Community deaths

One of the key indicators monitored through surveillance is community deaths. These are deaths that happen at home or outside health facilities of people who had symptoms that match those of Ebola disease. They are important as they may point at new clusters of infection.

Community deaths can also reveal gaps in the response. People may not recognise the symptoms of Ebola disease, may not know what to do if symptoms appear, may not have sought care early enough, or may not be able to reach a health facility. During the current outbreak, more than 68 per cent of Ebola-related deaths in DRC are estimated to be community deaths, peaking at 75 per cent during the first week of September.

Community deaths are also important because anyone who has contact with the deceased person after symptoms began, or with the body after death, may have been exposed to the disease and will need to be followed up.

Contact tracing

Another key part of surveillance is contact tracing. This means identifying everyone who had close contact with a person with Ebola disease – whether living or dead – after that person’s symptoms began. MSF teams and other response partners can then contact them, explain the risk that they may have been infected, tell them what symptoms to watch for and what to do if they become sick. By identifying contacts early and monitoring them for 21 days – the time it can take for Ebola symptoms to appear – health teams can detect new cases faster, isolate and treat patients earlier, and help reduce the spread. This is known as “cutting the chain of transmission”.

Known contacts

Health teams also look at how many confirmed Ebola patients had already been identified as contacts before becoming sick. This helps show how well the outbreak is being tracked and whether there are gaps in the response.

During the current Ebola disease outbreak, this remains difficult. Some patients may be reluctant to share the names of people they were in contact with, while some contacts might not be properly registered, reachable, or consistently followed up. These challenges make it harder for health teams to bring the outbreak under control, as they do not fully understand how the disease is spreading.

Testing and diagnosis
  
To understand how the outbreak is spreading and respond quickly and effectively, suspected cases – including deaths from suspected Ebola – must be confirmed as soon as possible.

To do this, samples must be collected, transported quickly, and analysed without delay in properly equipped laboratories. This requires enough laboratories, trained staff, supplies, and protection equipment, as well as laboratories located close enough to affected areas – including remote locations – to reduce delays in transporting samples and receiving test results.

Strong and decentralised laboratory capacity also improves patient care. It allows patients who test positive to be admitted and treated more quickly, and those who test negative to be discharged sooner. This also helps to free up beds in Ebola treatment centres when they are urgently needed.

Community-based surveillance

Affected communities themselves also play a key role in surveillance. Community members are often the first to notice possible cases or unusual deaths and can provide essential information to help health teams track the outbreak and identify new chains of transmission early. For this reason, communities must be fully involved in surveillance efforts through community-based surveillance.
 

Ebola disease spreads through contact with the bodily fluids of an infected person, such as blood, vomit, or diarrhoea. If these fluids come into contact with broken skin or the eyes, nose, or mouth, the virus can enter the body.

In health facilities, staff quickly identify people who have symptoms consistent with Ebola disease and separate them from other patients while awaiting test results. Ideally, people with suspected Ebola disease stay in individual rooms – preferably with their own toilet – to reduce the risk of infecting others. Patients who test positive are then moved to a dedicated area for confirmed cases. Patients, families, staff, and equipment are also given clear routes for moving around to help reduce the risk of transmission. Families may visit but only from a safe distance and without physical contact.

Protecting health workers is essential. Staff wear full PPE, which covers the skin and protects the eyes, nose, and mouth from infected fluids. PPE only works if used correctly. Staff are trained on, and practice, putting it on and taking it off safely. They work in pairs to check each other for mistakes.

Because PPE is extremely hot and uncomfortable, time spent inside high-risk areas is kept short — around one hour in the DRC, and sometimes as little as 20 minutes in hotter climates. This helps reduce mistakes caused by heat, fatigue, or loss of concentration.

IPC also includes routine safety measures such as safe blood collection, disposing of needles in secure containers, cleaning and disinfecting beds and equipment, and careful handling of contaminated waste. 
 

WASH forms part of wider IPC and also seeks to reduce the risk of infection.

Inside ETCs, WASH teams keep surfaces and shared spaces clean and safe. Dozens of hygienists may be working at the same time, constantly cleaning rooms, floors, beds, toilets, buckets, and other items. This work is vital because Ebola patients often vomit or have bloody diarrhoea — fluids that carry large amounts of the virus.

This cleaning process follows strict steps using soap and water, as well as chlorine solutions. 

