DRC: Children, disproportionately affected yet left behind in the current Ebola outbreak response

Children are paying a devastating price in the Ebola outbreak unfolding in northeastern Democratic Republic of the Congo (DRC). While children face a higher risk of death from Ebola than adults, they also represent a significant proportion of those affected by the current outbreak. According to Epicentre, MSF’s epidemiological research centre, nearly one in four confirmed Ebola cases in North Kivu is a child. Médecins sans Frontières (MSF) is deeply concerned by the disproportionate impact of the disease on children and calls for more attention to their specific vulnerabilities in both the medical and research response.

While Ebola remains a deadly disease for all age groups, the youngest children face the highest risk of death. In North Kivu, children have been particularly affected by the current outbreak: 24% of confirmed cases are among children under five years of age, compared with 13% in Ituri, while infants under one year old account for 13% of cases, compared with 6% in Ituri. At the Ebola Treatment Centre (ETC) in Butembo, North Kivu, MSF teams have observed that the case fatality rate among children was particularly high. Between June and September 2026, 24 out of 30 children—most of whom under the age of five—died from the Bundibugyo virus in this ETC alone. The rapid progression of the disease in communities and limited access to specialised care at health facility level are contributing to such alarming high fatality rates. ​

“Primary health facilities often lack the specialized expertise, equipment, and infection prevention and control measures needed to identify and safely manage suspected cases,” explains Stéphanie Hoffmann, project coordinator for MSF in Butembo. “Most of the paediatric cases admitted in our ETC in Butembo, North Kivu, over the summer, had already been hospitalised for other illnesses in several facilities during the days or weeks before their admission. Their family members did not have Ebola themselves, and it is highly likely that these children contracted the disease inside healthcare facilities.” Strengthening infection prevention and control (IPC) measures in health facilities, ensuring the availability of personal protective equipment (PPE), and reinforcing the training of healthcare workers in non-Ebola health centres across at-risk areas are critical to maintaining essential services while preventing healthcare-associated transmission.

While efforts have been made to reduce the emotional toll of isolation on children in ETCs, including the creation of visibility areas where parents can see and communicate with their hospitalised children, being admitted to an Ebola Treatment Centre remains a deeply distressing experience for young patients. Children may be too young to understand their situation or meet their own basic needs. To help address this situation, MSF has recruited and trained caregivers who provide daily support and comfort to children inside several MSF-supported ETCs while wearing full personal protective equipment (PPE). These caregivers come from diverse backgrounds, including but not limited to Ebola survivors. Today, 13 caregivers are supporting children at Kitatumba Ebola Treatment Centre in Butembo. While far from a perfect solution, this initiative provides essential human contact and emotional support for children facing the outbreak.

"On top of enormous challenges caring for young patients, medical facilities are dealing with a lack of paediatric dosing guidance, and limited availability of child-friendly formulations of investigational medicines. A child-centred approach must be at the heart of medical care, operational planning, and research efforts", said Dr. Guyguy Manangama, epidemiologist and deputy director of operations at MSF.

Children have been disproportionately affected by the current outbreak, yet they are left behind when it comes to access to innovative medical tools. Historically, children are often excluded from clinical research or included only after significant delays, creating dangerous gaps in evidence and access to potentially life-saving interventions. ​

"Treatments, vaccines, and other preventive tools should be evaluated for use in children from the outset of research efforts and made available to them without delay. Yet in the current outbreak, children are still being left behind, with very limited access to vaccination trials and campaigns, as well as the latest therapeutic innovations despite bearing a significant burden of disease. Children cannot continue to wait for data generated in adults before benefiting from advances in Ebola care and prevention," added Dr. Guyguy Manangama. ​

MSF urges national authorities, research institutions, pharmaceutical developers, and international funders to prioritise the inclusion of children in all ongoing and future Bundibugyo virus studies. Ensuring equitable access to research and new medical tools, including vaccines, is essential to reducing preventable deaths and improving outcomes for one of the most vulnerable groups.

The impact of the outbreak on children extends beyond Ebola infection itself. Disruptions to essential health services can rapidly increase risks from vaccine-preventable diseases, malnutrition, and other common childhood illnesses. Preserving routine immunization, nutrition programmes, and access to primary healthcare must therefore be considered a core component of the outbreak response, not an afterthought. ​

Note to editors:

Treatment: One ongoing study, EBO-PEP, is evaluating an oral antiviral drug, obeldesivir, to prevent Ebola infection after high-risk exposure. If proven effective, the treatment could provide a practical way to protect people who have recently been in contact with an Ebola patient. While the trial is expected to expand eligibility to include some children, those under 20 kilograms remain excluded because an appropriate paediatric formulation is not yet available.

For the youngest children, the current alternative involves a 10-day course of intravenous treatment, an approach that is particularly difficult to implement in outbreak settings and can be especially challenging for young patients and their caregivers. More information here: An urgent opportunity to ensure children's access to oral post-exposure prophylaxis trials for Bundibugyo virus disease - The Lancet Child & Adolescent Health

Vaccination: While the results of ongoing trials evaluating vaccines specifically designed for the Bundibugyo virus are not expected for several months, ERVEBO® is an immediately available option. Its safety profile is well established, it is approved for use in children aged one year and older, and health authorities in the DRC have extensive experience deploying it in outbreak settings. Emerging evidence also suggests that it may offer some protection against the Bundibugyo virus, although the degree of protection remains to be clarified. In areas at high risk of Ebola transmission, vaccinating contacts of confirmed cases, including children over one year of age, could help prevent severe illness and save lives.