On May 17, 2026, the World Health Organization declared the Ebola outbreak in eastern Democratic Republic of Congo (DRC) and ongoing cases in Uganda an “international public health emergency.” The Africa CDC followed suit the next day. By June 5, both institutions had launched a joint six-month response plan and launched a call to mobilize $518 million. Caused by the rare Bundibugyo strain, which has no approved vaccine or treatment, this 17th outbreak is striking a region plagued by conflict and destabilized by shifts in American aid. The crisis unfolds against a backdrop of widespread instability in the country, marked by numerous armed groups and persistent violence. How will this epidemic worsen the security and humanitarian vulnerabilities in eastern DRC and complicate access to healthcare for local populations? What risks does it pose to regional stability in Central Africa? And what does the resurgence of Ebola reveal about the international community’s capacity to respond to major health crises? These questions are explored with Fatou Élise Ba, IRIS researcher and Head of the Human Security Program.

In a context of armed conflict, political instability, and severe economic and social fragility—particularly in eastern Democratic Republic of Congo—how is the Ebola outbreak exacerbating internal instability in affected areas and complicating the establishment of healthcare systems to ensure populations can access medical care?

This new wave of Ebola arrives in a zone already grappling with multiple structural crises. Though it primarily affects the Democratic Republic of Congo, this is the 17th outbreak since 1976 (when the virus was first identified in Yambuku). This time, it involves the Bundibugyo strain, which currently has no approved vaccine or treatment and can kill up to half of those infected. The provinces of eastern DRC—North Kivu, South Kivu, and Ituri—are particularly vulnerable to epidemic spread. Last year, the UN reported one of the worst cholera outbreaks in 25 years. Since 2020, the spread of Mpox has also been massive, especially since September 2023. Ituri, the epicenter of the current outbreak, is one of the most troubled provinces in DRC, with poor road infrastructure, violence from armed groups, and nearly a million displaced people crowded into camps. The health crisis is compounding an already dire humanitarian and security situation. Decades of endemic conflict, intensified since the M23 offensive in 2023, have plunged local populations into daily instability marked by regular internal displacement and crowded, unsanitary camp conditions. These factors facilitate the resurgence and rapid spread of pathogens. Moreover, the complex crisis in eastern DRC—with only brief periods of calm—has severely weakened social fabric and healthcare services, leaving them unable to meet vital needs. This has entrenched structural dependence on Western aid. It’s worth noting that systemic violence from waves of conflict in eastern DRC has deprioritized health and normalized violence, particularly against women and children. Into this precarious environment steps a major epidemic, deepening the crisis amid collapsing security.

The Congolese Minister of Health, Samuel-Roger Kamba Mulamba, described Ebola as an “absolute emergency.” National data as of May 31, 2026, reported 282 confirmed cases and 42 deaths, with 19 new positive tests recorded the same day. The WHO reported on June 1 that 349 suspected cases were under surveillance while awaiting results, primarily in Ituri province—specifically in the health zones of Bunia, Rwampara, and Mongbwalu. Bunia’s main hospital quickly became overwhelmed, forcing the establishment of peripheral and rural treatment centers. Yet there is a glimmer of hope: four infected healthcare workers have recovered. By June 5, 2026, pressure on the healthcare system had intensified further; local sources reported that six health centers in Bunia were temporarily closed for disinfection. This measure reduced the city’s capacity to care for patients and raised concerns, especially among pregnant women seeking consultations, while others with unrelated conditions received minimal care before being redirected or sent home. Additionally, as health services scramble to adapt, access to routine care has been restricted.

The real challenge lies in the lack of coordinated response from Kinshasa in areas partially occupied by the Rwandan-backed M23 and proliferating armed groups with extractive motives. This echoes a recurring issue: maintaining national unity across a country of nearly 100 million people and ensuring basic social and health services function effectively. Several cases have also been reported in M23-controlled areas. Without coordinated health response from Kinshasa, the risk of epidemic spread remains high. While negotiations may be underway according to some reports, they have yet to establish the necessary health coordination framework for an effective response in these zones. Territorial fragmentation in the east prevents a unified approach. Two Ebola treatment centers are reportedly being set up in Goma, the provincial capital under M23 control, with limited capacity. The armed group claims to have recognized the gravity of the situation and implemented contingency plans. The epidemic is thus advancing in rebel-held areas. The question remains: who controls public health when the state no longer has territorial monopoly?

Community resistance also plays a role. As seen during the 2018–2020 outbreaks, acceptance of the response is far from guaranteed. An anti-response protest in Rwampara escalated into the incineration of a suspected case’s body. Distrust and hostility toward medical teams are critical stability factors. Community resistance is rooted in cultural logic. The refusal to return the bodies of Ebola victims to their families is perceived as an unbearable symbolic violence. In eastern DRC societies, funeral rituals—including washing the deceased and physical contact—are spiritual imperatives. Yet these very practices are among the primary transmission vectors for Ebola.

The resentment of populations in Ituri and Kivu stems from a structural suspicion built over decades of violence, state neglect, and perceived predatory external interventions. The health response is often seen as a new form of imposed control, fueling rumors and conspiracy theories.

Can the Ebola outbreak have lasting consequences on relations between DRC and neighboring countries? How might this crisis further destabilize Central Africa?