Ensuring a reliable water supply is also central to WASH activities. ETCs typically use around 300 litres of water per patient each day, predominantly for laundry, cleaning, and disinfection. Handwashing stations are placed at key points in the ETC, laundry is managed safely, and wastewater is managed in ways to prevent contamination. When patients recover and are ready to leave, they wash thoroughly, change into clean clothes, and have their shoes and belongings disinfected before discharge.

WASH support also extends beyond treatment centres. Specialist teams clean and disinfect ambulances after transporting a patient with suspected or confirmed Ebola disease, as well as the homes of people who are infected with Ebola disease. Such activities are key to protecting family members from contracting the disease, and to build trust with affected communities.

They also support safe burials. A person who has died from Ebola disease remains highly infectious. Bodies must be handled carefully, washed, and prepared by trained teams, sealed in waterproof body bags, and buried in a way that prevents contact with fluids and protects mourners and the wider community.
 

Ebola is a frightening disease that has impacted families and entire communities in a context already marked by conflict, displacement, food insecurity, and very limited access to healthcare. For years, people have been forced to rely on private or religious health facilities, or traditional healers for care. 

It is understandable that some people question the sudden surge of resources and international attention directed toward Ebola disease when many of their basic needs have gone unmet for decades. This fear, frustration, and uncertainty can lead to distrust toward humanitarian and health organisations. 

At the same time, women still give birth, children still need vaccinations, and people remain at risk from other diseases, such as malaria and cholera. For this reason, Ebola disease care must be integrated into the broader health response in DRC — both to help build community acceptance and to ensure that other urgent health needs continue to be addressed.

To respond to this outbreak effectively, it is essential that people in affected areas understand the disease and are actively involved in the response. This includes sharing information through health promotion activities with different groups within the community, while also engaging with them to better understand local practices, beliefs, needs, and expectations.

Community engagement is a participatory process that prioritises listening to people’s concerns and feedback, two-way communication, and collaboration. Listening to community members – including patients – and responding to their feedback and concerns is essential to building trust and making the response more effective.

To support this, MSF teams work closely with local leaders, including women’s groups, traditional leaders, and youth groups. In Ituri and North Kivu provinces, MSF health promotion teams have also worked with motorbike taxi drivers, who provide most of the local transport and can play an important role in sharing accurate information and helping keep themselves and their passengers safe.

Community-based surveillance and contact-tracing are also essential to quickly identify people who may have been infected. In community-based surveillance, community members help identify and report possible Ebola disease cases or other health risks within their communities. By alerting health authorities early, they help health teams detect new cases more quickly and respond faster.

There are other community-based activities can also help to keep people safe and build trust. For example, in some areas, teams disinfect the homes of people who have tested positive for Ebola disease and are being treated in Ebola treatment centres. This helps reduce the risk of further spread and protect other family members.
 

Patient care is one of the most important parts of an Ebola disease response. It means looking after people who are sick in a safe, supportive, and respectful way. This gives patients the best chance of recovery while helping prevent the disease from spreading to others.

Although there are currently no specific treatments or vaccines specifically available for Bundibugyo virus, early supportive care can save lives. When people with Ebola disease are identified early and brought to a facility where they can be treated safely, they can receive care for symptoms such as pain, fever, weakness, vomiting, and diarrhoea. They can be given water, food, rest, and treatment for other illnesses, such as malaria. Even without a specific treatment, this type of care can help the body stay strong enough to fight the virus.

Patient care is also essential for protecting families, health workers, and communities. When patients are treated in prepared facilities with proper IPC measures in place, the risk of transmission to others is reduced.

Good patient care also helps to build trust. When people believe that treatment centres provide safe and dignified care, they are more likely to seek help early. This makes it easier to identify cases quickly, begin treatment sooner, reduce transmission, and lower fear in the community.

Bringing Ebola disease care closer to affected communities is also essential to improving trust and acceptance. MSF works with communities to integrate Ebola disease isolation centres into existing healthcare facilities, while also strengthening general healthcare services in the affected areas. This brings Ebola disease care closer to home, where families can visit, people can be tested, and supportive treatment can begin quickly, even before a patient is transferred to an Ebola treatment centre. It also helps address other important health needs in the community beyond Ebola care.

For all these reasons, patient care is a key element of an Ebola disease response. It saves lives, helps reduce the spread of the disease, protects health workers and communities, and shows people that the response is there to support them.