The deaths, recorded at the Médecins Sans Frontières (MSF)-supported treatment centre in North Kivu, have raised fresh concerns over delayed diagnosis, limited access to specialised care and inadequate infection prevention measures in health facilities.
MSF, an international medical humanitarian organisation, said children were disproportionately affected by the outbreak, with nearly one in four confirmed Ebola cases in North Kivu involving a child. The organisation's epidemiological research centre, Epicentre, reported that children under five accounted for 24 per cent of confirmed cases in the province, compared with 13 per cent in neighbouring Ituri.
Infants under one year accounted for 13 per cent of cases in North Kivu, against six per cent in Ituri, according to the figures cited by MSF.
The organisation warned that younger children faced a particularly high risk of dying from the disease, raising concerns about the adequacy of current medical and research responses to the outbreak.
Although Ebola is dangerous across all age groups, MSF said the youngest patients were especially vulnerable because of the rapid progression of the disease, difficulties in recognising symptoms early and limited access to specialised treatment.
Stéphanie Hoffmann, MSF's project coordinator in Butembo, said many children admitted to the treatment centre had previously received care for other illnesses at several health facilities before their Ebola infections were identified.
“Primary health facilities often lack the specialized expertise, equipment, and infection prevention and control measures needed to identify and safely manage suspected cases,” Hoffmann explained.
She added that most paediatric patients admitted to the Butembo centre over the summer had already been hospitalised elsewhere for days or weeks before their transfer.
“Their family members did not have Ebola themselves, and it is highly likely that these children contracted the disease inside healthcare facilities,” she said.
The observations have raised concerns about possible healthcare-associated transmission, with MSF calling for stronger infection prevention and control (IPC) measures in health facilities across affected areas.
The organisation said health centres needed adequate supplies of personal protective equipment (PPE), improved screening and isolation procedures, and additional training for healthcare workers to identify and safely manage suspected Ebola cases.
Such measures, it noted, were necessary not only to prevent further transmission but also to ensure that routine medical services remained available to communities during the outbreak.
Isolation creates additional challenges for young patients
Beyond the immediate medical risks, MSF said the outbreak was placing considerable emotional and psychological strain on children admitted to Ebola treatment centres.
Young patients may be too young to understand why they have been separated from their families, while illness and isolation can leave them unable to meet even their basic needs without assistance.
To reduce the emotional toll, MSF has introduced measures such as designated visibility areas where parents can see and communicate with their hospitalised children.
The organisation has also recruited and trained caregivers to provide daily assistance, reassurance and human contact to children in several MSF-supported treatment centres. The caregivers, who come from different backgrounds, including Ebola survivors, work inside treatment facilities while wearing full protective equipment.
At the Kitatumba Ebola Treatment Centre in Butembo, 13 caregivers are currently supporting children undergoing treatment.
Although the initiative cannot eliminate the distress associated with isolation, MSF said it provides essential emotional support to young patients facing a potentially life-threatening illness away from their families.
Gaps in medicines, vaccination and research
MSF also expressed concern over the limited availability of child-specific medical guidance and formulations for investigational Ebola treatments.
Dr. Guyguy Manangama, an epidemiologist and MSF's deputy director of operations, said the difficulties of caring for young patients were compounded by gaps in the evidence and medical tools available to healthcare workers.
“On top of enormous challenges caring for young patients, medical facilities are dealing with a lack of paediatric dosing guidance, and limited availability of child-friendly formulations of investigational medicines,” Manangama said.
“A child-centred approach must be at the heart of medical care, operational planning, and research efforts,” he added.
The organisation said children have historically been excluded from clinical research or included only after considerable delays, leaving critical gaps in evidence about the safety and effectiveness of treatments, vaccines and other preventive interventions for younger age groups.
MSF warned that this pattern could prevent children from benefiting promptly from medical advances, even when they account for a substantial proportion of those affected by an outbreak.
“Treatments, vaccines, and other preventive tools should be evaluated for use in children from the outset of research efforts and made available to them without delay,” Manangama said.
He added that children affected by the current outbreak continued to face very limited access to vaccination trials and campaigns, as well as the latest therapeutic innovations.
“Children cannot continue to wait for data generated in adults before benefiting from advances in Ebola care and prevention,” he said.
MSF called on national authorities, research institutions, pharmaceutical developers and international funders to prioritise the inclusion of children in ongoing and future studies of the Bundibugyo virus.
It said equitable access to clinical research and emerging medical interventions, including vaccines, was essential to reducing preventable deaths and improving outcomes for children.
Outbreak threatens essential childhood health services
The effects of the outbreak extend beyond children who contract Ebola, with disruptions to routine healthcare potentially exposing thousands more to other preventable illnesses.
MSF warned that interruptions to childhood immunisation, nutrition programmes and primary healthcare could increase the risk of vaccine-preventable diseases, malnutrition and other common childhood conditions.
The organisation stressed that maintaining these essential services should be treated as a central part of the Ebola response rather than a secondary priority.
Health authorities and humanitarian partners, it said, must ensure that children continue to receive routine vaccinations, nutritional support and treatment for other illnesses while infection control measures are strengthened in affected communities.
The latest concerns have reinforced calls for a response that addresses both the immediate threat of Ebola and the broader health needs of children living in affected areas.
MSF maintained that improving survival would require stronger infection prevention measures, timely diagnosis, access to specialised paediatric care, better-supported healthcare workers and the inclusion of children in medical research from the earliest stages.
The organisation also urged authorities and international partners to ensure that advances in Ebola treatment and prevention reach children without unnecessary delays.
With young children accounting for a substantial share of confirmed cases in North Kivu and deaths continuing to be recorded among paediatric patients at the Butembo treatment centre, MSF said protecting children must remain central to efforts to contain the outbreak and prevent further loss of life.