Ebola epidemic in eastern DRC: how conflict and instability undermine the health response

On 17 May 2026, the World Health Organization declared the Ebola outbreak in eastern Democratic Republic of the Congo, which has also spread to Uganda, a public health emergency of international concern, followed the next day by the Africa CDC. On 5 June, both institutions launched a joint six-month response plan and appealed for $518 million. Caused by the rare Bundibugyo strain—for which there is no licensed vaccine or treatment—this 17th epidemic is hitting a region devastated by conflict and destabilised by the reshaping of US aid. The crisis unfolds against a backdrop of deep instability driven by numerous armed groups and persistent violence. How might this epidemic worsen the security and humanitarian fragilities in eastern DRC and complicate access to care? What risks does it pose to regional stability in Central Africa? Finally, what does the resurgence of Ebola reveal about the international community’s current capacity to respond to major health crises? An expert interview sheds light on these questions.

In a context marked by armed conflict, political instability, and severe economic and social fragility, especially in eastern DRC, how does the Ebola epidemic affect the internal stability of affected areas and complicate the establishment of health systems that ensure access to care?

This new Ebola wave hits a zone of multiple, structural crises. Mainly affecting the DRC, it is the 17th epidemic since 1976 (when the virus was first identified in Yambuku), and this time it is the Ebola Bundibugyo strain. Currently, even though some treatments are being tested, there is no licensed vaccine or treatment for this strain, which can kill one in every two people infected. The eastern regions—North Kivu, South Kivu, and Ituri—are especially vulnerable to epidemic spread. Last year, the UN reported one of the worst cholera outbreaks in 25 years. Since September 2023, Mpox has also been spreading massively. Ituri, the epicentre of the Ebola epidemic, is one of the most troubled provinces in the DRC, with poor road access, widespread armed-group violence, and nearly one million displaced people crammed into camps. The health crisis is thus superimposed on a pre-existing humanitarian and security crisis. This results from a context of endemic instability and conflict, particularly intense since the M23 offensive in 2023. Local populations live in daily instability, marked by regular internal displacement and overcrowded camps. Together, these conditions favour the resurgence of pathogens and their rapid spread. Moreover, the complex crisis in eastern DRC—with few periods of calm—has severely weakened the social fabric and health services, which can no longer meet the vital needs of local populations, creating a structural dependence on Western foreign aid. It is worth noting that the systemic violence from repeated waves of conflict in eastern DRC has deprioritised health and normalised violence, especially against women and children. A precarious context into which a large-scale epidemic now inserts itself, worsening the crisis amid a security collapse.

The Congolese health minister, Samuel-Roger Kamba Mulamba, stated that “Ebola is an absolute emergency.” According to national data, as of 31 May 2026, there were 282 confirmed cases including 42 deaths, after 19 new positive tests. The WHO indicated on 1 June that 349 suspected cases were under surveillance awaiting results, mainly in Ituri province, particularly in the health zones of Bunia, Rwampara, and Mongbwalu. Bunia hospital quickly became overwhelmed, forcing the setup of reception centres on the outskirts and in rural areas. Nevertheless, the recovery of four infected healthcare workers offers hope. By 5 June 2026, pressure on the healthcare system had further intensified; local sources say about six health centres in Bunia were temporarily closed for disinfection. This measure reduces the city’s capacity and particularly worries pregnant women coming for consultations, as some patients with other conditions received only minimal care before being redirected or sent home. Furthermore, faced with Ebola’s spread, health services had to adapt quickly, becoming disorganised and restricting access to routine care.

What is truly problematic is the lack of coordinated response from Kinshasa in a zone partially occupied by the Rwandan proxy M23, where many armed groups proliferate for extractive reasons. Here we see the recurring problem of national unity control in a country of nearly 100 million people and the effectiveness of basic social and health services. In areas controlled by the M23, several cases have also been counted. Since the Congolese government has not coordinated the health response with the armed groups illegally occupying the territory, the risk of epidemic spread remains high. While negotiations may be ongoing according to some information, they have not yet established the health coordination framework needed for an effective response in the area. Territorial fragmentation in the east prevents a unified response. Two Ebola treatment centres are reportedly being set up in Goma, the M23/AFC-held capital, with limited capacity, and the armed group claims it has taken the measure of the situation and put in place health contingency plans. The epidemic is thus also progressing in rebel-held areas. Who pilots public health when the state no longer has the territorial monopoly?

Added to this are community resistances, as during the 2018-2020 episodes; acceptance of the response is far from guaranteed. An anti-response protest in Rwampara degenerated to the point of incinerating the body of a suspected case. Mistrust and hostility toward medical teams are stability variables in their own right. Community resistances stem from a cultural logic. The refusal of health authorities to return the bodies of people who died from Ebola to their families is experienced as unbearable symbolic violence. In eastern DRC societies, funeral rituals—especially washing the body and physical contact with the deceased—are a spiritual imperative. Yet these practices are one of the main transmission vectors for the Ebola virus. The resentment of Ituri and Kivu populations is rooted in a structural suspicion inherited from decades of violence, state abandonment, and external interventions perceived as predatory. Thus, the health response is easily seen as a new form of imposed control, fuelling rumours and conspiracy theories.

Can the Ebola epidemic have lasting consequences on relations between the DRC and its neighbouring countries? To what extent might this crisis destabilise regional stability in Central Africa?

