Ebola outbreak in eastern DRC: a health crisis amid political and security turmoil

On May 17, 2026, the World Health Organization declared the Ebola outbreak in eastern Democratic Republic of Congo and neighboring Uganda a “Public Health Emergency of International Concern,” followed the next day by the Africa CDC. By June 5, both organizations had launched a joint six-month response plan and appealed for $518 million in funding. Caused by the rare Bundibugyo strain with no approved vaccine or treatment, this 17th outbreak is striking a region already devastated by conflict and destabilized by shifting U.S. aid priorities. How will this epidemic deepen the region’s security and humanitarian vulnerabilities while complicating healthcare access? What risks does it pose to Central Africa’s regional stability? And what does Ebola’s resurgence reveal about the international community’s capacity to handle major health crises? We explore these questions with Fatou Élise Ba, Human Security Program Lead at the Institute for International and Strategic Relations.

Health crisis in a war zone: How Ebola is exacerbating Congo’s multiple crises

This Ebola outbreak arrives in an area already grappling with multiple overlapping crises. As the Democratic Republic of Congo’s 17th Ebola outbreak since 1976—and the first caused by the Bundibugyo strain—it strikes without the benefit of approved vaccines or treatments, with mortality rates approaching 50%. The eastern provinces of North Kivu, South Kivu, and Ituri are particularly vulnerable to epidemic spread. Last year saw one of the worst cholera epidemics in 25 years, while Mpox has been spreading rapidly since September 2023. Ituri, the current epicenter, is one of Congo’s most troubled provinces: poorly connected by roads, plagued by armed group violence, and hosting nearly a million displaced people in overcrowded camps. The health crisis compounds an existing humanitarian and security emergency driven by endemic instability and conflict, particularly since the M23 offensive in 2023.

The daily reality for local populations includes regular displacement and overcrowded conditions in camps that facilitate rapid pathogen spread. Years of systemic violence have deprioritized healthcare and normalized violence against women and children. The arrival of a major epidemic in this already fragile context risks catastrophic consequences for an already strained health system.

Health Minister Samuel-Roger Kamba Mulamba has called Ebola “an absolute emergency.” As of May 31, 2026, Congo reported 282 confirmed cases including 42 deaths, with 19 new positive tests in the previous 24 hours. WHO data from June 1 showed 349 suspected cases under surveillance in Ituri province, particularly in Bunia, Rwampara, and Mongbwalu health zones. Bunia’s main hospital quickly reached capacity, forcing the establishment of peripheral treatment centers. The infection of four healthcare workers offered a glimmer of hope, but by June 5, local sources reported that six health centers in Bunia had temporarily closed for disinfection, further reducing the city’s already strained capacity to handle the outbreak.

This capacity strain disproportionately affects vulnerable groups like pregnant women seeking prenatal care and patients with chronic conditions who receive only minimal treatment before being turned away. The rapid adaptation required from health services disrupts routine care delivery while the outbreak response demands maximum resources.

Government paralysis and armed group control: Who coordinates the response?

The fundamental challenge lies in Kinshasa’s inability to coordinate a coherent response in a region partially controlled by the M23 rebel group and other armed factions operating for extractive purposes. This reflects a longstanding issue: maintaining national unity and basic service delivery across a country of nearly 100 million people. Cases have been reported in M23-controlled areas, but without government coordination with armed groups occupying these territories, epidemic spread continues unchecked. While negotiations may be underway, they haven’t yet established the necessary health coordination framework for an effective response across contested zones.

Two Ebola treatment centers are reportedly being set up in Goma, the M23-controlled provincial capital, but with limited capacity. The rebel group claims to have implemented contingency plans, yet the epidemic continues spreading through rebel-held territories. The fundamental question remains: who controls public health when the state no longer exercises territorial monopoly?

Community resistance further complicates the response, echoing the challenges faced during the 2018-2020 outbreaks. In Rwampara, anti-response demonstrations escalated to the point of incinerating the body of a suspected case. Such resistance stems from cultural practices where families traditionally perform burial rites involving physical contact with deceased loved ones—a practice that precisely drives Ebola transmission. The refusal to return Ebola victims’ bodies to families for traditional rituals is perceived as symbolic violence by communities that have endured decades of state abandonment and perceived predatory external interventions.

