In less than five months, the fastest-spreading Ebola outbreak in world history has killed at least 4,205 people in the conflict-ridden eastern region of the Democratic Republic of Congo (DRC) as of October 7.

It is the deadliest outbreak in the DRC since the disease was first discovered in the country in 1976, killing nearly one in two of the 8,728 people confirmed to be infected.

With treatment still in experimental stages, there is no specifically approved treatment for the particular Bundibugyo strain of the Ebola virus that caused this outbreak, declared on May 15.

However, the virus had been circulating in communities in Ituri province since mid-February, three months before the outbreak was identified and officially declared.​

Aid cuts: unpaid frontline workers

When the health response started, already late, it was severely underfunded, as the UK, France and Germany have also followed in the footsteps of the US to slash humanitarian aid and increase military spending.​

The UN Office for the Coordination of Humanitarian Affairs (OCHA) said in late September that the Humanitarian Response Plan had only half the funding needed to counter the outbreak.​

Contact tracing is well below the Africa Centers for Disease Control and Prevention (CDC) and the WHO-recommended 95% to effectively break transmission. Only now in October, it has been built up to 80.4%, which still means that almost 20% of the people at risk of exposure to the virus due to contact with confirmed cases are off the radar of the health authorities, and could potentially be transmitting the disease further.

Lack of funds has meant that the understaffed and overworked frontline health workers – scores of whom have died in the line of duty – have been repeatedly forced to go on strike to protest unpaid wages. Their efforts are further impeded by the poor transport infrastructure and lack of healthcare facilities in the remote eastern region where the disease is spreading.​

Armed conflict complicating health response

Armed conflict displacing millions on this mineral-rich land is another major hurdle in the way of effective health response. In Ituri, the epicenter of the outbreak, a key Ebola transit center in the fighting-affected Kigonze camp burnt down on September 29.​

The camp, which had housed 19,000 Internally Displaced People (IDPs) fleeing violence, was reportedly infiltrated by the Convention for the Popular Revolution (CRP).

Uganda​

This coalition of armed militias, formed in March 2025 at a hotel in Uganda’s capital, Kampala, is led by Thomas Lubanga, a former warlord, convicted by the International Criminal Court (ICC) of war crimes, released from prison in 2020 after serving 14 years. He resides in Uganda, where he is also known to have recruited fighters along ethnic lines.​

In a 2022 judgment, the International Court of Justice (ICJ) ordered Uganda to pay DRC USD 325 million in reparations. This included USD 225 million for killings, rapes, child soldier recruitment, and displacement, USD 40 million for damage to property, and USD 60 million for plundering its gold, diamonds, and timber as an “occupying power” in Ituri from 1998 to 2003.​

The nature of the occupation has since evolved. Under a bilateral agreement with the DRC, Uganda had deployed 2,000 troops to the country to jointly fight an Islamic State-affiliated group. However, Uganda deployed an additional 4,000 troops without the DRC’s consent in early 2025, around the time as the CRP’s formation in Kampala.  ​

Searching for CRP militants and weapons, soldiers and police entered the camp on September 20. When they came under fire, clashes erupted between the security forces and the militants. Thousands of IDPs fled again as gunfire continued rattling around the camp for days. Deaths, injuries, and arrests were reported.​

Ebola transit center burns down

Amid this violence, on September 29, fire engulfed the camp’s Ebola transit center. It is a facility for the isolation and care of suspected cases, until the results of the lab tests on their blood samples. If confirmed as positive, they are then transported to an Ebola treatment center.​

“It’s been a huge struggle to create Ebola transit centers [and] Ebola treatment centers; it’s required money, bringing in staff and it’s been a struggle all across the east. So, when we lose a center, that means we lose capacity, we lose investment and we have to start again,” said Julien Harneis, UN’s senior Ebola response official in the DRC.​

“Eastern DRC now faces a catastrophic collision of disease and conflict, with the Ebola outbreak in Ituri province outpacing the response,” the WHO’s director general, Tedros Ghebreyesus, had warned in May.​

The outbreak has since reached seven of DRC’s 26 provinces, predominantly in the east. About three-quarters of the confirmed cases remain concentrated in Ituri. However, its neighboring province, North Kivu, which has another 20% of confirmed cases, is emerging as the new hotspot.​

Rwanda

Large areas of this province are occupied by Rwandan troops and its proxy militias, the M23, which captured its capital, Goma, in January 2025, and went on to expand territorial control into South Kivu province.

​Without humanitarian access to these occupied areas, the government cannot mount a health response, Communications Minister Patrick Katembwe said in late May, second week after the outbreak was declared. He called for the “withdrawal of foreign forces and the removal of their auxiliaries.”

Instead, the M23’s parallel administration launched a separate health response in the areas under its control, independently of the DRC government, with which cooperation was limited to data sharing and lab testing. This severely hampered contact tracing, especially because people regularly travel between the M23-held areas and government-controlled territory.

“Multiple outbreaks are developing at the same time”

​The parallel M23 administration has also meant additional delays in diagnosis. With bed capacity in Ebola treatment centers stretched taut in North Kivu, medics in this province are forced to refer infected patients to general health facilities, where a third of all confirmed cases are being treated, posing further risk of transmission into the wider community.

​The spread has rapidly increased since September in this province, which now accounts for nearly 40% of all new confirmed cases, up from 24% in August-end, Doctors Without Borders (MSF) said on October 5.

​“It is like fighting a megafire,” said Stéphanie Hoffmann, MSF coordinator of the treatment center in Butembo, a major commercial city in the province. “Multiple outbreaks are developing at the same time, with varying intensity and in different locations. As long as new hotspots continue to emerge while the virus spreads across northern North Kivu, containing the epidemic will remain extremely difficult.”

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