Health workers responding to an Ebola outbreak in eastern Democratic Republic of Congo are struggling to contain the disease as staff shortages, logistical setbacks and delayed case reporting continue to hamper surveillance operations in Bunia, the epicentre of the outbreak.
Surveillance officer Dr. Moubarack Kano begins many of his workdays confronting a familiar challenge: too few vehicles to investigate suspected infections across Bunia, a city of about one million people spread across 23 health districts. With official transport frequently unavailable, he relies on his personal vehicle to visit clinics and follow up on potential Ebola cases.
As part of their daily rounds, Kano and his colleagues inspect patient registers, review suspected cases and verify whether health facilities have reported them through the national Ebola alert system. They frequently discover that clinics have failed to notify authorities about patients displaying symptoms consistent with Ebola, delaying investigations and increasing the risk of further transmission.
Many of the unreported cases involve patients initially diagnosed with illnesses such as typhoid fever, whose early symptoms closely resemble those of Ebola. Health officials say these missed alerts allow infections to spread before surveillance teams can intervene.
The current outbreak is being driven by the Bundibugyo strain of Ebola, a relatively rare variant for which there is no approved vaccine or specific treatment. Because its early symptoms are generally milder than those associated with other Ebola strains, identifying infections has become even more challenging.
According to government figures released on Sunday, the outbreak has infected more than 3,200 people and claimed at least 1,405 lives. The World Health Organization has warned that the true number of infections could be between two and four times higher than official figures suggest.
At one health facility in Bunia’s Nyakasanja district, Kano identified several cases that should have been reported to surveillance authorities but were not. In one instance, a teenager whose older brother had died from Ebola was never flagged for follow-up, despite the heightened risk of infection.
Health workers say some clinics are reluctant to report suspected Ebola cases because transferring patients to specialised treatment centres means losing revenue. Others cite practical challenges, including a lack of phone credit needed to contact surveillance teams.
Even when reports are submitted, response teams often lack the personnel and resources to respond quickly. Surveillance coordinator Dr. Rachel Ulingisayi recalled receiving a call from a father whose two children were critically ill. By the time health workers were able to reach the family, both children had died.
Public mistrust has also complicated containment efforts. At one clinic, two children displaying symptoms consistent with Ebola remained in a general ward after their mother refused to allow them to be transferred for testing and isolation. Health officials later deployed a psychologist to counsel the family and encourage their cooperation.
Kano, who worked during the country’s devastating Ebola epidemic between 2018 and 2020, said the current response has been undermined by inadequate planning, logistical constraints and the recruitment of inexperienced personnel. He also said many frontline health workers have not been paid since the latest outbreak was declared in May.
Congolese authorities have acknowledged operational challenges affecting the response. Health Minister Samuel-Roger Kamba said the government is working to resolve payment delays and strengthen the country’s Ebola response capacity.
As his day drew to a close, Kano joined burial teams at the home of a 67years old man believed to have died from Ebola. While specialists disinfected the property and prepared a safe burial, surveillance officers began tracing everyone who had come into contact with the victim, knowing the virus may already have spread beyond the deceased’s immediate contacts.
Goodness Anunobi
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