In a cramped isolation ward in Butembo, doctors are now watching for a pattern that has become grimly familiar this year: a cluster of fevers today usually means a cluster of deaths within the week. Nine months into an outbreak that has already killed more people than nearly any Ebola epidemic in recorded history, the numbers released by Congolese health authorities on September 16 make one thing clear. This crisis is not slowing down.

The Democratic Republic of the Congo now has 7,404 confirmed cases and 3,577 deaths from Ebola disease caused by Bundibugyo virus, according to the country’s official situation report, cited by the European Centre for Disease Prevention and Control (ECDC). In just the 24 hours before that count was taken, 59 new cases and 32 new deaths were recorded, a pace that has held largely steady for months even as the international response has scaled up around it.

A Rare and Especially Lethal Strain

Most people who have followed past Ebola outbreaks know the virus by its most infamous form, the Zaire strain, for which the world now has licensed vaccines and treatments. This outbreak is different. It is being driven by Bundibugyo virus, a rarer species of Ebola that has appeared only twice before, in Uganda in 2007 and DRC in 2012, and for which no approved vaccine or specific therapy exists.

That gap in medical countermeasures helps explain why the case fatality ratio has held near 48 percent since the outbreak began, roughly one in every two confirmed patients has died. It also explains why health officials describe this as more than a humanitarian emergency. It is, as one WHO scientist put it, a live test of how the global health system responds when it has almost none of the tools it would normally reach for.

The outbreak was first detected in Ituri Province in May 2026, after DRC’s National Institute of Biomedical Research confirmed Bundibugyo virus disease following an alert about an unusually deadly cluster of illness in the Mongbwalu health zone. It was the country’s 17th Ebola outbreak since the virus was first identified in 1976, arriving just five months after the previous one had ended. On May 17, WHO Director-General Dr. Tedros Adhanom Ghebreyesus determined that the epidemic constituted a Public Health Emergency of International Concern, the organization’s highest level of alert short of declaring a pandemic emergency, a threshold he said the outbreak did not meet.

From that initial cluster, the virus has spread into 62 of DRC’s 167 health zones across seven provinces, stretching from Ituri through North Kivu, South Kivu, Haut-Uélé, Tshopo, Bas-Uélé and Sud-Ubangi. Ituri remains the hardest-hit province by raw numbers, but it is North Kivu that is now drawing the most anxious attention from epidemiologists.

Why North Kivu Is the New Flashpoint

“Although the response has been unprecedented in its scale, the epidemic continues to expand,” said Dr. Olivier le Polain, WHO’s unit head for epidemiology and analytics for response, in comments reported by UN News on September 15. He said his team is watching North Kivu closely, “particularly Butembo and Katwa,” where weekly case counts have reportedly doubled from around 100 to around 200.

Le Polain estimated the response would need “many, many months” to bring the outbreak fully under control, a sobering timeline for an epidemic the US Centers for Disease Control and Prevention has already called the second-largest Ebola outbreak ever recorded. At one point in August, tracking aggregators identified it as the fastest-growing Ebola outbreak on record, with the CDC noting the case count reached roughly 5,000 in its first 100 days alone, a pace it described in a MMWR report as unprecedented.

The virus did briefly cross into Uganda, where 20 cases were confirmed between May and June. That linked outbreak was declared over by WHO on August 25 after 42 days passed without a new case, a rare piece of good news in an otherwise grim year. Three cases were exported outside Africa during the outbreak, two American aid workers evacuated to Germany and a French humanitarian doctor repatriated to France in late June. All three have recovered.

The Money Isn’t There Yet

Behind the case counts sits a second, quieter crisis: funding. Julien Harneis, the UN’s Special Ebola Coordinator, told reporters this week that the $1.3 billion humanitarian response plan for the outbreak is less than half funded, at 49 percent, with roughly $1 billion more needed to sustain operations beyond the first six months.

“If we don’t have the resources, the epidemic will come back,” Harneis said, according to UN News. “It remains a deadly and massive epidemic.” He was blunt about what a funding shortfall would mean on the ground. “If you don’t provide the care, if you don’t finance the care, if you don’t provide the technical resources, then Ebola is a live enemy and will come back at us.”

That warning lands against a backdrop of compounding hardship in eastern DRC, a region already strained by conflict. UN officials say the outbreak is worsening hunger, keeping people away from health facilities out of fear of exposure, driving up maternal mortality, and interrupting HIV treatment programs for patients who need consistent care to survive.

Racing to Build Tools That Don’t Yet Exist

With no licensed vaccine or treatment for Bundibugyo virus, researchers have spent the past several months trying to build one in real time. In July, the EBO-PEP trial launched in DRC and Uganda to test obeldesivir, an oral antiviral developed by Gilead Sciences, as a post-exposure prophylaxis for people who have had high-risk contact with confirmed patients. It is the first trial of this kind of drug for any filovirus, led by DRC’s biomedical research institute alongside French and international partners. No results have been reported publicly yet.

A separate trial is testing whether the monoclonal antibody MBP134, combined with the antiviral remdesivir, can improve survival odds for patients already diagnosed, though outcomes from that trial have also not yet been confirmed. On the vaccine front, the Coalition for Epidemic Preparedness Innovations announced in June that it would accelerate development of three investigational Bundibugyo vaccines, including a candidate developed with the Oxford Vaccine Group.

Tedros struck a note of cautious optimism when the post-exposure trial launched, saying that “every breakthrough begins with hope” and that a successful outcome “could mark a major step forward in preventing Bundibugyo Ebola.” For now, though, supportive care rather than any approved drug remains the only tool available to doctors treating patients in Ituri and North Kivu.

What to Watch

The coming weeks will likely turn on two questions that have nothing to do with each other and everything to do with whether this outbreak keeps growing. The first is scientific: whether the EBO-PEP and MBP134 trials produce results showing any real protective or therapeutic effect, which would be the first meaningful medical countermeasure this outbreak has had access to. The second is far more mundane and, right now, arguably more urgent: whether international donors close the gap on a response plan that is still less than half paid for.

Until one of those things changes, the trajectory described by WHO’s own epidemiologists is likely to hold: an epidemic that keeps expanding despite an unprecedented response, with North Kivu’s Butembo and Katwa health zones the places most likely to determine what the next update looks like.