Ebola’s Female Toll Risks Being Missed by Gender-Blind Data, New Congo Report Warns

PHNOM PENH — Women account for roughly two-thirds of confirmed Ebola cases in the Democratic Republic of the Congo’s latest outbreak, but a new report warns the disparity risks being obscured by gender-blind health data and response systems that still fail to measure how epidemics affect women differently from men.

The report, published by Aries Consult and African Intelligence on May 27, argues the imbalance is not biological. Instead, researchers say women are disproportionately exposed because they are often the ones caring for sick relatives, preparing bodies for burial, and working frontline healthcare jobs where Ebola spreads through direct contact with bodily fluids.

“Gender-blind data produce gender-blind policy,” the report states.

“The virus does not select women; the division of labour delivers women to the virus,” it says.

The warning comes as Congo and neighboring Uganda struggle to contain an outbreak caused by the Bundibugyo strain of Ebola, a rare species for which there is currently no approved vaccine or specific treatment.

The World Health Organization declared the outbreak a Public Health Emergency of International Concern earlier this month after infections spread across eastern Congo and into Uganda.

According to the U.S. Centers for Disease Control and Prevention, Congo has reported more than 1,000 suspected cases, including more than 240 suspected deaths, while Uganda has confirmed cross-border infections linked to the outbreak.

The epidemic was first detected in Ituri province, a region already battered by armed violence, displacement, weak health infrastructure, and illegal gold mining operations.

Researchers say the outbreak likely began in the Mongbwalu health zone, a mining corridor where highly mobile labor networks and poor healthcare access complicated early detection efforts.

The outbreak’s origin in a gold-mining region also fueled early concerns that transactional sex networks could be accelerating infections among women. Mining towns across eastern Congo have long been associated with commercial sex economies that emerge around migrant labor camps, cash-based informal markets, and weak state oversight.

Researchers therefore examined whether sexual transmission could explain why women account for such a large share of Ebola cases in the current outbreak.

But the report concludes the evidence points elsewhere.

Caregiving and Burial Rites Became Transmission Routes

Instead, researchers argue the outbreak is spreading primarily through caregiving and funerary labor — roles overwhelmingly carried out by women inside households and communities.

“The skew is not an artefact of female biology but the predictable output of a gendered division of labour,” the report says.

The paper argues Ebola spreads most aggressively through close physical contact during severe illness, particularly when patients are vomiting, bleeding, or suffering severe diarrhea.

In many affected communities, women are expected to care for sick relatives before patients ever reach clinics or isolation centers.

Wives, mothers, daughters, and female relatives are often the first people exposed to infected bodily fluids inside households.

“Caregiving is thus not a background social fact but the proximate vector through which the household epidemic becomes a female epidemic,” the report states.

Drawing from decades of Ebola research across Central and West Africa, the paper says women have repeatedly accounted for a disproportionate share of infections in outbreaks stretching back to 1976.

“The recurrence of a female-tilted burden across four decades, settings, and viral species is nonetheless robust enough to demand a mechanism,” the report says.

Researchers say the same exposure pattern extends into formal healthcare systems.

Citing World Health Organization workforce data, the paper notes women make up roughly 70 percent of the global health and social workforce while holding only about a quarter of senior leadership positions.

“Global health is, in the WHO’s phrase, delivered by women and led by men,” the report states.

Women dominate nursing, cleaning, auxiliary care, and community health jobs that require prolonged physical contact with patients.

“In an Ebola ward, occupational segregation becomes an exposure gradient,” the report says.

According to the paper, the first known patient in the current outbreak was a health worker, while several healthcare workers reportedly died before authorities officially confirmed the epidemic.

Researchers say the danger continues after death.

Ebola remains highly infectious in corpses, and funeral preparation has historically played a major role in transmission during outbreaks across Central and West Africa.

Family members often wash, dress, and prepare bodies before burial, bringing them into direct contact with infectious bodily fluids.

In many communities, women traditionally prepare the bodies of female relatives.

“Where caregiving disproportionately exposes women to the dying, funerary custom then exposes them again to the dead,” the report says.

The paper argues international Ebola responses have repeatedly failed to adequately involve the women actually carrying out funeral preparations.

“The interventions addressed only to male community leaders will systematically miss the women who actually handle the bodies,” the report states.

Mining-Town Sex Networks Failed to Explain Female Cases

Researchers also examined whether sexual transmission linked to mining-town transactional sex networks could explain the outbreak’s female skew.

The report says documented sexual transmission of Ebola is real, but usually occurs later, after recovery, when male survivors continue carrying viral RNA in semen for months.

“The documented sexual pathway is real but directional, low-frequency, and temporally displaced from the acute phase,” the paper states.

Rather than driving the current outbreak, researchers argue sexual transmission is more likely to pose a future “tail risk” capable of causing scattered flare-ups after the main epidemic wave subsides.

To support that argument, the report compares the Ebola outbreak with recent mpox outbreaks in mining areas of eastern Congo, where sexual transmission was clearly linked to sex-worker networks and intimate contact patterns.

Researchers say the Ebola outbreak does not show those same epidemiological characteristics.

When disease spreads mainly through sexual contact in mining towns, the patterns are usually obvious in the data. Researchers say the current Bundibugyo Ebola outbreak does not show those same signs.

The paper warns, however, that little research currently exists on how long the Bundibugyo strain can persist in survivor body fluids, leaving major unanswered questions about future transmission risks.

“The duration, frequency, and infectiousness of Bundibugyo virus in survivor body fluids are therefore unknown,” the report states.

Sex-for-Jobs Scandal Haunts Ebola Response

Beyond infection itself, researchers warn Ebola outbreaks often trigger secondary harms that disproportionately affect women and girls, including rising gender-based violence, economic hardship, disruptions to maternal healthcare, school closures, and the collapse of informal livelihoods.

The report also revisits the 2018–2020 Ebola outbreak in eastern Congo, during which dozens of women accused aid workers and health officials of sexual exploitation and abuse.

A World Health Organization investigation later identified more than 80 allegations involving aid workers linked to the Ebola response, including rape accusations and “sex-for-jobs” schemes.

“Any honest account of the gendered burden of an Ebola epidemic in this region must therefore include the response apparatus as a potential vector of harm,” the report says.

Researchers are calling for stronger gender-focused surveillance systems, expanded protections for female caregivers and health workers, and culturally sensitive burial protocols designed around women’s actual roles inside communities.

The paper also urges authorities and aid agencies to strengthen safeguards against sexual exploitation during outbreak responses.

“None of these measures is novel,” the report concludes. “Their persistence on the agenda is the clearest evidence that the gendered architecture of contagion is not a feature of any single virus but of the social order through which all of these viruses move.”

For the report’s authors, the latest Ebola outbreak is exposing far more than weaknesses in public health systems.

It is exposing the unequal structures of care, labor, and power that determine who absorbs the greatest risks when epidemics strike.