True scale of Congo Ebola outbreak still unknown one month in, responders say

One month after Ebola cases were confirmed in eastern Democratic Republic of Congo, the full scale of the outbreak remains uncertain, with significant gaps in data and ongoing community resistance complicating response efforts, according to health workers and officials.

The three affected provinces—Ituri, North Kivu, and South Kivu—have recorded 782 confirmed cases and 181 deaths so far, making this the third-deadliest Ebola outbreak on record. However, aid organizations and some government officials warn that these figures likely underestimate the true impact of the virus on the ground.

Medical charity Médecins Sans Frontières (MSF) said official data does not fully reflect the situation, citing persistent challenges in surveillance and reporting. “No one knows the true scale or exactly where the disease is spreading in the DRC,” said Kate White, MSF’s emergency medical coordinator, noting that the organization operates treatment centers across the affected eastern region.

Testing capacity remains one of the weakest points in the response. MSF reported that many communities—particularly those affected by armed conflict—still lack access to testing kits, while delays in laboratory results further slow case confirmation and response efforts.

A senior Congolese public health official, speaking anonymously, said the problem extends beyond testing. Data from laboratories, hospitals, treatment centers, and surveillance teams is often difficult to reconcile, leading to inconsistencies in reported figures. According to the official, cases may be counted more than once when patients are tested across different health zones, while other deaths occur in communities without ever being reported to health authorities. The official also said they believe the virus may have been circulating since February.

Discrepancies between official figures and local realities have been observed at the community level. In Ituri’s Nizi health zone, local health authorities reported 19 positive cases and 17 deaths since the outbreak was declared, while a national situation report listed only 11 cases and one death for the same area. Officials at the National Public Health Institute said figures are continuously updated as new information becomes available.

Beyond data challenges, responders are facing growing insecurity and resistance in affected communities. Security forces recently used warning shots and tear gas to disperse a crowd attempting to interfere with a burial of a suspected Ebola victim in Mongbwalu. Similar incidents have been reported elsewhere, including attacks on burial teams in South Kivu that forced health workers to abandon safety protocols.

The World Health Organization has warned that such security incidents, along with community mistrust, are undermining containment efforts. At least four instances of patients leaving isolation or treatment centers were reported in early June. MSF said mistrust remains widespread in parts of Ituri, complicating efforts to control transmission.

Authorities have indicated plans to involve family members more directly in safe burial procedures in an effort to build trust and reduce resistance.

Healthcare capacity is also under strain. According to the WHO, only 14 treatment facilities are currently operating across nine health zones in the affected provinces, while the outbreak has already spread to 31 of at least 90 health zones in the region.

In some areas, the lack of treatment centers is forcing patients to return home, where they often die without medical care, according to local health officials.

MSF warned that the window to contain the outbreak is narrowing. The 2014–2016 West Africa Ebola epidemic remains the deadliest on record, having claimed more than 11,000 lives.

“Diagnostics, surveillance, access to care, and community engagement must be urgently strengthened,” said Frédéric Lai Manantsoa, MSF’s emergency coordinator in the DRC. “We urge authorities and all stakeholders to do everything possible to facilitate the movement of health workers and supplies, and enable a response that matches the scale of this crisis.” -Reporting by Clement Bonnerot in Dakar and Emma Farge in Nairobi; Additional reporting by Benoit Nyemba and Gradel Muyisa in Bunia, Fiston Mahamba in Goma; Editing by Robbie Corey-Boulet and Alison Williams/Reuters