The situation is marked by high tensions and extractive competition between DRC and its eastern neighbors, particularly Rwanda, though relations with Uganda are also volatile. When an epidemic spreads in a state where parts of the territory are beyond central control—hampering a coordinated national response—the solution must be transregional or even continental. The Africa CDC, the AU’s operational health arm, has indicated that ten vulnerable countries could be affected, including South Sudan, Rwanda, Kenya, Tanzania, Ethiopia, Republic of Congo, Burundi, Angola, Central African Republic, and Zambia—on top of DRC and Uganda, which already have seven cases. However, response capacities vary widely. Kenya and Ethiopia have relatively stronger health systems and surveillance, with Kenya already setting up dedicated quarantine facilities, while Central African Republic remains one of the continent’s most fragile states, heavily dependent on external aid. South Sudan faces internal turmoil compounded by spillover from the war in neighboring Sudan.

By definition, an epidemic does not respect artificial borders. It targets living beings regardless of status, though some are more vulnerable—especially the poor—in areas where borders are highly porous. According to WHO, imported cases from Ituri have reached North Kivu and Kampala, Uganda, where two travelers returning from DRC tested positive, one of whom died. A case has also been reported in South Kivu; the M23 spokesperson stated the patient came from Kisangani in Tshopo province. This dynamic has led to border closures and diplomatic tensions, not to mention potentially severe economic consequences. In response to the risk, Uganda suspended flights and passenger transport with DRC on May 21, 2026. Rwanda closed its border with Goma. These unilateral measures have collided with already strained DRC relations with its neighbors.

Complicating matters further is the entanglement with the eastern conflict, which directly fuels epidemic spread. The outbreak is progressing in areas like Goma, seized in late January 2025, and Bukavu, fallen in February 2025—heightening fears of regional escalation. Health has become another battleground in the Kinshasa-Kigali rivalry, with M23 de facto acting as a public health actor in the territories it controls. To address this cross-border risk, the East African Community called on member states to activate laboratory networks and strengthen border surveillance. An extraordinary ministerial meeting of health ministers was held on June 1–2, 2026, resulting in commitments to harmonize sanitary controls at entry points without closing borders, establish a regional technical working group to coordinate surveillance, and bolster diagnostic capacities and healthcare worker protection.

Do health crises like Ebola expose the current limitations of the international humanitarian aid system, especially following USAID funding cuts? What role do international organizations like WHO and NGOs play in managing this crisis?

Amid regional instability, this outbreak arrives at a moment when the response is weakened by shifts in U.S. aid architecture. Cuts to health aid—quadruple in scope since January 2025—include withdrawal from WHO, dissolution of USAID, reductions at CDC, and decreased health funding to DRC and Uganda, crippling systems vital for responding to such outbreaks. Some experts believe these cuts may have delayed outbreak detection.

Today, DRC has signed a bilateral agreement with the U.S. (alongside Rwanda and Uganda) in an explicit “America First” approach. A portion of health funding has been transferred to the U.S. Department of State under this new deal, which promises $900 million over five years in a transactional bilateral framework that replaces multilateralism. This shift, driven by U.S. repositioning, has not been fully managed. In response to Ebola’s resurgence, the U.S. response has been delayed and operates outside the UN framework. Moreover, humanitarian principles appear deprioritized; the focus is on protecting Americans. The Department of State mobilized $23 million in emergency funds and announced financing for up to 50 clinics but did not indicate support for a WHO-led response—breaking with past practices. With the U.S. having withdrawn from WHO, the organization’s emergency fund (CFE) is operationally fragile, and other donors have been unable to fill the gap left by the American exit.

In this context, the response must be driven by national institutions in the hardest-hit countries, with support from WHO and NGOs, given the scale of virus spread—even as their resources are diminished by U.S. withdrawal and they operate in hostile security environments. WHO, fulfilling 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) has published a risk assessment to support coordination, particularly with Africa CDC. On the ground, medical NGOs like Doctors Without Borders and ALIMA (The Alliance for International Medical Action) have deployed care teams. The DRC Red Cross is mobilizing volunteers for dignified and safe burials, risk communication, and community engagement. Yet the humanitarian response remains far too limited to curb the epidemic.

On the continental front, Africa CDC and WHO announced on June 5, 2026, a joint six-month response plan (June–November 2026) and launched a call to mobilize $518 million to support African countries in early detection, prevention, and combating the disease. Centered on the operational principle of “one plan, one budget, one team” advocated by WHO Director-General Tedros Adhanom Ghebreyesus, the plan aims to coordinate a response led by affected countries. It involves WHO, Africa CDC, and partners (UNICEF, UNHCR, WFP, IFRC, FIND), UN agencies, African governments, and international donors. So far, only $315.8 million has been pledged—below even the target needed to implement a single coordinated plan.

While this co-coordinated plan shows early signs of continental-level response, it also reveals a structural hybrid strategy among several African states. On one hand, countries sign bilateral agreements—particularly with the U.S.—that tie aid to conditionalities supporting their health systems and combating infectious diseases. On the other, they demonstrate capacity to coordinate in the face of major crises through multilateral mechanisms. Time will tell whether this balance can yield lasting results.