Ebola could reach South Sudan within weeks, the World Health Organisation has warned, as modelling suggests the fast‑spreading outbreak in the Democratic Republic of the Congo and Uganda poses an almost 70 per cent chance of a case appearing in the war‑ravaged country within 12 weeks.
Why South Sudan is the greatest worry
South Sudan possesses some of the weakest public health infrastructure in the region, with critical gaps in border surveillance, contact tracing and safe burial practices. “I’m very worried about South Sudan,” said Dr Nahid Bhadelia, an infectious diseases physician and associate professor at Boston University School of Medicine who worked on previous Ebola outbreaks near the DRC and South Sudan borders. “There are large refugee and displacement camps. People live in close quarters and surveillance there is lagging and under‑resourced to begin with. I am concerned that we may miss cases and that it has already spread there.”
The country, already struggling with the legacy of decades of conflict, has a health system that health experts say is simply not equipped to detect and contain a pathogen as dangerous as Ebola. The WHO’s modelling, published in The Lancet Infectious Diseases, also warned of a small risk of spread to Rwanda and Burundi, but stressed that all projections depend heavily on the speed of detection and response once cases cross borders.
This is the 17th Ebola outbreak in the DRC since the virus was first identified in 1976. The current outbreak is caused by the rare Bundibugyo ebolavirus, a rarer species than the more common Zaire strain. Symptoms are less recognisably haemorrhagic, meaning it can be mistaken for other illnesses, delaying identification. There is no licensed vaccine or cure for the Bundibugyo strain, though several candidate vaccines and experimental treatments – including monoclonal antibodies and the antiviral remdesivir – are under development and being trialled in the DRC.
The fastest‑recorded Ebola outbreak
The outbreak was officially declared on 15 May, but retrospective investigations suggest transmission began in early April, meaning the virus circulated undetected for weeks. The WHO said it had the highest number of confirmed cases in its first month of any Ebola outbreak in Africa, echoing an earlier statement from Médecins Sans Frontières. During the current outbreak, it took just 37 days to reach 250 deaths – far faster than the 78 days needed in the 2014‑2016 West Africa outbreak and the 130 days in the 2018‑2019 outbreak.
As of 22 June, the DRC had confirmed over 1,000 cases with nearly 300 deaths, making it the second‑largest Ebola outbreak on record. The epicentre is Ituri province, which borders South Sudan and Uganda. Cases have also been confirmed in North Kivu and South Kivu provinces in the DRC, as well as in Uganda – including in the capital, Kampala. Real case numbers are thought to be higher because of delays in testing and surveillance, meaning the outbreak was likely already widespread before it was detected, Dr Bhadelia said.
Healthcare workers have been hit hard: nearly 80 infections have been reported, with a concerning mortality rate among them. Most are thought to have contracted the virus while treating patients before it was clear they had Ebola. Beyond the region, a doctor who returned from a humanitarian mission in the DRC tested positive in France – the first case confirmed in Europe – while an American surgeon who contracted Ebola in the DRC was treated and recovered in Germany. Health experts say the risk of widespread transmission to Europe remains low, but there is “real risk” of the outbreak expanding within the DRC or regionally.
How aid cuts have fuelled the crisis
Cuts to global aid following Donald Trump’s decision last year to effectively disband the US Agency for International Development have contributed directly to the severity of the outbreak. Health programmes that support infectious disease surveillance were reduced, weakening the capacity to detect and respond. “If all infectious diseases increase, it becomes harder to detect something like Ebola,” Dr Bhadelia said.
The cuts have also been linked to worsening conflict. A study published last month revealed a significant increase in violence across several African nations. Last year, M23 rebels staged a violent takeover of the DRC’s Goma amid the aid reductions, triggering mass displacement that is further complicating the response. The DRC’s health system was already fragile, and the combination of conflict and funding gaps has created a situation where containment is nearly impossible.
“Many things have been done,” said Adam Gonzalez, deputy director of operations for MSF, “but if we don’t have enough resources from the beginning, we are always going to be catching up.” MSF is running Ebola treatment centres in both the DRC and Uganda, and helping prepare neighbouring regions. Testing and treatment capacity has expanded, he said, but is still not sufficient to match the scale and pace of transmission. The strain on the health system has, in past outbreaks, led to rises in deaths from other diseases, such as malaria, as resources are diverted.
The United States has provided significant funding for the Ebola response and preparedness, contributing over $220 million directly and an additional $350 million for humanitarian assistance in the DRC, South Sudan and Uganda, while also implementing enhanced travel screening and entry restrictions. The WHO has declared the outbreak a Public Health Emergency of International Concern and is coordinating the international response, including supporting research into candidate vaccines and therapeutics. But the World Health Organisation’s own modelling is clear: the window for preventing a catastrophic spread to South Sudan – and beyond – is measured in weeks, not months.
“Outbreaks like this affect entire health systems, not just individuals, and the impact goes far beyond Ebola cases alone,” Dr Bhadelia said. “These are not numbers, they are families and communities.”