The deadly Ebola outbreak in the eastern part of the Democratic Republic of the Congo (DRC) continues to spread, with a spike in child infections becoming increasingly likely in the coming days, according to a warning issued by United Nations agencies on Friday. Since the outbreak was confirmed less than a month ago, more than 670 cases and 130 deaths have been reported.
“Every day, cases are being identified in new health zones. And that reflects really the scale of this outbreak, a scale that is much bigger than what is being detected and the high mobility of the population in this part of the DRC,” said Olivier le Polain, Unit Head for Epidemiology and Analytics for Response at the World Health Organization (WHO).
In the approximately three weeks since the fast-moving outbreak was confirmed, the DRC health authorities have reported 676 cases and 136 deaths from the rare and deadly Bundibugyo species of Ebola virus.
Infections have been identified across an area stretching from Aru in northern Ituri Province to Miti Murhesa in South Kivu — a distance of roughly 1,000 kilometers.
“And we have 34 health zones affected as of yesterday, so, those health zones [with Ebola] continue to expand, with new areas in North Kivu which also reported [cases] yesterday,” le Polain told journalists in Geneva, via video from Beni.
Those leading the response are increasingly concerned about a potential surge in the number of children infected and killed by the outbreak. Many of these children are malnourished and unvaccinated, leaving them extremely vulnerable to disease in this resource-rich region already experiencing a humanitarian crisis caused by decades of fighting between government forces and armed militias.
While most infections thus far have been among adults going about their daily lives, Douglas Noble, UNICEF Global Lead for Public Health Emergencies and Global Incident Manager for Ebola, warns that "as the outbreak evolves, we must be prepared for increasing household transmission, which means we may see more children affected in the days ahead."
“The point is, these are already very vulnerable children, so the capacity for this community to absorb any additional stressors was already stretched to breaking point,” he said, noting that more than half of children under five in Ituri are “chronically malnourished”. More than one in five are also “zero dose” children, meaning that they have never had their first dose of diphtheria, tetanus and pertussis vaccine.
Estimating the number of children who may be affected is problematic because sufficient surveillance tracking data is not yet available.
The Ebola response focuses on case management, operating treatment centers, delivering essential medicines and supplies, community engagement, risk communication, and strengthening surveillance. However, response efforts continue to face significant challenges, including gaps in contact tracing, limited treatment capacity, and shortages of essential medicines. To contain the virus, a major push for early testing and contact tracing is underway.
Significant logistical obstacles remain, particularly in remote locations with limited connectivity. In these areas, samples may take up to eight hours to reach a laboratory. Given the vast size of the affected region—Ituri, North Kivu, and South Kivu combined cover an area roughly the size of France—the process can take up to 24 hours for communities farther from testing facilities.
Past Ebola outbreaks in the DRC have shown that children make up a significant proportion of cases and an even greater proportion of deaths. The youngest children face the highest fatality rates, and the outbreak leaves many of them orphaned or separated from their caregivers, Noble explained.
As part of its six-month response plan to assist 3.7 million people, the UN agency has dispatched eight transport flights carrying over 100 tons of emergency humanitarian supplies to DRC with the support of the European Union. The emergency cargo includes personal protective equipment for frontline health workers, medicines, hygiene materials, and medical supplies to combat the virus in affected communities.
Other UN agencies are also scaling up their support in DRC and neighboring Uganda. The International Organization for Migration (IOM) and the UN Refugee Agency (UNHCR) are assisting with risk communication, border screening, surveillance, and services in refugee settings. Meanwhile, the World Food Programme (WFP) has transported 33 metric tons of relief supplies to Bunia, the capital of Ituri Province.
Although Ebola can be lethal, it transmits differently from how SARS-CoV-2 does, commonly via body fluids. Thus, children who can go to school should continue to do so, the UNICEF official stressed.
“There's no reason for a school to close. Infection prevention and control measures do have to be taken and there does have to be education within the school, amongst the teachers and the staff and amongst the children.”
Unlike the Zaire strain of Ebola, there are currently no approved therapeutics or vaccines specific to the Bundibugyo virus. This underscores the importance of bolstering surveillance efforts to contain transmission, said le Polain.
“We're now at just over 70 per cent in terms of the contacts that are being appropriately traced. That's a huge improvement from where we were about a week or two ago, but it's still too low to ensure appropriate control.”
Improving local testing capacity is another key factor in overcoming the health threat as the full scale of the outbreak is “not yet clear”, the WHO official explained. He noted that in Beni a testing laboratory processed 500 tests on Thursday alone.
“That will really help get clarity about the scale of the outbreak in Beni as well,” he added.
However, UN officials warn that containing the outbreak will be particularly difficult because it is unfolding amid one of the world's largest displacement and hunger crises.
Ebola spreads amid mass displacement and worsening hunger
The UN warns that the expanding Ebola outbreak is unfolding against a backdrop of escalating violence and mass displacement in eastern Congo, which puts civilians at further risk and complicates efforts to contain the disease. This health emergency comes amid an already severe humanitarian crisis.
Nearly 15 million people in the Democratic Republic of the Congo are in need of humanitarian assistance. More than half of the country's displaced people — 3.4 million — are living in areas affected by the outbreak, further complicating response efforts.
The rapid spread of Ebola is occurring amid a broader deterioration of the humanitarian situation. Conflict and weak government control hinder contact tracing and response operations, exacerbating the risk of the virus spreading to other parts of the country and neighboring states.
The humanitarian crisis in DRC is one of the world's longest-running and most neglected emergencies. Ongoing armed conflict continues to drive the crisis, and the country's human rights and humanitarian situation has steadily deteriorated for years, prompting repeated warnings from the United Nations.
The eastern provinces, particularly Ituri, North Kivu, and South Kivu, have experienced decades of violence as non-state armed groups compete for control of the region’s natural resources. Last year, escalating hostilities spread further across the region, triggering widespread displacement, continuous population movement, and heightened protection risks for civilians.
Across the country, millions of people are internally displaced, having lost their homes, farmland, livestock, and sources of income. Meanwhile, persistently high food prices, disrupted supply chains, and recurrent disease outbreaks, including cholera, measles, and mpox, are pushing already vulnerable communities closer to collapse.
DRC continues to face one of the world’s largest and most severe hunger crises. According to the latest Integrated Food Security Phase Classification (IPC) analysis, over 26.5 million people — nearly one out of every four Congolese — are struggling to meet their basic food needs.
The latest IPC update revealed that over 3.6 million individuals are currently experiencing emergency-level food insecurity (IPC Phase 4), which indicates critical food shortages jeopardizing their survival without immediate humanitarian assistance. This is currently the largest number of people facing Phase 4 conditions globally.