DRC: The Ebola Response amid Political and Security Instability

On 17 May 2026, the WHO declared that the Ebola outbreak affecting eastern Democratic Republic of the Congo and persisting in Uganda constituted a “public health emergency of international concern”, a declaration followed the next day by Africa CDC (Center for Disease Control and Prevention). On 5 June, the two institutions launched a joint six-month response plan and issued an appeal to mobilise 518 million dollars. Caused by the rare Bundibugyo strain, for which neither an approved vaccine nor treatment exists, this 17th outbreak is affecting a region devastated by conflict and destabilised by the reconfiguration of US aid. This crisis is unfolding in a context already marked by significant instability across the country due to the presence of numerous armed groups and persistent violence. How could this outbreak further aggravate the security and humanitarian vulnerabilities of eastern DRC and complicate access to healthcare for local populations? What risks does it pose to regional balances in Central Africa? Finally, what does the resurgence of Ebola reveal about the international community’s current capacity to respond to major health crises? Analysis by Fatou Élise Ba, researcher at IRIS and coordinator of the Human Security Programme.

Against a backdrop of armed conflict, political instability, and severe economic and social fragility, particularly in eastern Democratic Republic of the Congo, how is the Ebola outbreak affecting internal stability in the areas concerned and complicating the implementation of public health measures capable of guaranteeing access to care?

This new Ebola wave is emerging in an area facing multiple and structural crises. Affecting primarily the Democratic Republic of the Congo, it is the country’s 17th outbreak since 1976 (when the virus was first identified in Yambuku), and this time involves the Bundibugyo Ebola strain. At present, although treatments are undergoing testing, there is neither an approved vaccine nor an approved treatment for this strain, which can prove fatal in one out of every two infections. The eastern regions of the DRC, North Kivu, South Kivu and Ituri, are particularly vulnerable to the spread of epidemics. Last year, the United Nations reported one of the most severe cholera outbreaks in the past 25 years. In addition, since 2020, the spread of Mpox has intensified considerably, particularly since September 2023. Ituri, the epicentre of the outbreak, is one of the most unstable provinces in the DRC, poorly connected by road infrastructure, affected by armed group violence, and home to nearly one million displaced people living in camps. The health crisis therefore overlaps with a pre-existing humanitarian and security crisis. This reflects a context of instability and endemic conflict, particularly intense since the M23 offensive in 2023. Local populations live in a daily climate of insecurity, characterised by repeated internal displacement and overcrowded camp conditions. Combined, these conditions create fertile ground for the resurgence of pathogens and their rapid spread. Moreover, the complex crisis affecting eastern DRC, punctuated only by rare periods of relative calm, has severely weakened both the social fabric and healthcare services, which are currently unable to meet the essential needs of local populations, creating a pattern of structural dependence on Western foreign aid. It should also be noted that the systemic violence generated by successive waves of conflict in eastern DRC has contributed to deprioritising healthcare and normalising violence, particularly against women and children. This is an already precarious environment onto which a large-scale epidemic is now superimposed, further deepening the crisis in a context of security collapse.

The Congolese Minister of Health, Samuel-Roger Kamba Mulamba, stated that “Ebola was an absolute emergency”. According to national data, as of 31 May 2026, there were 282 confirmed cases including 42 deaths, following the recording of 19 new positive tests. For its part, the WHO indicated on 1 June that 349 suspected cases were under surveillance awaiting results, mainly in Ituri Province, and more specifically in the health zones of Bunia, Rwampara and Mongbwalu. Bunia Hospital quickly reached saturation point, making it necessary to establish reception centres on the outskirts of the city and in rural areas. Nevertheless, the recovery of four infected healthcare workers offers a glimmer of hope. As of 5 June 2026, pressure on the healthcare system had intensified further. According to some local sources, around six health centres in Bunia were temporarily closed for disinfection. This measure further reduced the city’s reception capacity and raised particular concern among pregnant women seeking medical consultation, while some patients suffering from other illnesses received only minimal treatment before being redirected or sent home. In addition, as health services adapt rapidly to the spread of Ebola, they are becoming increasingly disrupted, further restricting access to routine care.

