High contact follow-up rates suggest progress, but who is being missed? Inside the DRC’s Ebola response, shortages, strained treatment centers, and gaps in community trust reveal a more complicated story.
On September 10, a man in Sud-Ubangi, northwestern province of the Democratic Republic of the Congo (DRC), tested positive for Bundibugyo virus.1 This was the province’s first recorded case. Before he arrived, he spent the prior 3 weeks traveling from the southeast province of South Kivu, covering hundreds of miles across the country2 (Figure 1). Soon after he arrived, he died. Teams are still working to trace and contact the people he met.
He was infected before anyone knew to look for him.
That is the story of this outbreak captured in one person’s travel history. It is one example of how this virus is showing signs of containment in some areas, while new cases are being recorded in provinces for the first time. The local and international responses over the last 4 months are working, even if they cannot predict where the virus will travel next.
On May 15, when the DRC declared its 17th Ebola outbreak, the official count stood at just 8 cases and 4 deaths.1 Just 18 weeks later, as of September 18, the national total is 7614 confirmed cases and 3676 deaths, a case fatality rate of 48%.3
At this point, this outbreak has recorded nearly 6 times as many cases (Figure 2) and 5 times as many deaths (Figure 3) as the 2014 West Africa outbreak did over the same time frame.1 For context, that historic outbreak ultimately became the largest on record, lasting roughly 27 months and reaching 28,610 cases.4 On September 18, the 63rd health zone was affected in Haut-Uélé, which borders South Sudan.3
Africa CDC reported that 87% of contacts under follow-up were seen on September 15, a figure that held at 88% the following day.1,5 At first glance, this metric reads as success.
Broken down by province, it reads differently. On September 15, Ituri was at 91%, North Kivu at 83%, Haut-Uélé at 81%, Tshopo at 76%, Bas-Uélé at 68%, and Sud-Ubangi at 41%.6 That last figure is 16 people seen out of 39 listed. By September 18, that province had reached 100% (42 of 42.3). On September 16, it was the only affected province to report no alerts.5
Two caveats give that number context. It counts contacts seen in the past 24 hours, not contacts who completed the full 21-day monitoring period.5 And it tells us nothing about the contacts who were never listed.
Africa CDC addresses the second gap directly. Measured against its estimated benchmark of 60 contacts per confirmed case, current follow-up represents about 27% of the expected contact volume.1
We have seen this pattern in the DRC before. During the 2018 to 2020 North Kivu outbreak, an analysis of nearly 130,000 contacts showed that while over 90% were checked on at least once, only 9% finished the full 21-day monitoring period.7 Missed follow-ups were significantly more common in active conflict zones, and contacts in cities had more than twice the odds of incomplete follow-up.7
A successful response relies on having the infrastructure to actively track people across communities, not just on how hard teams are working on the ground.
Read the daily situation reports, and a pattern quickly emerges: breakdowns in payroll, transport, supplies, and institutional capacity.
Payroll and Compensation Failures: North Kivu reports unpaid security personnel guarding health facilities and delayed compensation for first responders.5 In Haut-Uélé, psychosocial support personnel face missing payments,6 while Ituri reports worker demotivation linked to unpaid arrears.5 At one checkpoint, workers went on strike over non-payment.6 The commitment to fix this is on record: an August 5 high-level meeting chaired by President Félix Tshisekedi listed prompt, transparent, and fair payment of salaries, hazard pay, and other entitlements owed to health workers and response staff among its 8 immediate priorities.8
Transport and Mobility Bottlenecks: Transportation shortages severely limit the ability of multiple provinces to deploy personnel and essential supplies to high-priority areas. Tshopo faces a critical shortfall of motorcycles, and a lack of transport forced the cancellation of scheduled vaccination sessions in the province.5 Similar mobility constraints prevent the deployment of provincial infection prevention and control (IPC) teams in North Kivu, as well as psychosocial support staff in Haut-Uélé,5. At the same time, impassable roads delay humanitarian responses in parts of Bas-Uélé.6
Supply Chain Breakdowns: Ituri reported a lack of personal protective equipment (PPE).6 Elsewhere in the province, a lack of testing supplies and personnel, combined with family refusal, prevented post-mortem Ebola testing on 10 deceased individuals.6 In Haut-Uélé, outreach teams have exhausted all communication materials across every affected health zone.5 Concurrently, Tshopo lacks a secure blood supply, while Bas-Uélé operates without a dedicated treatment center or patient transport ambulance.5
Institutional Vulnerabilities: Systemic weaknesses across field security, data infrastructure, community trust, and essential support services are severely restricting where and how the response operates. Security threats directly reduce response coverage across affected areas. These risks range from insecurity preventing the opening of a key checkpoint in Ituri to active intimidation of health workers in North Kivu.5 Simultaneously, network connectivity losses and hardware failures cripple real-time surveillance, leaving South Kivu with only 5 of its 9 expected reports submitted5 and 4 Haut-Uélé checkpoints fully off the grid.6
Together, these persistent barriers demonstrate that frontline teams are struggling against larger systemic constraints rather than temporary logistical delays.
