DRC: One month on, MSF warns dangerous gaps persist in Ebola disease response

Key Takeways

• The officially reported numbers (over 650 confirmed cases and 130 deaths) likely underestimate the true scale of the outbreak due to surveillance and testing gaps.
• Uganda has also reported confirmed cases, highlighting the risk of regional spread.
• Most treatment centres in affected areas are overwhelmed. Routine healthcare services (maternal care, vaccinations, malaria, and cholera treatment) are also critically needed and support surveillance efforts.

Overview

One month after the Ebola disease outbreak was declared in the Democratic Republic of Congo (DRC), Doctors Without Borders (MSF) warns that despite the recent scale-up in the response, major gaps in surveillance, diagnosis, contact tracing and community engagement continue to undermine efforts to bring the outbreak under control. A response that is proportionate to the scale of the outbreak is urgently needed.

“One month on, the Ebola disease outbreak is outpacing the response effort,” says Kate White, emergency medical coordinator for MSF in DRC. “No one knows the true scale or exactly where the disease is spreading in DRC. What we do know is that most treatment centres in Ituri province are overwhelmed; many of our patients arrive at a late stage of the disease, and the majority were never identified or monitored as contacts before seeking care.” 

Ebola cases in North Kivu and South Kivu

The disease is spreading across Ituri, North Kivu, and South Kivu provinces in eastern DRC, with Ituri accounting for nearly 95 per cent of the cases. The response, led by the Congolese Ministry of Health and supported by several international partners, is being put in place in the affected areas. Unfortunately, insecurity makes reaching certain communities difficult, and even in more stable areas, efforts to detect cases, test patients, identify contacts, and monitor transmission are insufficient. In neighbouring Uganda, 19 confirmed cases have also been reported by the health authorities. 

Congolese health authorities officially reported more than 650 confirmed cases and over 130 deaths. However, MSF warns that these figures likely represent only part of the picture. 

Response constraints

“Testing remains one of the most significant weaknesses in the response, despite recent improvements in laboratory capacity and the arrival of hundreds of mobile test kits in eastern DRC, designed specifically for the Bundibugyo virus,” says White. “Many communities, especially those affected by ongoing insecurity, still have limited access to these kits, while treatment centres continue to face significant delays in receiving laboratory results. Without faster and more widely available testing, we will struggle to detect cases early enough to contain the outbreak.” 

Limited Access to healthcare 

In areas where the outbreak is unfolding, millions of people have already been living with decades of active conflict, repeated displacement, chronic gaps in healthcare, and a limited humanitarian response. These conditions severely hamper response efforts and create an environment in which the disease can spread more easily.  

In Ituri, where MSF has been present for decades, we have observed fear and mistrust among communities, with some being wary of the sudden arrival of Ebola response teams.

Challenges in Surveillance, Testing, and Healthcare Delivery

“Setting up activities and explaining the disease is not enough to build community trust -   people’s concerns need to be listened to, and communities should help shape the response,” says Frederic Lai Manantsoa, emergency coordinator for MSF in DRC.

For many communities, the outbreak is just one of several health emergencies that have been inadequately addressed for years. Maintaining access to routine healthcare is just as important as controlling the outbreak itself to save lives.  

“Pregnant women still need maternal care, children still need vaccinations, and patients still need treatment for malaria and cholera,” says White. “Maintaining access to routine healthcare also helps support Ebola disease surveillance among communities.”

Although the number of confirmed cases reported in North Kivu and South Kivu is relatively low, they face many of the same challenges around surveillance and testing. In North Kivu, there is only one laboratory to test blood samples, and they take several days to process. Since there is no automated system for sending them to healthcare facilities, it can sometimes take almost a week to get results.  

Expanding Outreach to Remote and Insecure Areas

Alongside direct patient care, MSF is also sending teams to more remote and insecure areas to strengthen detection and response capacity where alerts have been reported.  

“This outbreak can still be brought under control, but the window for action is narrowing,” says  Lai Manantsoa. “Diagnostics, surveillance, access to care, and community engagement must be urgently strengthened. We urge authorities, and all stakeholders involved in the response, to do everything possible to facilitate the movement of health workers and supplies, and enable a response that matches the scale of this crisis.” 

What comes next

As cases continue to rise, and with the response still ramping up, the coming weeks will be critical for strengthening care capacity, accelerating testing, and maintaining access to essential healthcare in affected areas.

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