Women are bearing the heaviest toll in eastern Congo’s latest Ebola outbreak, a crisis that is spreading faster than the response and exposing the deep fault lines of gender, conflict and failing health infrastructure. For women like Aline Kasiwa, a 28-year-old in the city of Bunia, the outbreak is a daily, intimate threat. For the past week she has been the sole caregiver for her sick mother—feeding her, helping her drink, washing her clothes—all while knowing that the simple act of care could cost her her life. “She is the only family I have left. I cannot abandon her,” Kasiwa said. Her reluctance to take her mother to a hospital reflects the profound fear gripping the region: “These days we hear that many people are dying there, even nurses.”
Caregiving roles place women on the front line
The virus, a rare strain known as Bundibugyo, is spreading along the lines of domestic labour and care. In a region where women are almost invariably the primary caregivers, their exposure is relentless. Dr Furaha Elisabeth, director of the Karibuni Wa Maman gynaecology and obstetrics clinic in Bunia, put it plainly: “It’s the woman who gives them a bath, it’s the woman who feeds them, and it’s the woman who’s there to wash the dirty clothes and everything else.” Unlike the more common Zaire strain, for which vaccines like Ervebo exist, the Bundibugyo strain currently has no approved vaccine or specific treatment. Existing countermeasures are ineffective against it due to differences in surface molecules. UK scientists are among those working on potential vaccines, with three candidates in development and some possibly ready for trials within months, while experimental treatments—including monoclonal antibodies MBP134 and Maftivimab, the antiviral remdesivir, and a repurposed COVID-19 drug, obeldesivir—are under investigation.
Yet in the meantime, even basic protective equipment is scarce. At the Karibuni wa Maman clinic, staff said they had received no personal protective equipment since the outbreak began, despite repeated appeals to health authorities. Patients showing symptoms are examined at the clinic before being referred to larger treatment centres, exposing doctors and nurses to potential infection with minimal safeguards. Julienne Lusenge, president of Women’s Solidarity for Inclusive Peace and Development, the aid group running the clinic, said they have sought protective equipment from various partners but received only hand sanitiser and a few masks for nurses. Women caring for sick relatives at home are even more exposed, most of them unaware that Ebola may be the cause. “During previous outbreaks, many women died because they were the ones nursing sick family members,” Lusenge said. The shortages are compounded by a broader humanitarian funding crisis: drastic aid cuts, particularly from USAID, have weakened health surveillance and outbreak preparedness precisely when needs are rising.
History shows women bear the greater burden
The pattern is not new. It is not yet clear how many women have been infected in the current outbreak, but past outbreaks tell a stark story. In the first recorded Ebola outbreak in the 1970s, women accounted for 56% of deaths, according to UN Women. During the 2018–2020 outbreak in Congo—the deadliest in the country’s history—women and girls made up about two-thirds of reported cases. “We will certainly see the same pattern emerge in the current outbreak,” Sofia Calltorp, UN Women’s chief of humanitarian action, said in a statement. “Ebola transmission follows social realities. The virus spreads along the lines of care-giving, domestic labor, front-line health work and burial practices.” Women in many eastern Congo communities are the ones preparing bodies for burial, placing them in direct contact with the highly infectious deceased. Female healthcare workers are also disproportionately represented on the frontlines, increasing their exposure. Yet women are often marginalised in response activities, with few serving on surveillance, contact monitoring or social mobilisation teams.
Pregnant women caught between fear and necessity
Pregnant women face a particularly cruel dilemma. Anny Ekyambo, 32, from Bunia and five months pregnant, expressed the fear that is keeping many away from routine check-ups. “When you see the way people die—even the nurses who treat us are dying—how can you not be afraid?” she said. UN Women has warned that pregnant women could be more exposed because of their frequent contact with health services. But staying away carries its own lethal risk. “We risk seeing a rise in prenatal and postnatal mortality, for both mothers and children,” Lusenge said. Historically, contracting Ebola during pregnancy has led to near 100% adverse pregnancy outcomes, including miscarriage and stillbirth.
The outbreak itself is unfolding in unforgiving surroundings. Ituri province, the epicentre, has poor road networks and underequipped health facilities more than 1,000 kilometres from the capital, Kinshasa. Testing capacity remains extremely limited, with hundreds of samples awaiting processing. The outbreak was identified weeks late because the rare Bundibugyo type was not tested for at first. Congolese authorities said they have confirmed 363 cases, including 62 deaths, and more are suspected. Neighbouring Uganda has reported 15 confirmed cases, including one death. The World Health Organization has declared the outbreak a Public Health Emergency of International Concern, and the Africa Centres for Disease Control and Prevention has declared it a Public Health Emergency of Continental Security. Despite new arrivals of aid and better-organised health facilities in recent days, Doctors Without Borders has said the virus continues to spread faster than the response. “Nobody knows the true scale and severity of this outbreak,” Dr Alan Gonzalez, the medical charity’s deputy director of operations, said in a statement.
Attacks by the Allied Democratic Forces, a rebel group allied with the Islamic State group, and a coalition of ethnic militias have hindered the response. Other cases have been reported in North Kivu and South Kivu provinces, where the Rwanda-backed M23 rebel group controls key cities Goma and Bukavu. Decades of conflict and poorly managed past Ebola responses have fostered deep community mistrust, keeping people away from clinics and in women’s care. Wariness of outsiders, misinformation, and even attacks on treatment centres are additional obstacles. In some areas, up to 70% of health facilities have been rendered non-functional. The combination of armed violence, a rare untreatable strain, critical shortages of protective equipment, and a health system already ravaged by funding cuts means that women—as caregivers, as patients, as pregnant mothers—are left to shoulder a crisis that no single community can contain alone.