Ebola becomes the deadliest outbreak in DR Congo’s history

An Ebola outbreak in the Democratic Republic of the Congo (DRC) has become the deadliest in the country’s history, with more than 4,900 confirmed cases and over 2,300 deaths recorded three months after the outbreak is declared.

The outbreak, caused by the rare Bundibugyo virus disease (BVD), is first identified in Ituri Province before spreading to other areas. Health authorities say transmission is already taking place before the outbreak is officially declared on May 15.

The first warning signs emerge at Mongbwalu General Hospital in Ituri, where Dr Richard Lokudu becomes concerned after three members of his hospital team die within days of treating the same patient. The patient arrives at the hospital for surgery in early April, weeks before authorities officially declare the outbreak.

“Almost a month later, we recorded the deaths of the surgical assistant, the anaesthetist, and a member of the post-operative care team,”says Dr Richard.

The deaths raise concerns that Ebola is spreading before health authorities detect it.
The current outbreak surpasses the previous record set during the 2018-2020 Ebola outbreak, which is caused by the Zaire strain and kills 2,299 people.

Unlike the Zaire strain, vaccines and some treatments have been developed for, there are currently no licensed vaccines or specific approved therapies for Bundibugyo virus disease. Health workers are therefore relying on early detection, supportive care, infection-prevention measures and community engagement to control the spread.

The World Health Organization (WHO) says the outbreak is initially concentrated in Mongbwalu Health Zone in Ituri before expanding to other provinces. Health officials say delays in identifying cases allow the virus to spread through communities and create chains of infection before response teams are fully deployed.

Racing against transmission.

The DRC has dealt with Ebola outbreaks since 1976 and has developed significant experience in responding to the disease. However, health workers in Ituri say that experience is being tested by conflict, difficult terrain, delayed detection and mistrust among some communities.

Professor Pierre Akilimali, head of the DRC’s Ebola response, says laboratory capacity in Ituri has increased since the outbreak begins. “When we first started, we didn’t have any laboratories. Today, we have more than 12 laboratories here in Ituri Province,” Professor Pierre said.

Akilimali says relying on laboratories outside the province slows the confirmation of cases during the early stages of the outbreak.

Conflict and mistrust

The Ebola response is taking place in Ituri, a province that has experienced decades of armed conflict. Armed groups are fighting for influence and control over mineral-rich areas, making movement difficult and restricting access to some communities.

The Africa Centres for Disease Control and Prevention (Africa CDC) is supporting the response through surveillance, laboratory work, infection prevention, patient care and community engagement. Dr Justus Nsio, Africa CDC’s field incident manager for the DRC’s Ebola response, says the security situation is making the response more difficult.

“As for Ituri, the situation is not very favourable. We are in a war zone, and the province is under a state of siege,” said Dr Justus Nsio, Africa CDC’s field incident manager for the DRC’s Ebola response. “We are making do with what we have to show our solidarity with the communities.”

The WHO says movement between affected areas is also contributing to the spread of the virus. Dr Thierno Balde, WHO incident manager for Bundibugyo virus disease in the DRC, says uncontrolled movement of sick people between affected areas is making containment harder. “The geographical spread of the outbreak is mainly linked to the uncontrolled movement of people, particularly those who are ill, between localities that are already affected and neighbouring areas,” said Dr Thierno.

For communities in affected areas, the outbreak is bringing personal loss on top of insecurity and poverty. Furaha Gisèle, 35, loses her uncle to Ebola in Rwampara, about 10km from Bunia, the capital of Ituri Province.“Coping with insecurity, poor governance, and poverty all at once is difficult, and I fear we will also suffer from this deadly epidemic,”says Furaha.

For health workers, the fight against Ebola is therefore not only a medical challenge but also a race against insecurity and limited access to affected communities. Dr Charles Kashindi, head of Nyakunde Hospital, nearly 40km southwest of Bunia, says security problems can force health workers to abandon their positions. “When there are problems, particularly gunfire, nobody can hold their position,” says Dr Kashindi.