What is truly problematic is the lack of a coordinated response from Kinshasa in an area partially occupied by Rwanda’s proxy, the M23, and where numerous armed groups continue to proliferate for extractive purposes. This reflects a recurring structural issue: maintaining national cohesion in a country of nearly 100 million inhabitants and ensuring the effectiveness of basic social and healthcare services. Several cases have also been recorded in areas controlled by the M23. Since the Congolese government has not coordinated the health response with armed groups illegally occupying parts of the territory, the risk of epidemic spread remains fully intact. Although negotiations may reportedly be under way according to some information, they have not yet resulted in the establishment of the health coordination framework required for an effective response in the affected areas. Territorial fragmentation in the east prevents a unified response. Two Ebola treatment centres are reportedly being established in Goma, the provincial capital held by the M23/AFC, although with limited reception capacity, and the armed group claims to have taken stock of the situation and introduced health contingency plans. The outbreak is therefore also advancing in areas controlled by the rebellion. Who, then, governs public health when the State no longer exercises territorial monopoly?

Added to this are forms of community resistance. As during the 2018–2020 episodes, acceptance of the response remains far from guaranteed. An anti-response demonstration in Rwampara escalated to the point that the body of a suspected case was set on fire. Distrust and hostility towards medical teams have become variables of stability in their own right. These forms of resistance are rooted in cultural dynamics. 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 societies across eastern DRC, funeral rituals, particularly washing the body and maintaining physical contact with the deceased, are considered a spiritual imperative. Yet these are precisely among the principal transmission routes of the Ebola virus.

The resentment expressed by populations in Ituri and Kivu is rooted in structural suspicion, inherited from decades of violence, state abandonment and external interventions perceived as predatory. As a result, the health response is easily interpreted as another imposed mechanism of control, feeding rumours and conspiratorial narratives.

Can the Ebola outbreak have lasting consequences for relations between the DRC and its neighbouring countries? To what extent could this crisis undermine regional stability in Central Africa?

From the outset, the situation is one of heightened tension and extractive competition between the DRC and its eastern neighbours, particularly Rwanda, though not exclusively, with relations with Uganda also proving uneven at times. When an outbreak of this nature spreads within a State whose territory is only partially under central control, making coordinated action at national level difficult, the response must necessarily be transregional, if not continental. At present, Africa CDC (Center for Disease Control and Prevention), the AU’s operational health arm for identifying epidemiological hotspots, has indicated that around ten vulnerable countries could potentially be affected by the outbreak: South Sudan, Rwanda, Kenya, Tanzania, Ethiopia, Congo-Brazzaville, Burundi, Angola, the Central African Republic and Zambia, in addition to the Democratic Republic of the Congo and Uganda, which have already recorded seven cases. It should nevertheless be noted that response capacities vary considerably from one country to another. Kenya and Ethiopia possess relatively stronger healthcare and surveillance systems, Kenya having already begun establishing dedicated quarantine facilities, whereas the Central African Republic remains one of the continent’s most fragile states and continues to depend heavily on external assistance. South Sudan, meanwhile, is simultaneously facing a severe internal crisis and the spillover effects of the war in neighbouring Sudan.

By definition, an epidemic does not recognise artificial borders. It affects human beings regardless of status. Some populations remain more vulnerable than others, particularly the poorest, especially in contexts where borders are highly porous. According to the WHO, imported cases originating in Ituri have reached North Kivu as well as Kampala in Uganda, where two travellers returning from the DRC tested positive, one of whom died. Another case was also reported in South Kivu, according to the M23 spokesperson; the patient had arrived from Kisangani, in Tshopo Province. This dynamic has been accompanied by border closures and diplomatic tensions, not to mention potentially significant economic consequences. In response to the risk, Uganda suspended flights and passenger transport links with the DRC on 21 May 2026. Rwanda closed its border with Goma. These unilateral measures directly affect bilateral relations with the DRC, which were already under severe strain.

