While health authorities and international partners have intensified response measures in recent weeks, MSF says critical shortcomings in surveillance, diagnosis, contact tracing and community engagement continue to hamper progress, allowing the outbreak to expand across several provinces.
The warning comes as confirmed infections and deaths continue to rise, with health experts cautioning that the true scale of the outbreak may be significantly larger than official figures currently indicate.
“One month on, the Ebola disease outbreak is outpacing the response effort,” says Kate White, emergency medical coordinator for MSF in DRC.
“No one knows the true scale or exactly where the disease is spreading in DRC. What we do know is that most treatment centres in Ituri province are overwhelmed; many of our patients arrive at a late stage of the disease, and the majority were never identified or monitored as contacts before seeking care.”
Outbreak Expands Across Eastern Congo
The Ebola outbreak has spread through the eastern provinces of Ituri, North Kivu and South Kivu, with Ituri accounting for nearly 95 percent of all reported infections.
The response is being coordinated by the Congolese Ministry of Health with support from international partners, but ongoing insecurity in parts of eastern Congo continues to complicate efforts to reach affected populations.
Health workers face significant challenges accessing some communities because of armed conflict, while shortages in testing, surveillance and contact-tracing capacity continue to undermine containment efforts.
The outbreak has also crossed borders. In neighbouring Uganda, health authorities have reported 19 confirmed Ebola cases, raising concerns about regional transmission.
Officially, Congolese authorities have recorded more than 650 confirmed infections and over 130 deaths since the outbreak began. However, MSF believes these numbers likely underestimate the true extent of the crisis.
Testing Delays Hampering Containment Efforts
One of the biggest obstacles identified by MSF is inadequate diagnostic capacity.
Although laboratory capabilities have improved in recent weeks and hundreds of specialised mobile testing kits have been deployed to eastern Congo, many communities remain unable to access timely testing services.
“Testing remains one of the most significant weaknesses in the response, despite recent improvements in laboratory capacity and the arrival of hundreds of mobile test kits in eastern DRC, designed specifically for the Bundibugyo virus,” says White.
“Many communities, especially those affected by ongoing insecurity, still have limited access to these kits, while treatment centres continue to face significant delays in receiving laboratory results.”
According to MSF, delayed diagnoses make it far more difficult to isolate infected individuals, trace contacts and prevent further spread of the virus.
“Without faster and more widely available testing, we will struggle to detect cases early enough to contain the outbreak,” says White.
Conflict and Displacement Complicate Response
The outbreak is unfolding in a region already facing some of the world's most complex humanitarian challenges.
Millions of people living in eastern Congo have endured decades of armed conflict, displacement, fragile healthcare systems and recurring humanitarian emergencies.
These conditions not only make response efforts more difficult but also create an environment where infectious diseases can spread rapidly.
In many communities, healthcare facilities remain overstretched, while insecurity frequently disrupts access to medical services and humanitarian assistance.
Building Trust Remains Critical
Beyond medical and logistical challenges, MSF says community trust remains a major factor in controlling the outbreak.
In Ituri province, where the organisation has worked for decades, many residents remain cautious about the sudden influx of Ebola response teams.
Health workers say fear, misinformation and mistrust can discourage people from seeking treatment or cooperating with surveillance efforts.
“Setting up activities and explaining the disease is not enough to build community trust — people’s concerns need to be listened to, and communities should help shape the response,” says Frederic Lai Manantsoa, emergency coordinator for MSF in DRC.
Experts argue that involving local communities in decision-making and response planning is essential to improving acceptance of public health interventions.
Routine Healthcare Must Not Be Neglected
MSF also warned that the focus on Ebola should not come at the expense of other critical healthcare services.
Many communities affected by the outbreak already struggle with limited access to maternal healthcare, childhood immunisation programmes and treatment for diseases such as malaria and cholera.
“Pregnant women still need maternal care, children still need vaccinations, and patients still need treatment for malaria and cholera,” says White.
“Maintaining access to routine healthcare also helps support Ebola disease surveillance among communities.”
Health experts note that preserving trust in healthcare systems often depends on ensuring people continue receiving routine medical care alongside emergency outbreak responses.
Surveillance Challenges Persist
Although North Kivu and South Kivu currently account for a smaller proportion of Ebola cases, MSF says these provinces face many of the same operational difficulties.
In North Kivu, only one laboratory is currently available to process blood samples, resulting in significant delays.
Test results can take several days to process and, due to the absence of automated reporting systems, healthcare facilities may wait nearly a week before receiving confirmation.
Such delays can hinder efforts to identify cases quickly and respond before transmission spreads further.
To address these challenges, MSF has deployed additional teams to remote and insecure locations where potential Ebola alerts have been reported, aiming to strengthen detection and emergency response capacity.
Window for Action Is Narrowing
Despite the growing challenges, MSF believes the outbreak can still be contained if response efforts are significantly strengthened in the coming weeks.
The organisation is calling for urgent improvements in diagnostics, surveillance systems, community engagement and healthcare access, while also urging authorities to facilitate the movement of medical personnel and supplies.
“This outbreak can still be brought under control, but the window for action is narrowing,” says Lai Manantsoa.
“Diagnostics, surveillance, access to care, and community engagement must be urgently strengthened. We urge authorities, and all stakeholders involved in the response, to do everything possible to facilitate the movement of health workers and supplies, and enable a response that matches the scale of this crisis.”
As the outbreak enters its second month, health experts warn that rapid action will be crucial to preventing further loss of life and stopping the virus from gaining a stronger foothold across eastern Congo and neighbouring countries.