Ebola in DRC: Persistent gaps between resources and action remain six months on

Despite hundreds of millions of US dollars disbursed by the international community, critical shortcomings in essential aspects of the response persist, undermining efforts to contain the outbreak and save lives. 

“Despite the vast amounts of money provided for the response, many frontline responders are left trying to contain the outbreak with empty hands and empty pockets,” says Dr Javid Abdelmoneim, MSF International President. “Our teams are often left speechless by the dysfunctions they witness in many areas. Six months into the response, this situation is simply unacceptable.” 

These dysfunctions take many forms: response personnel who are untrained, unpaid, and sometimes on strike; vehicles and ambulances without fuel; surveillance teams that exist on paper but are nowhere to be seen on the ground; community workers without phones or mobile data to share alerts; and healthcare staff left without the necessary supplies or technical support to handle suspected cases.  

One of our greatest concerns is the persistent failure of the epidemiological surveillance system, a cornerstone of any Ebola response. Despite the resources officially allocated to this critical activity, surveillance remains deeply problematic, with entire areas poorly covered or even completely neglected. Over the past month, close to two-thirds of reported Ebola-related deaths have occurred in communities rather than in treatment centres.

“Data collected by MSF illustrates just how serious the problem is,” says Abdelmoneim. “Since the beginning of the response, in Ituri province, only nine per cent of patients with Ebola disease treated by our teams had previously been identified as contacts by the surveillance system. Although community mistrust makes surveillance difficult, urgent improvements in oversight, staffing, and operational support are essential.” 

MSF is also concerned about the excessive concentration of efforts in certain areas, at the expense of other hotspots where needs are increasingly urgent. 

For example, in North Kivu province, the scale of the epidemic is met with a response that is too slow to mobilise, while Haut-Uélé province remains dramatically overlooked. In both provinces, MSF has observed teams inadequately resourced to respond effectively, as well as health facilities operating without adequate sterilisation capacity, water, chlorine, or triage systems. This has turned some facilities into new centres of transmission, rather than places of care that contribute to containing the disease.  

In the Beni health zone, North Kivu province, close to three-quarters of Ebola patients contracted the disease in a health facility. Six months into the response, MSF continues to receive requests for personal protective equipment (PPE) from health facilities and humanitarian organisations, many of which we cannot fulfil.

“Too few responders are operating beyond the initial hotspot to tackle the spread of the virus in other hard-hit parts of the country,” says Abdelmoneim. “Meanwhile, private health providers, such as clinics, hospitals, and pharmacies, as well as traditional healers, remain largely forgotten from the response plans. Yet they are often first point of contact for people seeking care — and too often where they get infected. The response must be adapted to this reality. Otherwise, we risk spending years constantly playing catch-up with this outbreak.” 

Over the past six months, the Congolese authorities and their international partners have achieved tangible results: diagnostic capacity has been strengthened; isolation and treatment units have expanded; community engagement activities have increased; and trials have been launched to identify treatments and develop vaccines. 

Yet, the shortcomings of the Ebola response remain profound and largely unaddressed, despite being widely acknowledged. The Congolese authorities have announced measures aimed at strengthening oversight and transparency in the activities carried out by the different stakeholders involved in the response, in order to provide a clearer understanding of how resources are being allocated and used. Commitments and announcements must now translate into concrete changes on the ground.  

With the outbreak having surpassed 11,000 cases and over 5,000 deaths, the need for action is urgent. The Congolese government and United Nations agencies must ensure that the resources already mobilised translate into an effective response. This means strengthening oversight and accountability, ensuring that response personnel are properly trained, paid, equipped, and supported, and directing resources towards the areas where needs are greatest. 

“This is not just a question of operational effectiveness — it is also a question of restoring trust among communities that have already paid an enormous price,” says Abdelmoneim.