DRC: “Children are paying the price for gaps in the Ebola response”

In this long read, she describes the high rate of child mortality she has seen and the limited measures taken to protect children.

More than 4,000 people have died in the DRC since the Ebola outbreak was declared on 15 May 2026, out of over 9,000 confirmed cases.

As the disease continues to spread, Médecins Sans Frontières / Doctors Without Borders (MSF) teams are responding in the affected areas of Ituri, North Kivu, and Haut-Uélé with eight Ebola treatment centres.

I arrived in Butembo, a city in North Kivu, in mid-August 2026 for an assignment of nearly six weeks as a paediatrician with MSF. In 2014, I worked as an epidemiologist for another organisation in Guéckédou, Guinea, at the epicentre of the Ebola outbreak that struck West Africa.

Until this year, I had never been involved in the paediatric care of children with Ebola in a treatment centre. Most importantly, I had never witnessed such high child mortality. It was the most difficult assignment I have ever undertaken.

Around thirty children were admitted over the summer to the Kitatumba Treatment Centre in Butembo, managed by the Ministry of Health and supported by MSF. Twenty-four of them died. Their average age was seventeen months, including several newborns. I was involved in the care of three seven-year-olds and one six-year-old. All the others were under the age of five. 

Looking at the data

I remember hearing one sentence repeatedly during my assignment: “These children arrive very late; their parents should have brought them sooner.” Yet these children had already been hospitalised in several facilities during the days or weeks before their admission to the Ebola treatment centre.

I reviewed the investigation records of children who had previously been treated at the centre, as well as those I cared for myself. For over 82 percent of children under five, nobody else in the family was sick. Not the parents, not the grandparents, not the older siblings who attended school. These were often large families with four, five or six children. Only the youngest child had Ebola.

Some colleagues suggested a possible explanation for these isolated cases within a family: perhaps the parents had been vaccinated during a previous outbreak in 2018 and had retained immunity ever since. But then why were the older siblings not infected? 

The only common factor was that all of these children had been admitted to multiple healthcare facilities before arriving at our centre. A health post, then a clinic, then a hospital, for example. They were usually being treated for common illnesses such as malaria, pneumonia, diarrhoea, or vomiting.

At the same time, we were receiving healthcare workers infected with Ebola who had come from these very same facilities. I know that many of these places do not always have gloves available, or even water and soap for staff to wash their hands between consultations.

This is not a scientific study, of course. I worked only in the Kitatumba Treatment Centre in Butembo and I am speaking only about the children who reached us. Community transmission is widespread and must be tackled, because that is how chains of transmission are broken.  

Many children are probably dying at home alongside sick relatives. But for the children I treated, no other explanation made sense. I believe they were infected in healthcare facilities, just like the healthcare workers employed there.

Until health facilities at every level have stronger infection prevention and control measures for both patients and staff, Ebola will continue to spread within them. 

Caring for the children

We were sometimes advised to entrust children to adult patients, but most adults were too ill even to sit up or drink unassisted and could not care for an energetic toddler.  

Only one survivor, a woman in her thirties who had no connection to the children or their families, agreed to enter the ward. She cared for a newborn for two weeks, then for a fifteen-month-old child for four days before leaving.

For the Zaire ebolavirus, which affected the DRC between 2018 and 2020, we had extensive data on survivors. With the Bundibugyo ebolavirus which has caused this outbreak, however, we do not know whether someone who has recovered and is later heavily exposed can become sick again. The team explained this uncertainty honestly to the survivor who agreed to care for the children.

It was extremely difficult to stay with the children because, for safety reasons, healthcare workers cannot wear protective equipment for more than one hour at a time. There were occasions when I had to wait an hour before being able to enter, and then another thirty to forty-five minutes to remove my protective gear because there was only one designated area for doing so.

During my final two weeks, the treatment centre was operating at almost 100 percent capacity. To ensure that someone could remain continuously with the children, we would have needed at least twenty-four staff members per day able to enter the high-risk zone.

Many children died alone. That is why it is essential to take their needs into account when considering the next steps, whether in treatment development, clinical trials, or any other initiative involving children. Too often, children and pregnant women, who are the most vulnerable groups, are excluded from vaccine trials. Like many others, I refer to them as “therapeutic orphans.”

Distrust of healthcare workers

Throughout my career with MSF, palliative care has always been one of my priorities. In Butembo, however, it was almost impossible to provide.

Health centres have been burned down in other towns, and I was told this often happened after children had died. Rumours circulated that healthcare workers were being paid to kill patients. Some colleagues even requested that their names be removed from their protective suits. Instead, labels such as “Nurse 1,” “Nurse 2,” and “Doctor 1” were written on them because they feared reprisals.

In such an atmosphere, telling parents who already struggle to believe Ebola exists, “We are going to relieve your child’s suffering,” can sound as though we are giving up on their child. In many cases, I did not even raise the subject. When possible, I would simply say: “I need to prepare you, and I am deeply sorry, but your child is unlikely to survive the night. Please call as many relatives as you can.”

The Congolese healthcare workers I worked alongside were highly skilled, but most of them had little experience in paediatrics. They treated children like small adults, and that was not their fault. Either they weren't trained to care for children, or they didn't have the appropriate treatments available. Also, they are often not paid on time. And they risk their lives every day. 

Three critical practices that can reduce mortality

I focused on three simple but critical practices:  

1. Using paediatric intravenous infusion sets rather than ones used for adults which can deliver twenty to eighty times too much fluid to a child.  
2. Treating hypoglycaemia with 10 per cent glucose rather than 50 per cent, which can damage veins.  
3. Administering oxygen properly.  

As I implemented these practices over the weeks, I earnt my colleagues’ trust.

There are very few organisations capable of managing Ebola patients in North Kivu. Over time, local communities came to trust us more and brought us their sick relatives, both adults and children.  

One of the most important measures for stopping an outbreak is isolating patients. We also train healthcare workers. A mental health team operates inside the high-risk zone. And we provide our Congolese colleagues with the protective equipment they need.

Mortality has declined, but despite all these efforts, not yet to a significant extent.