DR Congo

DRC 2018 Ebola outbreaks: Crisis update - 3 April 2019

Situation Report
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Dr. Théo has done countless interventions with the emergency pool of MSF Congo in the most remote areas of the country. He’s a man of experience, he has seen all kind of epidemics: measles, cholera, yellow fever, … but this time it’s his first Ebola intervention. Mangina, DRC, September 2018. © CARL THEUNIS/MSF



Democratic Republic of Congo (DRC) declared their tenth outbreak of Ebola in 40 years on 1 August 2018. The outbreak is centred in the northeast of the country. With the number of cases passing 1,000, it is now by far the country's largest-ever Ebola outbreak. It is also the second-biggest Ebola epidemic ever recorded, behind the West Africa outbreak of 2014-2016.

Latest figures - information as of 2 April 2019; figures provided by DRC Ministry of Health.

  • 1,092 total cases

  • 1,026 confirmed cases

  • 683 confirmed deaths

Retrospective investigations point to a possible start of the outbreak back in May 2018 – around the same time as the Equateur outbreak earlier in the year. There is no connection or link between the two outbreaks.

The delay in the alert and subsequent response can be attributed to several factors, including a breakdown of the surveillance system due to the security context (there are limitations on movement, and access is difficult) and a strike by the health workers of the area which began in May, due to non-payment of salaries.

A person died at home after presenting symptoms of haemorrhagic fever. Family members of that person developed the same symptoms and also died. A joint Ministry of Health/World Health Organization (WHO) investigation on site found six more suspect cases, of which four tested positive. This result led to the declaration of the outbreak.

The national laboratory (INRB) confirmed on 7 August that the current outbreak is of the Zaire Ebola virus, the most deadly strain and the same one that affected West Africa during the 2014-2016 outbreak. Zaire Ebola was also the virus found in the outbreak in Equateur province, in western DRC earlier in 2018, although a different strain than is affecting the current outbreak.


Located in northeastern DRC, the North Kivu province is a densely populated area with approximately 7 million people, of whom more than 1 million are in Goma, and about 800,000 in Butembo. Despite the rough topography and the bad roads in the region, the population is very mobile.

North Kivu shares a border with Uganda to the east (Beni and Butembo are approximately 100 kilometres from the border). This area sees a lot of trade, but also trafficking, including ‘illegal’ crossings. Some communities live on both sides of the border, meaning that it is quite common for people to cross the border to visit relatives or trade goods at the market on the other side.

The province is also well-known for being an area of conflict for over 25 years, with more than 100 armed groups estimated to be active. Criminal activity, such as kidnappings, are relatively common and skirmishes between armed groups occur regularly across the whole area. Widespread violence has caused population displacement and made some areas in the region quite difficult to access. While most of the urban areas are relatively less exposed to the conflict, attacks and explosions have nonetheless taken place in Beni, an administrative centre of the region, sometimes imposing limitations on our ability to run our operations.

North Kivu is also a very rich region with a lot of natural resources (a third of its territory is dedicated to mining exploitation) which is also a political challenge as the province has the reputation of being an area that favours the opposition. The last elections were controversial with the population, who represents 10 percent of the DRC electorate.