What is Ebola and why is stopping the latest outbreak so difficult?

An Ebola outbreak in the Democratic Republic of Congo has been declared a public health emergency of international concern, by the World Health Organization (WHO).

The latest outbreak is challenging because it involves a rare species of Ebola for which there is no vaccine, and the epicentre is in an area affected by conflict.

What is Ebola and what are the symptoms?

Ebola is a rare but deadly disease caused by a virus.

Ebola viruses normally infect animals, typically fruit bats, but outbreaks among humans can sometimes start when people eat or handle infected animals.

It takes two to 21 days for symptoms to appear. They come on suddenly and start like the flu or malaria, with fever, headache and tiredness.

As the disease progresses, vomiting and diarrhoea develop and it can lead to organ failure. Some, but not all, patients develop internal and external bleeding.

The virus spreads from one person to another by contact with infected bodily fluids such as blood or vomit.

Ebola outbreaks used to be small and contained to remote rural areas. However, urbanisation is pushing larger populations closer to these natural reservoirs of Ebola and increasing the risk of transmission.

Why is this Ebola outbreak different and is there a vaccine?

This outbreak is caused by the rare Bundibugyo species of Ebola, which had not been seen for over a decade.

Named after a district in Uganda where it was first detected, Bundibugyo has only caused two previous outbreaks – in 2007 and 2012.

One study showed that it killed about a third of those infected, far less than the more common Zaire (66.6%) and Sudan (48.5%) species. About a quarter of those known to have been infected in the current outbreak have died.

Initial blood tests for Ebola in the affected areas were negative as they were designed to identify the more common species of the disease.

There is no approved vaccine for Bundibugyo, but experimental ones are in development. It is possible that a vaccine for the Zaire species may offer some protection.

There are also no drugs that target Bundibugyo, making it harder to treat. The WHO has recommended the evaluation – under strict protocols – of the experimental anti-viral drug obeldesivir, developed during Covid, to see if it is effective in stopping those who have been in contact with Ebola patients from getting sick.

A further complication is that the outbreak is taking place in a conflict zone, with a quarter of million people displaced from their homes and people moving across porous borders into neighbouring countries.

Trish Newport, from medical charity Doctors Without Borders, who is heavily involved in efforts to tackle the outbreak, told the BBC World Service that territory constantly changed hands between different armed groups, making it difficult for emergency response teams to simply drive to Ebola hot-spots.

She pointed out that a further problem was bad roads, with a 90km (56-mile) journey from Bunia city to Mongbwalu, one of two gold-mining towns where the majority of cases have been reported, taking more than three hours.

However, the WHO’s declaration of a public health emergency of international concern does not mean we are in the early stages of a Covid-style pandemic. The risk Ebola poses outside Central and East Africa is minimal.

How did the current Ebola outbreak start?

The first known case was a nurse who developed symptoms on 24 April, which means the virus had been spreading undetected for weeks.

The nurse died in Bunia, the capital of eastern DR Congo’s Ituri province, according to Congolese Health Minister Samuel Roger Kamba.

The victim’s body was repatriated to Mongbwalu.

Kamba said one of the reasons the virus spread so quickly was the number of people exposed to the body during the funeral ceremony.

Africa’s public health agency, the Africa Centres for Disease Control and Prevention (Africa CDC), said that World Service that funerals were a particular concern, as they also helped spread the disease during previous outbreaks.

Africa CDC director Dr Jean Kaseya said public health information campaigns were “providing information on how to handle funerals” and the importance of basic hygiene and sanitation, as well as providing protection measures for health workers.

Kamba said there had been delays in reporting Ebola cases because infected communities believed the disease to be “witchcraft” or a “mystical illness”, resulting in people seeking treatment from prayer centres and witchdoctors rather than hospitals.

How many Ebola cases have been reported and where are they?

WHO chief Tedros Adhanom Ghebreyesus said he was “deeply concerned about the scale and speed of the epidemic”.

On 21 June, DR Congo said there had been 1,048 confirmed cases and 267 confirmed deaths from the virus in the country.

These figures are lower than those mentioned in earlier reports as those had reflected suspected cases, many of whom later tested negative. The death toll includes five health workers who the Congolese health ministry has described as “courageous”.

There have also been 112 recoveries from Ebola so far, including four nurses whose discharge from hospital was celebrated at a special ceremony.

Ituri province is the epicentre of this outbreak.

Officials in neighbouring Uganda have so far confirmed two deaths from Ebola – individuals who had travelled to Uganda from DR Congo. The authorities there have also confirmed 20 cases with 14 people discharged from hospital.

Why does Ebola keep on occurring in DR Congo?

American doctor Peter Stafford tested positive after treating patients at Nyankunde Hospital in Bunia, where he has worked since 2023.

In early June, he was discharged from a hospital in Germany, where had been evacuated to for treatment.

Cases have also been confirmed in North Kivu (44) and South Kivu (3), provinces partly controlled by the rebel AFC-M23 alliance. These discoveries signalled the outbreak’s spread from its epicentre.

What is being done in DR Congo to tackle the current Ebola outbreak?

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The Congolese government has established four laboratories in Ituri – in Bunia, Mongbwalu, Beni and Aru – which can test blood samples for the Bundibugyo species of Ebola. Results can now be delivered within 24 hours, removing earlier delays.

Surveillance systems, contact tracing and the treatment infrastructure, with dedicated centres in several affected towns, have also been expanded, according to the health minister.

The WHO has dedicated $3.9m (£2.9m) to tackling the outbreak, while Africa CDC has announced a $319m budget. South African President Cyril Ramaphosa has pledged an initial $5m to support the agency’s plan.

A toll-free number, 151, has been provided for reporting symptoms and people are being reminded to:

• avoid contact with bodies of people who died with symptoms, or with dead animals
• not eat raw meat, as undercooked food may transmit the virus
• practise social distancing.

How have the rebels responded to the latest Ebola outbreak?

The AFC-M23 group says it is creating an Ebola response team to prevent the spread of the disease in the areas it controls.

On 17 May, spokesman Lawrence Kanyuka said the group had “immediately activated” response mechanisms in conjunction with health services and local medical facilities.

Neither the government nor the rebels have explicitly said whether they are prepared to work together to tackle the outbreak.

However, a case in Goma, North Kivu’s provincial capital, was confirmed by a state-run body, the INRB.

Caitlin Brady, the country director for the Danish Refugee Council, was in Goma to prepare her organisation’s response. She said she had been informed by the rebels that they were using contact tracing and all appropriate measures to contain the virus.

She told the BBC World Service’s Newsday programme that “a lot of the health officials and healthcare workers stayed and continued working” after rebels seized the city, meaning “the capacity to respond has remained”.