This structural suspicion fuels conspiracy theories and turns health responses into perceived instruments of control rather than humanitarian assistance.

Regional spillover: How Ebola threatens Central Africa’s stability

The outbreak occurs against a backdrop of tense relations between Congo and its eastern neighbors, particularly Rwanda, with strained dynamics also evident with Uganda. When an epidemic spreads in a state where portions of territory elude central control—making national coordination difficult—regional and continental responses become essential. Africa CDC has identified ten vulnerable countries that could be affected: South Sudan, Rwanda, Kenya, Tanzania, Ethiopia, Republic of Congo, Burundi, Angola, Central African Republic, and Zambia, in addition to DRC and Uganda where seven cases have already been confirmed.

Epidemics know no borders, and the most vulnerable—particularly the poor—suffer most in regions with porous borders. WHO reports that imported cases from Ituri have reached North Kivu and Kampala, Uganda, where two travelers returning from Congo tested positive, one of whom died. A case has also been reported in South Kivu, according to M23 spokesperson, originating from Kisangani in Tshopo province. These developments prompted border closures and diplomatic tensions, with Uganda suspending flights and passenger transport with Congo on May 21, and Rwanda closing its border with Goma. These unilateral measures further strain already tense bilateral relations.

The outbreak’s spread through rebel-held areas like Goma (captured in January 2025) and Bukavu (taken in February 2025) risks regional escalation. Health thus becomes another arena for Kinshasa-Kigali rivalry, with M23 effectively acting as a de facto public health actor in controlled territories. Facing this cross-border threat, the East African Community has called on member states to activate laboratory networks, strengthen border surveillance, and held an extraordinary ministerial meeting on June 1-2, 2026. Officials committed to harmonizing health controls at entry points without closing borders, creating a regional technical working group for surveillance coordination, and strengthening diagnostic capacities and healthcare worker protection.

International aid in crisis: Can the world respond effectively?

This epidemic arrives as the regional response capacity faces upstream weakening from shifts in U.S. aid architecture. Quadruple cuts implemented since January 2025—withdrawal from WHO, dissolution of USAID, CDC budget reductions, and decreased health aid to Congo and Uganda—have weakened systems vital for responding to epidemic outbreaks. Experts suggest these cuts may have delayed outbreak detection.

Congo has since signed a bilateral agreement with the U.S. under an “America First” approach, transferring some health funding to the State Department through a five-year, $900 million deal with extractive conditionality. This shift from multilateral to transactional bilateralism isn’t fully controlled, as the U.S. response to Ebola appears delayed and outside UN frameworks. The State Department mobilized $23 million in emergency funding and announced support for up to 50 clinics, but hasn’t indicated willingness to support a WHO-led response, breaking from past practices. With the U.S. withdrawal from WHO, the organization’s emergency fund faces operational fragility as other donors struggle to fill the gap left by American retreat.

In this context, the response must be activated by national institutions in affected countries with support from WHO and NGOs, despite reduced means and hostile security environments. WHO, exercising its mandate, declared the outbreak a Public Health Emergency of International Concern and coordinates the response. The European Centre for Disease Prevention and Control has published risk assessments to support coordination, particularly with Africa CDC. On the ground, medical NGOs like Doctors Without Borders and ALIMA have deployed care teams, while the Congolese Red Cross mobilizes volunteers for safe burials, risk communication, and community engagement. However, the humanitarian response remains insufficient to contain the epidemic.

On the continental level, Africa CDC and WHO announced a joint six-month response plan on June 5, 2026, covering June-November 2026, with a $518 million appeal to support African countries in early detection, prevention, and disease control. This “one plan, one budget, one team” approach aims to coordinate efforts under country leadership, involving WHO, Africa CDC, UN agencies, African governments, and international donors. To date, only $315.8 million has been pledged—below even the target for a single coordinated plan.

This hybrid approach reveals structural tensions between bilateral agreements with major donors (particularly the U.S.) and multilateral coordination mechanisms during major crises. The coming months will determine whether this articulation proves sustainable over time.