From the outset, we are in a situation of high tension and extractivist competition between the DRC and its eastern neighbours, particularly Rwanda but not only, with sometimes strained relations with Uganda. So, when an epidemic of this type spreads in a state where part of the territory escapes central control, making a coordinated national response difficult, the response must be transregional, even continental. Currently, the Africa CDC, the operational health arm of the African Union for identifying epidemiological hotspots, has indicated that about ten vulnerable countries could be affected: South Sudan, Rwanda, Kenya, Tanzania, Ethiopia, Congo-Brazzaville, Burundi, Angola, the Central African Republic, and Zambia, in addition to the DRC and Uganda, which already have seven cases. However, response capacity varies greatly from country to country. Kenya and Ethiopia have relatively stronger health and surveillance systems—Kenya has already begun setting up dedicated quarantine facilities—while the Central African Republic remains one of the continent’s most fragile states heavily dependent on external aid. South Sudan combines a severe internal crisis with the repercussions of the war in neighbouring Sudan. By definition, an epidemic knows no artificial borders; it affects living beings regardless of status. Some are more vulnerable than others, especially the poorest, particularly where borders are extremely porous. According to the WHO, imported cases from Ituri have reached North Kivu and Kampala, Uganda, where two travellers returning from the DRC tested positive, one of whom died. A case was also reported in South Kivu, according to an M23 spokesman; the patient had come from Kisangani in Tshopo province. This dynamic is accompanied by border closures and diplomatic tensions, not to mention major economic consequences. Faced with the risk, Uganda suspended flights and passenger transport with the DRC on 21 May 2026. Rwanda closed its border with Goma. These unilateral measures hit already extremely strained bilateral relations with the DRC. Add the entanglement with the conflict in the east, which directly contributes to the epidemic’s spread. The outbreak progressing in areas like Goma—taken in late January 2025—and Bukavu—fallen in February 2025—raises fears of a regional conflagration. Health thus becomes another battleground in the Kinshasa-Kigali rivalry, with the M23 imposing itself as a de facto public health actor in the territories it controls. Facing this cross-border risk, the East African Community called on its member states to activate laboratory networks and strengthen border surveillance, and held an extraordinary ministerial meeting of health ministers on 1-2 June 2026. According to official sources, the ministers committed to harmonising health checks at points of entry without closing borders, creating a regional technical working group to coordinate surveillance, and strengthening diagnostic capacities and healthcare worker protection.

Do health crises like Ebola reveal the current limits of the international humanitarian aid system, especially following the dismantling of USAID funding? What role do international organisations like the WHO and NGOs play in managing this crisis?

Added to a context of regional instability, this epidemic arrives at a time when the response risks being weakened upstream by the reshaping of the US aid architecture. Cuts specifically targeting health aid were “quadripartite” from January 2025: withdrawal from the WHO, dissolution of USAID, reductions at the CDC, and decreased health aid to the DRC and Uganda, weakening vital systems to respond to such outbreaks. Some experts even believe these cuts may have delayed detection of the epidemic. Today, the DRC has concluded a bilateral agreement with the United States (as have Rwanda and Uganda), in a stated “America First” logic. Part of the health funding has been transferred to the State Department through this new agreement, promising $900 million over five years, in a dynamic of extractive conditionality and a shift from multilateralism to transactional bilateralism between the US and the DRC. More precisely, this reshaping, driven by the new US stance, is not fully under control; in the face of this Ebola resurgence, the US response is late and outside the UN framework. Moreover, there is a deprioritisation of humanitarian and solidarity principles in the way the response to this epidemic is approached. The objective is first to protect Americans. The State Department mobilised $23 million in emergency funding and announced financing for up to 50 clinics, but because of the WHO withdrawal, it has not indicated it wants to support a WHO-led response, breaking with past practices. With the US out of the WHO, the organisation’s emergency fund (CFE) is operationally fragile, as other donors cannot fill the gap left by the US withdrawal. In this context, the response must be activated by national institutions of the most affected countries, with support from the WHO and NGOs, given the level of virus spread, even as their resources have been reduced by the US withdrawal and they operate in a hostile security environment. The WHO, as per its mandate, declared the epidemic a public health emergency of international concern and coordinates the response; the European Centre for Disease Prevention and Control (ECDC) published a risk assessment to support response coordination, notably with the Africa CDC. On the ground, medical NGOs such as Médecins Sans Frontières and ALIMA have deployed care teams. Finally, the Red Cross of the DRC mobilises volunteers for dignified and safe burials, risk communication, and community engagement. Nevertheless, the humanitarian response remains far too limited to contain the epidemic. On the continental response side, the Africa CDC and the WHO announced on 5 June 2026 a joint six-month response plan covering June to November 2026 and appealed for $518 million to support African countries in early detection, prevention, and control of the disease. Structured around the operational principle “one plan, one budget, one team” advocated by WHO Director-General Tedros Adhanom Ghebreyesus, this plan aims for a coordinated response under the leadership of affected countries. It is a funding appeal relying on the WHO, Africa CDC, and their partners (UNICEF, UNHCR, WFP, IFRC, FIND), UN agencies, African governments, and international donors. So far, only $315.8 million have been pledged, short of even the objective of a single coordinated plan. Moreover, while this co-coordinated plan shows that preliminary response elements appear to be managed at the continental level, it also structurally highlights a hybrid strategy by several African states. On one hand, countries sign bilateral agreements, especially with the US, as conditional aid from donors to support their health systems and fight infectious diseases; on the other, they demonstrate their ability to coordinate in the face of a major crisis through multilateral mechanisms. Time will tell if this articulation bears fruit.