From Mystery Deaths to Ebola's Return: Why the DRC's Outbreak Cycle Keeps Repeating

On an August afternoon, a quiet home becomes a threshold where grief meets risk. Loving hands reach to honor the departed, and without safe and dignified burial practices, the act of farewell can open a path for a deadly virus. This is what has been observed in Kasai, where recent Ebola transmission has been linked to care-giving and funeral practices, prompting rapid deployment of safe and dignified burials, contact tracing, ring vaccination and case management.

The first known patient presented on August 20th, 2025, and died on August 25th from the Zaire strain of Ebola virus – a disease with an average case fatality ratio of about 50%, though past outbreaks have ranged from 25 to 90 percent⁷⁻⁹. By September 12th, this outbreak sparked the DRC's 16th confirmed Ebola emergency, with 43 suspected cases, 30 confirmed cases, and 16 deaths – including four healthcare workers who tried desperately to save them¹⁰.

This heartbreaking scene in Kasai Province represents the latest chapter in a recurring nightmare that has haunted the DRC for decades: deadly outbreaks that emerge without warning, spread faster than health systems can respond, and leave devastated communities in their wake.

Earlier this year, three children under five in northwestern DRC shared a meal of forest bat meat and died within 48 hours, their bodies wracked by hemorrhagic fever that initially sparked fears of "Disease X" before being confirmed as severe malaria¹. In late 2024, hundreds of severely malnourished children in remote Kwango province began dying from what officials termed an "undiagnosed disease" – later revealed as a lethal combination of malaria and respiratory viruses⁴⁻⁵. By the time health officials could identify these threats, dozens were already dead and panic had spread faster than medical supplies.

The pattern is as predictable as it is tragic: whether facing familiar killers like Ebola or mysterious clusters of unknown illness, the DRC's fragile health infrastructure struggles under pressure, leaving communities to face these challenges with limited support.

The Deadly Geography of Isolation

The DRC spans an area the size of Western Europe, yet vast regions remain as disconnected from modern healthcare as they were decades ago. When outbreak alerts reach Kinshasa, response teams face formidable logistical barriers: roads that become impassable during rainy seasons, infrastructure damaged by conflict, and journeys that should take hours stretching into multi-day expeditions.

During the Kwango outbreak, crucial samples endured a 700-kilometer journey over damaged roads, taking 48 hours to reach the capital's laboratory while communities buried their dead without understanding the threat⁶. For the current Ebola response in Kasai, emergency teams require up to three days of difficult travel to reach affected villages – time that allows transmission to continue unchecked¹¹.

This geographic isolation compounds deeper systemic vulnerabilities. Decades of instability have displaced over 3 million people, disrupted healthcare delivery, and weakened disease surveillance networks¹³, leaving rural health posts to serve tens of thousands across vast distances with minimal resources. Chronic food insecurity has left millions with compromised immune systems, turning manageable infections into life-threatening conditions – every severely ill patient in the Kwango outbreak was undernourished⁶.

Under-resourced laboratory networks create delays that prolong uncertainty and hamper effective response, as demonstrated when only 13 samples could be processed initially during the Equateur investigation¹⁶. Remote communities often lack access to timely health information, creating situations where traditional practices inadvertently facilitate disease transmission. These interconnected factors create conditions where common diseases become diagnostic mysteries and known threats like Ebola exploit every weakness in the health system.

Emergency Response: Capabilities and Constraints

When outbreaks occur, Congolese health authorities collaborate with WHO, Africa CDC and other partners to deploy comprehensive responses. Teams establish isolation facilities, collect samples, provide treatment, and conduct epidemiological investigations. The Congolese Red Cross supports case finding and community engagement to counter misinformation.

The Kasai Ebola response shows both progress and persistent constraints. After an alert on Sept 1, samples from Bulape arrived at the National Public Health Laboratory (INRB) in Kinshasa on Sept 3 and tested positive the same day, leading the Ministry of Health to declare an outbreak on Sept 4⁸. Public health measures were activated immediately, including contact tracing, risk communication, clinical care, and ring vaccination using doses from the national Ervebo stockpile. With 4,180 doses available at the national level, 350 doses had been delivered to Bulape by Sept 12, resulting in 60 people vaccinated, primarily healthcare providers. However, distance and poor roads mean even well-coordinated operations can take days to reach remote health areas.

