Dr Minga Mbweck Kongo*
The growing political and socio-environmental pressure on President Félix Tshisekedi raises a question that extends far beyond the DRC: when does this pressure become a legitimate mechanism of democratic accountability, and when does it risk destabilising democratic institutions?
Poor sanitation and living conditions—which prompted Tshisekedi to make a surprise visit to the Zando market (Grand Marché) on 23 May 2026—leave the population highly vulnerable to epidemics, including the Ebola outbreak confirmed in both the DRC and Uganda and officially declared on 15 May 2026. This outbreak involves the Bundibugyo strain of the virus. While vaccines exist for the prevalent Zaire ebolavirus, the Bundibugyo strain currently has no approved vaccine or targeted treatment.
Urban challenge and mobility
The severe water and sanitation crisis in the DRC is exacerbated by the state utility, REGIDESO, which struggles to meet demand. This lack of clean water infrastructure forces citizens to rely on unprotected sources, fuelling waterborne diseases. Although Ebola is not a waterborne disease and is not spread through drinking water or properly handled food, water, sanitation, and hygiene (WASH) are critical during an outbreak, as the virus can persist in environments such as wastewater for days.
This crisis is compounded by the outbreak unfolding in a remote, densely populated, and insecure region. The DRC, already facing a humanitarian crisis, is experiencing high levels of cross-border trade, mining, and population displacement, increasing the risk of transmission within the DRC and into neighbouring Uganda. To control the spread of the disease, the World Health Organisation (WHO) is ramping up support by focusing on surveillance, contact tracing, clinical preparedness, supply chain management, and cross-border cooperation. However, because inadequate water and sanitation infrastructure limit basic hygiene, engaging the local community remains the most essential defence against the spread of the virus.
Global and national health
Compared with the certainties of the Cold War nuclear stalemate, it is argued that we now live in a different world, where health is increasingly challenged by the growing interconnectivity of contingent global events. The idea of ‘Global and national health’ is now grounded in the principle of uncertainty. Because the past has not fully equipped the DRC health system to address today’s emergent, unforeseen, and networked threats, the Congolese remain constantly exposed and unprepared. Keeping populations healthy is harder than ever, as the country faces a minefield of unpredictable viral mutations, expanding wars, and sudden pathogen spillovers. To build genuine resilience, global health frameworks must move from rigid, reactive containment models to adaptive systems that empower local populations through sustainable, everyday infrastructure.
Clinical and scientific lacunae
Because the Bundibugyo ebolavirus is a rare strain, medical teams face significant clinical and scientific knowledge gaps. Without approved vaccines or specific therapies explicitly targeting this strain, frontline protocols, such as post-exposure prophylaxis or investigational vaccine trials, rely heavily on operational reasoning and on-the-ground adaptations rather than pre-existing, large-scale clinical evidence.
The Interconnected Crises
The war in the eastern DRC, driven by M23/AFC, backed by the Rwanda Defence Force (RDF), regional geopolitical tensions, and the illicit exploitation of mineral resources, has created a humanitarian crisis. When violence erupts, thousands of civilians are forced to flee into overcrowded settlements. In these displacement camps, clean water is scarce, making basic preventive measures such as handwashing nearly impossible.
The government’s responsibilities are often complicated by humanitarian, conflict, and security issues, particularly in the eastern provinces. Armed conflicts often prevent medical teams from safely isolating the sick, severely hampering the government’s ability to enforce containment. WHO Director-General Tedros Adhanom Ghebreyesus has expressed concern that eastern DRC is facing a heartbreaking convergence of disease and conflict. The ongoing Ebola outbreak is overwhelming response efforts, highlighting the urgent need for continued support and solidarity. Health workers and treatment centres have frequently faced violence and intimidation from armed groups and from communities that are highly mistrustful. As a result, critical public health measures—such as safe burials, contact tracing, and ring vaccinations—are often delayed.
Actionable Solutions to Build Resilience
To overcome these structural and health challenges, several concrete, systemic solutions can be implemented:
- Decentralised WASH Initiatives: Because the state utility (REGIDESO) cannot reliably meet demand, international NGOs (such as UNICEF) and local governments must prioritise decentralised solutions. This includes point-of-use chlorination tablets, communal boreholes, and protected spring systems.
- Community-Led Health Education: Building local trust is important for controlling outbreaks. Employing trusted local leaders, religious figures, and community health workers to explain safe and dignified burial practices and early symptom reporting is crucial when treatments are limited.
- Cross-Border Surveillance & Trade Hub Screening: Because of porous borders and high cross-border trade, authorities in the DRC and Uganda must establish coordinated, minimally disruptive screening protocols at key transit points (like Goma and Bunia).
- Accelerated R&D and Clinical Support: Welcome and the Coalition for Epidemic Preparedness Innovations (CEPI) continue to drive Research and Development, but local clinical networks require immediate support to scale up supportive care (e.g., intravenous fluids and symptom management) to reduce high case fatality rates.
- State of consciousness: Raising public consciousness about good sanitation is a critical health intervention. It requires targeted, context-specific education that links hygiene practices to community health. Sustainable behaviour change relies on shifting social norms and addressing practical barriers—such as access to clean water and adequate facilities—rather than just sharing information.
*Dr Minga Mbweck Kongo is a Social and urban Water Consultant
An informative piece, well done Doc!