Ebola is spreading faster than responders can track it in eastern Congo, where health workers managed to follow up with barely one in five identified contacts in a single day.

Authorities in the Democratic Republic of Congo reported 83 confirmed infections, 746 suspected cases and 1,603 identified contacts as of May 21, according to the health ministry. Yet health workers were able to follow up with only 342 contacts that day — about 21% of the total under monitoring — according to ministry data released Friday.

The figures suggest the response is falling behind the outbreak itself, even as governments and international agencies ramp up emergency measures after the World Health Organization declared the epidemic a public health emergency of international concern on May 17.

The outbreak has now spread across three provinces including South Kivu, where officials confirmed a case this week near Bukavu, a major city near Congo’s border with Rwanda. Uganda on Saturday confirmed three additional Ebola cases tied to earlier infections, including a health worker, as authorities struggle to contain regional spread.

The epidemic is unfolding in “one of the most challenging operational environments possible,” the WHO’s emergency committee said Friday.

Congo stretches across an area about a quarter the size of the continental U.S. Large parts of the east are accessible only by rough roads, motorcycles or footpaths winding through forests and mountains. Armed groups control significant territory. Millions of people have been displaced by conflict.

Tensions are already surfacing around containment measures. Relatives of a man who died at Rwampara Hospital near Bunia, the capital of Ituri province, where the outbreak was first detected, clashed with health workers after authorities refused to release the body for burial because of infection risks, according to local media reports. Ebola treatment tents run by the aid group Alima were set on fire during the unrest, and six patients fled the facility, including three confirmed Ebola cases, according to reports from the area.

The outbreak is caused by the rare Bundibugyo strain of Ebola, for which there is no approved vaccines or antibody treatments. The virus appears to have circulated undetected for months in Ituri province before authorities recognized what they were dealing with.

Testing gaps

Health officials are now trying to track thousands of people who may have been exposed as infections spread through remote mining areas and urban centers including Bunia and Goma, cities with populations approaching 700,000 and 860,000 respectively.

The latest ministry figures suggest confirmed transmission is spreading beyond the gold-mining hub of Mongbwalu, initially viewed as the epicenter. While Mongbwalu remains the largest suspected cluster, confirmed infections are increasingly concentrated in surrounding health zones including Rwampara and Bunia.

Nyankunde, home to a major referral hospital serving about 200,000 people, has also emerged as a growing cluster, with 11 confirmed cases and 340 contacts under follow-up, according to the ministry.

The WHO warned that weak surveillance and laboratory capacity are hampering the response, noting that the GeneXpert diagnostic platform widely used during previous Ebola outbreaks can’t detect the Bundibugyo strain. Virus-specific PCR kits are also in limited supply, medical aid group Médecins Sans Frontières said this week.

Countries should rapidly expand laboratory testing, contact tracing and community outreach while negotiating “security corridors” to allow responders to safely reach affected communities, the WHO said in temporary recommendations issued Friday.

The Congolese government reported a positivity rate of almost 46%, suggesting many infections may still be going undetected.

Conflict zone

The outbreak is unfolding in one of the world’s most volatile regions, where armed groups control large areas, roads are poor and millions of people move between mining camps, towns and neighboring countries. An alliance that includes the Rwanda-backed M23 rebels announced its own Ebola response structure Friday in territory under its control, urging communities to cooperate with health workers and avoid politicizing the outbreak.

The risk inside Congo is now considered “very high,” while neighboring countries face a “high” regional threat, the WHO said. Uganda has tightened border controls and suspended passenger transport links with Congo after reporting five confirmed Ebola cases. Rwanda has also tightened screening measures and said Friday most foreign travelers who recently visited Congo will be denied entry, while returning residents will face mandatory quarantine.

The outbreak has also exposed growing concerns about the fragility of global outbreak-response systems after years of aid cuts and shifting political priorities.

Countries responding to the outbreak have requested about $319 million for emergency response and preparedness measures. About 84% would be earmarked for Congo and Uganda and the rest for neighboring high-risk countries including South Sudan, Jean Kaseya, Director-General of the Africa Centres for Disease Control and Prevention, said in a briefing Saturday.

Major funding needs include infection control, water and sanitation programs, case management, surveillance and logistics. Africa CDC also said it is partnering with India to deliver about 20 tons of medical supplies by Monday.

“We are running behind, we are not yet under control,” Anne Ancia, the WHO’s representative in Congo, said this week.

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(With assistance from Sonja Wind, Jessica Nix, John Tozzi and Janice Kew.)

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