In December 2024, Africa CDC leadership conducted a field mission to the DRC to strengthen diagnostic capacity during the Kwango "undiagnosed disease" crisis¹⁵, illustrating the growing technical depth now supporting national responses. These interventions save lives, but emergency actions alone cannot fix the structural vulnerabilities that make outbreaks recurrent.

Toward Resilient Health Systems: An Integrated Approach

The International Health Regulations (2005) framework emphasizes core capacities for health emergency management: surveillance, laboratory networks, workforce development, risk communication, and logistics coordination¹⁸. For the DRC, implementing these principles requires strengthening surveillance networks through training community health workers to recognize and report unusual disease patterns rapidly, supported by mobile communication technologies that function in remote areas. Equally important is establishing distributed laboratory capacity with regional diagnostic facilities to reduce sample transport times and enable faster case confirmation and outbreak response.

A comprehensive approach must integrate human, animal, and environmental health monitoring to detect zoonotic threats early, while promoting community education about disease prevention. This includes maintaining pre-positioned medical supplies and developing all-weather transport systems that function during crisis conditions. Building trust through collaboration with traditional leaders and local health committees ensures culturally appropriate health messaging reaches vulnerable populations effectively.

The rapid identification of Ebola in Kasai shows what becomes possible when surveillance functions effectively, while ongoing challenges highlight areas requiring sustained investment.

Sustainable Financing for Health Security

With shifting global health funding priorities, the DRC's health security requires innovative and sustainable financing approaches. The September 2025 Ebola outbreak and recurring disease emergencies demonstrate that reactive responses, while necessary, cannot substitute for systematic capacity building. To protect its population and strengthen resilience, the DRC must adopt innovative, community-centered financing strategies that prioritize long-term investment in public health infrastructure.

One foundational step is the creation of a National Health Fund. This fund should be transparent, accountable, and led by Congolese institutions. It could be housed within the Ministry of Public Health, leveraging existing governance structures, or established as an independent public health financing body with oversight from civil society, provincial health authorities, and international advisors. Its purpose would be to support laboratories, disease surveillance systems, and vaccination programs across all provinces - ensuring that remote and underserved communities receive their fair share of resources.

Government investment must also be scaled up. The DRC should commit to increasing domestic health spending, with international partners offering matching funds and technical expertise. Crucially, this must be done in a way that keeps local communities in control of their health priorities. Funding should reflect what people say they need most - from cold chain systems to mobile clinics - and be tracked transparently.

Beyond government and donors, the DRC can mobilize its diaspora and ethical businesses to co-invest in health infrastructure. These partnerships must be designed to strengthen communities without creating debt or dependency. Diaspora-led initiatives and responsible corporate contributions can support digital health platforms, training centers, and emergency response systems that build lasting capacity.

To ensure accountability and impact, financing should be linked to tangible results. Communities must see improvements they can measure: faster disease diagnosis, quicker outbreak detection, and higher vaccination rates. Funding mechanisms should include community-led monitoring, so that progress is tracked not just by institutions, but by the people themselves.

Above all, sustainable financing must put communities first. Every investment decision should begin with local consultation. Communities must help plan, monitor, and evaluate health programs. Training initiatives should build enduring expertise within the DRC, and public dashboards should show clearly how health funds are spent and what outcomes they achieve.

This is a blueprint for resilience. Investing in systems, empowering communities, and embracing transparency, the DRC can move from emergency-driven spending to a sustainable model of health security that protects every citizen, in every province, for generations to come.

Data as of: 12 September 2025. References available upon request.

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Tambe Elvis Akem – Medical Field Epidemiologist | Health & Immunization Specialist | Advocate for Equity in Health @ImmunizationForResilienceNewsletter

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