As it approaches 100 days since the Ebola disease outbreak was declared in Democratic Republic of Congo (DRC), Médecins Sans Frontières (MSF) warns that communities are not receiving adequate support to contain the disease. This outbreak has become the largest and deadliest in the country’s history, and it continues to spread at an alarming rate within communities who already contend with conflict, violence, displacement, and hunger, among other health emergencies, in their daily lives.

Training for health workers and community leaders on case detection, referrals, and infection prevention and control measures must be urgently bolstered within communities affected by the outbreak.

Over the past week, deaths due to Ebola disease have been reported at a rate of roughly one every half hour. Since the outbreak began and as of 16 August, national authorities have reported more than 5,000 confirmed cases and over 2,400 deaths. 

“This epidemic continues to spread, moving faster than the response can keep up,” says Dr Javid Abdelmoneim, International President of MSF. “Treatment centres remain essential for saving lives, but this response needs more than extra beds.”

“It needs better detection, safe isolation for sick people and their contacts, and support to health workers,” says Dr Abdelmoneim. “People seeking care in existing health facilities also need to be protected from infection. Crucially, the response must be built with communities, not around them.”

In Rho displacement camp, near Drodro, Ituri province, community leaders have worked with MSF to encourage people with symptoms to seek testing, isolation and treatment early. They also promote infection prevention and control measures to reduce the risk of community transmission. In the overcrowded camp, which is home to nearly 50,000 people, this collaboration has helped limit the spread of Ebola and reduce mortality.

“We know our communities and how to reach our people,” says Ezrome Kiza Lumani, a community leader living in the camp. “When Ebola arrived, we did not wait. We spoke with families, listened to their fears, and encouraged people with symptoms to seek care. We have a crucial role to play in stopping this outbreak.”

Since the outbreak was officially declared, more than 60 per cent of Ebola disease deaths in DRC have occurred outside – and often far away from – Ebola treatment centres. This means many people are dying at home or in their communities without receiving care, and the virus continues to spread before cases are detected.

Worryingly, case numbers are rising rapidly beyond the epicentre of Ituri, with North Kivu province experiencing particularly high levels of mortality and mistrust in the response.

“With cases emerging in new areas with little or no previous experience managing Ebola disease, Ebola-trained healthcare workers are urgently needed not only inside treatment centres, but also directly in affected communities,” says Trish Newport, MSF’s emergency programme manager in Ituri.

MSF is currently responding across Ituri, North Kivu, South Kivu, Tshopo, and Haut-Uélé provinces. Teams are operating six Ebola treatment centres, as well as isolation units, in affected areas, with more than 400 beds available — representing one third of all beds in the overall response. More than 1,400 MSF staff are supporting the response. Since the start of the outbreak, our teams have admitted more than 2,000 patients, of which more than 800 patients were confirmed to have Ebola disease.

In Beni, North Kivu province, we have worked to move our response within communities. Through supporting existing health facilities that also offer general healthcare services, which are also crucial to saving lives, systematic and symptomatic treatment can start quickly. Across the response to the outbreak in DRC, more must be done to ensure people can receive the care they need closer to home.

“Health workers and community leaders need training to help detect cases early, refer people safely, reinforce infection prevention and control, and protect themselves and others from infection,” says Newport. “The World Health Organization (WHO), other UN agencies, humanitarian organisations, including MSF, and the Congolese Ministry of Health must urgently expand this training and support.”

Community leaders like Emery Guba Mateso, also from Rho displacement camp, are sharing their experiences to encourage people to seek care. He lost his son to the disease and later survived an infection himself.

“As a person who has recovered from Ebola disease, the message I would like to share with the community is: as soon as the first symptoms appear, it is important to seek medical care promptly, because early access to appropriate treatment increases the chances of recovery,” says Guba Mateso.