Before Ebola began to spread last April, the health situation in Ituri province in northeastern the Democratic Republic of the Congo (DRC) was already dire, with cholera outbreaks, diarrheal diseases, and thousands displaced from their homes. But what is coming now is a major crisis.
“With a strain for which there are no vaccines or treatments — the Bundibugyo variant — and with the epidemic’s epicenter in a border area with large population movements and zones difficult to access because of conflict, this outbreak is very worrying,” says Lucas Molfino, medical director of the Swiss branch of Médecins Sans Frontières (MSF), whose teams are already working on the ground.
“The tools we have to tackle it are greatly reduced, which forces us back to the essentials: early detection, contact tracing, and diagnostic capacity,” Molfino adds.
The virus is moving quickly and has gone from fewer than a hundred cases to more than 500 in just four days, with 130 deaths. The Congolese government has announced the opening of three treatment centers, where symptoms will be managed until something better is developed. That is why the key now is to break chains of transmission through isolating infected people and ensuring safe burials.
The 2014–2016 Ebola epidemic in West Africa marked a turning point in the response to this disease, which was first identified in 1976. For nearly half a century, outbreaks in more or less remote areas of countries such as Gabon, the Republic of the Congo, the DRC, Uganda, and Sudan followed a familiar pattern: a sharp initial surge in cases, the isolation of patients and communities, and a gradual decline in transmission until the virus weakened or stopped circulating, leaving behind dozens or hundreds of deaths.
However, the 2014 epidemic, which began in Guinea and spread to Liberia, Sierra Leone, and Nigeria, caused more than 28,000 cases and 11,000 deaths. It was then that approved vaccines and treatments were developed — tools that proved crucial in ending that outbreak and those that followed.
At that time, all international efforts focused on the Zaire strain, the most common. The Bundibugyo variant, named for a small Ugandan town where it first appeared in 2007, has caused only three epidemics, including the current one. With a case fatality rate ranging from about 20% to 50%, according to the World Health Organization (WHO), its symptoms are, as with other strains, fever, muscle aches, vomiting, diarrhea, and, in its final stage, internal bleeding. Ebola is endemic in Congo and Uganda, which means there is an epidemiological surveillance system that triggers alerts when cases appear and a network of laboratories to detect the virus. Nevertheless, the outbreak went unnoticed for more than a month.
“The health system in Ituri has its shortcomings, which, combined with the conflict, make epidemiological surveillance difficult,” Molfino says. “We received the first warning signs around May 9 and 10, but by then, 55 people had died since early April. There are hard-to-reach localities and a great deal of population movement. This lack of diagnosis has meant many cases went unreported. Right now, it is very difficult to get a clear picture because the epidemiological situation is changing very rapidly.”
Tracing Ebola to break chains of transmission is detective work that requires enormous logistical effort. Teams must identify everyone who had contact with each patient and monitor them closely for at least 21 days to ensure early detection and isolation if symptoms develop. This becomes even more complicated when several countries are involved and, within a single country, when some areas are controlled by the government and others by armed groups — as is the case in the DRC.
“International coordination has to be extremely tight; no country can handle this alone. In just the first quarter of 2026, more than 100,000 people were displaced by the conflict in Ituri — people who were already living in catastrophic health conditions, with cholera, malaria, diarrhoea, and now Ebola, which severely strains relations with communities because of fear and distrust,” says the medical director of MSF Switzerland.
For all these reasons, planning the response to an Ebola outbreak like this one — which requires thousands of personnel on the ground and a major international effort — must also include strengthening the health system for other conditions. “People keep getting sick, women give birth, we cannot forget all of that,” Molfino explains. “We need to scale up our operational capacity and do it very quickly. Let’s hope the international community is up to the task, because it will be greatly needed. I say this because we are living in a terrible context of cuts to health funding.”
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