknowledged that although progress has been made to curb transmission in the east of the country, between 400 and 500 new cases continue to be detected each week, a dynamic associated with infections in rural areas that are difficult to access, despite the “significant reduction” in some epicenters such as Bunia, Mongbwalu, Rampara and Nizi, in Ituri.
Ihekweazu has also highlighted the impact of insecurity on health operations, after the dozens of attacks recorded in recent months in eastern DRC—some attributed to the Allied Democratic Forces (ADF), linked to Islamic State—, which have caused hundreds of deaths and the displacement of thousands of people.
"We have seen countless attacks on the health system, attacks against communities, attacks against those who provide medical care, and people who have lost their lives, nurses at funerals," he said. "Therefore, we must keep working with the community, and this is very important. We must also work with the specific groups that instigate these attacks," he added.
The International Rescue Committee (IRC), for its part, has warned of the impact of rumors and fears circulating among the population about the virus and treatment centers. The organization says it has documented more than 80 hoaxes, including that those who go to the centers "do not return alive," which fuels distrust toward the health response.
An epidemic "out of control" and with misdirected resources
The NGO has warned that the epidemic is "out of control" and has denounced "a worrying disconnect between the considerable resources mobilized for the response and what really reaches patients, front-line staff, and communities."
"Despite the enormous amounts of money allocated to the response, many front-line workers are forced to try to contain the outbreak with their hands and empty pockets," emphasized the international president of MSF, Javid Abdelmoneim.
"Our teams are often left speechless by the dysfunctions and failures in the response that they witness in many areas. After six months, this situation is simply unacceptable," he said, before уточning that "the data collected by MSF illustrates the seriousness of the problem."
Along these lines, he explained that, since the start of the response, only 9% of the Ebola patients treated by the NGO teams in Ituri "had previously been identified as a contact by the surveillance system." "Although community distrust makes contact tracing difficult, it is essential to introduce urgent improvements in supervision, staffing, and operational support," he reiterated.
The organization has also shown its concern about what it considers "an excessive concentration of efforts" in certain areas, to the detriment of "other focal points where needs are increasingly urgent and that are being left without support", citing the province of Alto Uélé as one of the territories forgotten by the response to the outbreak.
"There are very few response teams that operate beyond the initial focus to tackle the spread of the virus in other areas of the country that are gravely affected," Abdelmoneim lamented, who warned of the danger of "spending years constantly trying to catch up with this outbreak." "This is not only a matter of operational effectiveness, but also of restoring trust among communities that have already paid an enormous price," he added.
Devastating impact on children and worsening of the humanitarian crisis
At the same time, the United Nations Children's Fund (UNICEF) has put the focus on the consequences of the outbreak for minors and has regretted that, despite some progress in the response, children continue to bear a disproportionate cost. In addition to the risk of contagion, many have lost their parents or caregivers, lack basic protection and medical care, and have seen their schooling interrupted.
Minors account for 28% of confirmed cases, but concentrate 35% of deaths. The situation is even more dramatic among children under five, who represent 14% of infections and 21% of deaths, with a mortality rate close to 72%. Nearly 80% of child deaths occur outside Ebola treatment centers and, even when they access medical care, they often arrive too late.
UNICEF has insisted that access to health services remains very limited. Between January and September, deliveries in health facilities in areas affected by Ebola in North Kivu fell by nearly 18% compared with the previous year. In Tshopo, almost 11% fewer children received the third dose of the vaccine against diphtheria, tetanus, and pertussis, while the administration of the first dose against measles decreased in the three provinces with available data, to as much as 7.6% in South Kivu.
The outbreak, added to the conflict and internal displacement, is worsening an already extreme humanitarian crisis. Projections indicate that the number of people in levels of severe food insecurity could exceed 30 million by mid-2027, which would represent the highest figure on record for the country.
Against this backdrop, the United Nations and several NGOs have intensified their calls to urgently strengthen the response, especially after cases were detected in neighboring states, which raises fears of a regional expansion with enormous difficulties for health control and potential major economic and social repercussions.