Currently, Ituri accounts for more than 75% of all confirmed cases in this outbreak. The good news is that it has 1015 treatment beds. With 434 occupied on September 18, bed occupancy is a manageable 43%.3
However, North Kivu has only 228 beds in standard treatment structures, and 224 were occupied on September 18, an occupancy rate of 98%. Of its 392 hospitalized patients, roughly 40% were being cared for outside standard structures.3 In fact, there are no open beds at all in Butembo or Katwa.3
Here is the conflict: the response-built capacity where the outbreak was, but the outbreak moved.
Two health zones in North Kivu now carry most of the province's outbreak. As of September 18, Butembo and Katwa accounted for 789 of North Kivu's 1388 confirmed cases and 503 of its 843 deaths, meaning more than half of the province's total cases and deaths come from these 2 areas alone.3
The impact compounds with each new patient because Butembo is also one of the province's largest cities, with roughly 670,000 residents.9 In a village, a sick person's contacts are mostly family sharing the same home. In a city, those contacts multiply across neighbors, coworkers, and everyday public interactions. Consistent with this, during the 2018 to 2020 Ebola outbreak, contacts in urban health zones had more than twice the odds of falling out of follow-up.7
Between August 24 and September 13, nearly 70% of deaths occurred in the community rather than in a treatment center, up from roughly 50% at the end of June.1 Deaths among children under 5 increased 15% over the prior period.1 Community deaths are patients who died outside a treatment center, whether or not they were seen elsewhere first. A death at home means someone was caring for them when the virus was most contagious. In a prior Ebola outbreak, it was estimated that primary caregivers were roughly 2.6 to 6 times more likely to become infected than people whose only contact came after death, and 46% of contacts had both kinds of exposure.10
On the ground, this resistance takes a clear shape: a confirmed patient in Tshopo left a treatment center and stayed home; people exposed to another case refused to be listed as contacts; families declined post-mortem testing for loved ones; and poor experiences at a North Kivu treatment center added to community resistance.5,6
New treatment capacity is under construction, but none of it comes with an opening date. In North Kivu, the Ministry lists continued construction of a treatment center at a provincial referral hospital, with neither capacity nor a completion date reported.3 Doctors Without Borders (MSF) already runs a 30-bed treatment center in Butembo and isolation units at 2 hospitals there, including the hospital where the new center is going up.11 In Tshopo, construction of an isolation facility and a treatment center was underway in mid-September.5,6 MSF also operates a 12-bed isolation unit in Tshopo's provincial capital and is building a 20-bed treatment center there.11 In Haut-Uélé, the province's treatment center has stalled: the Ministry reported the work was still suspended on September 16, with no reason given.5
The community side of the response is being rebuilt around villages. The first of the August 5 meeting's priorities was a village-centered response, with traditional and religious leaders, women's and youth organizations, community health workers, and survivors sharing leadership of prevention, early alerts, contact follow-up, referral, and safe burials.8 Under the plan, each affected village chooses its own community health workers, who are to be trained, equipped, supervised, and paid to report alerts, support contact follow-up, encourage early referral, explain vaccination, support safe burials, and carry community concerns back to the response.12
The stated goal is a village-by-village reset that recovers missed transmission chains and produces a complete, verified contact list.12 In recommendations presented at the September 17 briefing, Africa CDC's Emergency Consultative Group called for strengthening this approach through village chiefs and community health workers.1
