The violence is forcing people to flee, including health workers themselves
In the Ituri province of the Democratic Republic of Congo, a centuries-old truth is reasserting itself: disease and disorder are ancient allies. More than 900 suspected cases of Ebola — 101 confirmed as the Bundibugyo strain — have emerged among a population of nearly five million already fractured by armed conflict and displacement. The World Health Organization, which declared an international public health emergency on May 16, warns that as long as violence drives people from their homes and health workers from their posts, the virus will find every opening that fear and mistrust leave behind.
- An Ebola outbreak carrying a roughly 50 percent fatality rate is accelerating through a conflict zone where one in five residents has already been forced to flee their home.
- Armed fighting in Ituri province is dismantling the very infrastructure needed to fight the disease — contact tracers cannot work, health workers are evacuating, and surveillance is collapsing.
- Communities fractured by violence have lost trust in authorities and health workers, allowing the virus to exploit silence: people hide symptoms, avoid clinics, and unknowingly spread infection.
- The WHO escalated its national risk assessment to 'very high' just six days after declaring an international emergency, signaling that the outbreak's trajectory is worsening faster than the response can stabilize it.
- Humanitarian partners are maintaining a presence in the most dangerous and remote areas of Ituri, betting that consistent, comprehensive care — not Ebola treatment alone — is the only path to rebuilding the trust an effective response requires.
The Democratic Republic of Congo is fighting two crises simultaneously. In Ituri province, home to nearly five million people, an Ebola outbreak has surpassed 900 suspected cases, with 101 confirmed to carry the Bundibugyo virus. But the disease is only part of the story — armed conflict is tearing apart the very systems needed to contain it.
WHO Director-General Tedros Adhanom Ghebreyesus described the dynamic plainly: fighting forces civilians to flee, and health workers follow. When they go, contact tracing collapses, early detection fails, and people die without the supportive care that might have saved them. One in four residents of Ituri needs humanitarian assistance; one in five has been internally displaced. These are people already pushed to the edge, now facing a virus with a fatality rate near 50 percent.
On May 16, Tedros declared the outbreak a public health emergency of international concern. Six days later, the WHO raised its national risk assessment to 'very high.' The Bundibugyo virus spreads through direct contact with blood and bodily fluids — conditions that crowded displacement camps and fractured communities make nearly ideal for transmission.
The WHO and its partners have held their ground even in Ituri's most dangerous and inaccessible areas. But Tedros was clear that presence is not enough. Delivering a full spectrum of healthcare — addressing all the diseases ravaging the province, not just Ebola — is the only way to rebuild the community trust that any outbreak response ultimately depends on. Without that trust, people conceal symptoms, avoid clinics, and the virus advances unchallenged.
The DRC has confronted Ebola before and built real expertise in containment. But expertise requires stable ground to stand on. The violence in Ituri is not a backdrop to this outbreak — it is its engine. Until conflict eases, until displaced populations can return, until health workers can move freely and be welcomed, the numbers will keep rising.
The Democratic Republic of Congo is fighting two crises at once. In Ituri province, where nearly five million people live, an Ebola outbreak has grown to more than 900 suspected cases, with 101 of those confirmed to carry the Bundibugyo virus. But the numbers alone don't capture what's happening on the ground. The province is also gripped by armed conflict, and that violence is making it nearly impossible to stop the disease from spreading.
WHO Director-General Tedros Adhanom Ghebreyesus laid out the problem plainly in a statement this week: the fighting is forcing people to flee their homes and communities. Health workers and humanitarian staff are leaving too. When they go, the machinery of disease control goes with them. Contact tracing—the painstaking work of finding everyone who touched an infected person and monitoring them for symptoms—becomes impossible. Early detection fails. People don't get the supportive care that might save their lives.
The human toll is staggering. One in four people in Ituri province needs humanitarian assistance. One in five has been internally displaced by the violence. These are not abstract statistics. They describe a population already fractured, already struggling, now facing a virus with a fatality rate around 50 percent. Fear and mistrust are spreading as fast as the disease itself. Communities don't trust the authorities or the health workers trying to help them, and that distrust is a weapon the virus can use.
On May 16, Tedros declared the outbreak a public health emergency of international concern. Six days later, the WHO escalated its risk assessment to "very high" at the national level. The regional risk remains "high," and globally it's still assessed as "low"—for now. But the trajectory is clear. The Bundibugyo virus spreads through direct contact with blood, bodily fluids, and contaminated materials. In a conflict zone where people are crowded together, fleeing, displaced, and unable to access reliable healthcare, those conditions are ideal for transmission.
The WHO and its humanitarian partners have maintained a presence even in the hardest-to-reach and most insecure areas of Ituri. That presence matters. But presence alone is not enough. Tedros emphasized that delivering a full package of healthcare services is essential—not just to treat Ebola, but to address the other diseases ravaging the province and, crucially, to rebuild the trust that any effective response depends on. Without trust, people hide their symptoms. Without trust, they avoid health facilities. Without trust, the virus wins.
This outbreak carries echoes of the 2014-2016 West African epidemic, which killed thousands and spread across borders. That outbreak was the largest Ebola event since the virus was first identified in 1976. The DRC has faced Ebola before and has developed expertise in containment. But expertise means nothing if the ground beneath it is collapsing. The violence in Ituri is not incidental to this outbreak. It is the outbreak's accelerant. Until the conflict is addressed, until displaced people can return home, until health workers can move freely and communities can trust them, the numbers will keep climbing.
Citações Notáveis
The violence is forcing people to flee, including health and humanitarian workers. This is severely impeding efforts to scale up Ebola contact tracing and identify infections early enough to provide supportive care.— WHO Director-General Tedros Adhanom Ghebreyesus
Delivering a comprehensive package of healthcare services is essential—not only to meet urgent health needs, but also to build the trust that is critical for an effective Ebola response.— WHO Director-General Tedros Adhanom Ghebreyesus
A Conversa do Hearth Outra perspectiva sobre a história
Why is conflict making this outbreak so much harder to control than previous ones?
Because you can't trace a disease if the people carrying it are running from bullets. Contact tracing requires trust, access, and stability. Conflict destroys all three. Health workers flee. Communities hide. The virus moves through the chaos.
The WHO says one in five people in Ituri are internally displaced. That's a massive number. What does that actually mean for disease spread?
It means people are packed into camps and transit routes with minimal sanitation, no medical screening, and constant movement. It's the perfect environment for a virus that spreads through bodily fluids. One infected person in a displacement camp can infect dozens.
The fatality rate is around 50 percent. Is that the worst-case scenario, or is it typical?
It's actually the average. Past outbreaks have ranged from 25 to 90 percent. So this virus is reliably deadly, but the outcome depends heavily on whether people get supportive care early. In a conflict zone, early care is almost impossible.
What does "building trust" actually require in a place like Ituri?
It requires showing up consistently, treating other diseases alongside Ebola, and proving you're not there to harm people. In a conflict zone, that's extraordinarily difficult. But without it, people won't come forward when they're sick. They'll hide, and the virus spreads invisibly.
Is there any precedent for controlling an Ebola outbreak in an active conflict zone?
Not really. The 2014-2016 outbreak was massive, but it wasn't in an active war. This is new territory. The DRC has experience with Ebola, but not like this.