Added to this is the overlap with the conflict in the east, which directly contributes to the spread of the outbreak. As the epidemic advances into areas such as Goma, captured at the end of January 2025, and Bukavu, which fell in February 2025, fears of wider regional escalation are increasing. Health is therefore becoming an additional arena in the Kinshasa–Kigali rivalry, with the M23 emerging as a de facto public health actor in the territories under its control. Faced with this cross-border risk, the East African Community called on its member states to activate their laboratory networks and strengthen border surveillance, and convened an extraordinary ministerial meeting of Health Ministers on 1 and 2 June 2026. According to official sources, at the conclusion of the meeting, ministers committed to harmonising health controls at entry points without closing borders, establishing a regional technical working group to coordinate surveillance, and strengthening diagnostic capacities and the protection of healthcare workers.

Do health crises such as Ebola reveal the current limits of the international humanitarian aid system, particularly following the removal of USAID funding? What role are international organisations, such as the WHO and NGOs, now playing in managing this crisis?

Combined with a context of regional instability, this outbreak is unfolding at a time when the response risks being weakened upstream by the reconfiguration of the US aid architecture. Cuts specifically affecting health assistance have been fourfold since January 2025: withdrawal from the WHO, dissolution of USAID, reductions at the CDC, and cuts to health aid for the DRC and Uganda, weakening systems that are essential for responding to outbreaks of this nature. Some experts even suggest that 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), within an openly asserted “America First” framework. Part of health funding has been transferred to the State Department under this new agreement, which promises 900 million dollars over five years, reflecting a dynamic of extractive conditionality and a shift away from multilateralism towards transactional bilateralism between the United States and the DRC. More specifically, this reconfiguration, driven by the new US positioning, remains only partially under control, as in the face of this resurgence of Ebola, the American response has proved both delayed and outside the UN framework. At the same time, one can observe a deprioritisation of humanitarian and solidarity-based principles in the way the response to this outbreak is being approached. The priority is first and foremost to protect Americans. The State Department mobilised 23 million dollars in emergency funding and announced support for up to 50 clinics, but following the US withdrawal from the WHO, it did not indicate any intention to support a WHO-led response, marking a departure from previous practice. As the United States has withdrawn from the WHO, the Organisation’s emergency contingency fund (CFE) is consequently operationally fragile, with other donors unable to fill the gap left by the American withdrawal.

In this context, the response must be led by the national institutions of the most affected countries, supported by the WHO and non-governmental organisations, given the level of viral spread, even though their resources have been reduced by the US withdrawal and they are operating in a hostile security environment. The WHO, in accordance with its mandate, declared the outbreak a Public Health Emergency of International Concern (PHEIC) and is coordinating the response. The European Centre for Disease Prevention and Control (ECDC), the European Union’s health agency, published a risk assessment in support of response coordination, particularly with Africa CDC. On the ground, medical NGOs such as Médecins Sans Frontières and ALIMA (The Alliance for International Medical Action) have deployed healthcare teams. Finally, the Red Cross of the DRC has mobilised volunteers to support safe and dignified burials, risk communication and community engagement. Nevertheless, the humanitarian response remains far too limited to contain the outbreak.

On the continental front, Africa CDC and the WHO announced on 5 June 2026 a joint six-month response plan covering the period from June to November 2026 and launched an appeal to mobilise 518 million dollars to support African countries in early detection, prevention and disease control. Built around the operational principle of “one plan, one budget, one team”, promoted by WHO Director-General Tedros Adhanom Ghebreyesus, this plan is intended as a coordinated response led by the affected countries. It is a fundraising appeal built around the WHO, Africa CDC and their partners (UNICEF, UNHCR, WFP, IFRC, FIND), UN agencies, African governments and international donors. At present, only 315.8 million has been pledged, falling short even of the objective of implementing a single coordinated plan.

Moreover, although this co-coordinated plan suggests that initial elements of the response are beginning to be managed at continental level, it also structurally highlights the hybrid strategy adopted by several African states. On the one hand, countries are signing bilateral agreements, particularly with the United States, in the form of donor-conditioned assistance to support health systems and combat infectious diseases; on the other, they are demonstrating their capacity to coordinate in response to a major crisis through multilateral mechanisms. Time will tell whether this articulation proves effective over the long term.