Africa CDC officials also said the plan targets more than 70,000 community health workers, requires roughly $100 million, and aims to list at least 50 contacts for every confirmed case.1
The early numbers are uneven. On September 18, home visits in Ituri reached 81,306 people, although fewer than half of the province's 28 health zones submitted data.3 In North Kivu, community alerts reached 300 of the 450 expected, and a dialogue with 104 opinion leaders focused on welcoming a survivor home. Yet, only a quarter of the residents targeted for engagement were reached.3 In Sud-Ubangi, community teams made 358 home visits reaching 1790 people and supported the surveillance, laboratory, IPC, and burial teams working around a community death.3
One confirmed case. One death. Thirty-nine contacts listed, 16 of them seen on September 15.6 By September 18, all 42 listed contacts had been seen, and samples from 2 community deaths in the province were awaiting results.3
That single travel history from South Kivu to Sud-Ubangi is a stark reminder of what is at stake. Behind every daily situation report, percentage point, and missing payroll transfer is a frontline worker trying to trace a moving target, or a family deciding whether to trust a treatment center. The containment strategies, community health deployments, and international funds moving through the DRC are vital, but they are racing against time, geography, and human movement. Until the response can reliably support the people on the ground, from village chiefs to mobile contact tracers, the story of this outbreak will continue to be written one unmonitored journey at a time.
References
1. Press briefing on health emergencies: Ebola outbreak in the Democratic Republic of the Congo. Africa CDC. YouTube. September 17, 2026. Accessed September 19, 2026.
2. Ebola outbreak in Congo spreads to a 7th province. Associated Press. Updated September 11, 2026. Accessed September 19, 2026.
3. de situation de la 17ème épidémie de la maladie à virus Ebola/RDC. Institut National de Santé Publique, Task Force Présidentielle Ebola 17. Rapport SitRep No. 127. September 18, 2026. Accessed September 19, 2026.
4. History of Ebola outbreaks. CDC. Last reviewed May 29, 2026. Accessed September 17, 2026.
5. Rapport de situation de la 17ème épidémie de la maladie à virus Ebola/RDC. Institut National de Santé Publique, Task Force Présidentielle Ebola 17. SitRep No. 125. September 16, 2026. Accessed September 17, 2026.
6. Rapport de situation de la 17ème épidémie de la maladie à virus Ebola/RDC. Institut National de Santé Publique, Task Force Présidentielle Ebola 17. SitRep No. 124. September 15, 2026. Accessed September 17, 2026.
7. Ngalamulume W, Kayembe HC, Mutombo G, Mossoko M, Mutombo A, Bompangue D. Evaluation of contact tracing performance during an Ebola virus disease outbreak in a complex security environment: the case of North Kivu province, Democratic Republic of the Congo, 2018-2020. Confl Health. 2025;19:12. doi:10.1186/s13031-025-00650-8
8. Africa CDC welcomes President Tshisekedi's direction and guidance for a village-centered, accountable and intensified response to the Ebola Bundibugyo outbreak in the Democratic Republic of the Congo. Africa CDC. August 6, 2026. Accessed September 20, 2026.
9. Vinck P, Pham PN, Bindu KK, Bedford J, Nilles EJ. Institutional trust and misinformation in the response to the 2018-19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. Lancet Infect Dis. 2019;19(5):529-536. doi:10.1016/S1473-3099(19)30063-5
10. Tiffany A, Dalziel BD, Kagume Njenge H, et al. Estimating the number of secondary Ebola cases resulting from an unsafe burial and risk factors for transmission during the West Africa Ebola epidemic. PLoS Negl Trop Dis. 2017;11(6):e0005491. doi:10.1371/journal.pntd.0005491
11. Ebola disease outbreak 2026: how MSF is responding. Doctors Without Borders. Accessed September 20, 2026.
12. Africa CDC supports the immediate implementation of the DRC Government's decisions to control the 2026 Bundibugyo Ebola emergency. Africa CDC. August 10, 2026. Accessed September 20, 2026.
