How conflict in Congo, Sudan and Yemen is fueling disease
D’zirava Lety sums up the hopelessness of her situation in just a few words: “There is no water. In the entire camp, there is only one tap. Another challenge is the lack of toilets. Children relieve themselves anywhere. With the disease that has arrived, we are being told to wash our hands, but there are no hygiene kits. And when we go into town to sell our products, people push us away, saying that we are carrying diseases.”
Lety lives with 20,000 other internally displaced people (IDPs) at the Kigonze camp on the outskirts of Bunia in eastern Democratic Republic of the Congo(DRC). They fled the violence of the many rebel groups that have destabilized the region for decades. But now they face a new threat: Camp officials told DW that in June the Ebola virushad been detected for the first time amid people who had died. “Since Ebola arrived, we have been recording up to six deaths a day,” said camp chairman Étienne Ndrutsi.
How conflicts speed up the spread of disease
The rare Bundibugyo strain of the virus has been circulating in the area since at least April, according to experts. Shortly after the outbreak was identified in May, the World Health Organization (WHO) declared a public health emergency. By mid-July, DRC had recorded 1,963 confirmed infections and 719 deaths, while neighboring Uganda reported 20 cases and two deaths. The WHO estimates, however, that only one in two cases — and maybe as few as one in four — is being detected.
In eastern DRC, ongoing armed conflict is hampering efforts to contain the outbreak. At the same time, the virus is able to spread more easily because people such as D’zirava Lety are living in overcrowded displacement camps or are forced to move from place to place, accelerating transmission.
“Health workers, treatment centers, laboratories, ambulances, medical supply routes must always be protected from military interference and political competition,” said Juste Codjo, a former officer in the Beninese army and a security researcher at Kean University in the US state of New Jersey.
“International humanitarian law protects access to health care during armed conflicts, but the reality is that these legal obligations must be reinforced through practical negotiations with every actor controlling territory in the conflict zone,” Codjo told DW.
The overlap between conflict and disease is part of a larger global pattern. In war-torn Yemen, aid groups and authorities have spent the past decade battling recurring cholera outbreaks. Likewise, the cholera epidemic in Sudan, which has claimed more than 3,500 lives since 2024, has been linked to the country’s ongoing civil war. This is partly due to warring parties severely restricting humanitarian access to outbreak response efforts.
History also offers examples of approaches that can help halt the spread of disease. During the civil war in El Salvador (1980–92), the warring sides agreed on three one-day ceasefires to allow aid organizations to carry out safe vaccination campaigns against several childhood diseases.
In DRC, however, calls for ceasefires to help curtail the spread of Ebola have so far gone unanswered.
The pattern of past outbreaks: First attacks, then more infections
When eastern Congo was hit by another devastating Ebola outbreak in 2018, US researchers documented a clear correlation between violence and the spread of the virus. Several cases showed the same pattern: Rebels attacked a location or health center. Contact tracing and vaccinations for people exposed to the virus then broke down. Following this, local case numbers rose significantly.
In the city of Beni, each infected person transmitted the virus to an average of 0.8 others after the vaccination campaign began, according to the study — meaning transmission gradually declined. After a rebel attack, however, the reproduction number (RO value) rose again to 1.9, meaning each infected person was temporarily infecting nearly two additional people. As the impact of the violence subsided, the ratio fell again, reaching 0.72 by November 2018.
The threat was exacerbated by certain residents alarmed by conspiracy theories. In this remote region, access to health care is something many people rarely experience outside acute crises, which fuels skepticism about the health workers in protective gear. Against this backdrop, experts repeatedly call for trust-building measures, including efforts led by local community figures or faith leaders.
Ebola as a political tool for rebel groups
The epicenter of the current outbreak is Ituri province, where various militias and the Congolese army are fighting for control. But cases continue to be reported in neighboring areas — including farther south, where the rebel coalition AFC/M23 has seized large territories since early 2025. The group appears to be pursuing a strategy of building its own institutions and strengthening its long-term leverage over the government in Kinshasa, the capital of DRC.
That includes Ebola response efforts. When the first cases were reported in areas under its control, the AFC/M23 rebels established an emergency zone and increased testing. Rwanda is also providing support, according to a Reuters report, although Kigali continues to officially deny widely documented allegations that it backs the rebels. The WHO, pragmatically, is cooperating with them.
The Health Ministry in Kinshasa has reportedly been largely sidelined, but it continues to receive data and test results from the areas concerned. While transmission continues to rise in Ituri, AFC/M23 said in late June that the local outbreak in the territories it controls had been contained.
Security expert Juste Codjo also does not rule out that the political standing of the rebels could be boosted because of their management of the epidemic, and warns that both they and the government could seek to monopolize aid. “They should not allow concerns about political optics to obstruct life-saving assistance. Public health cannot be held hostage to a legitimacy contest,” he said. “Assistance must be carefully depoliticized, monitored and delivered through neutral intermediaries.”
Reporting from Kigonze: Markus Loïka
This article was originally published in German.