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The World Health Organization (WHO) announced Wednesday that the ongoing deadly Ebola outbreak in the eastern Democratic Republic of the Congo (DRC) has likely been spreading undetected for months, updating its official risk assessment as high for the DRC and neighboring regions but low for the entire globe.

Current investigations into the origins of the outbreak — which was formally declared last Friday — are still ongoing, but WHO officials say early evidence points to the virus circulating unreported for a significant period. “Given the scale, we are thinking that it has started probably a couple of months ago,” Anais Legand, a WHO technical officer specializing in viral haemorrhagic fevers, told reporters during a press briefing in Geneva.

Ebola, a severe viral haemorrhagic fever first documented in 1976 and linked to bat reservoirs, has claimed more than 15,000 lives across Africa over the past 50 years. This marks the 17th Ebola outbreak recorded in the DRC, and already, health officials are tracking roughly 600 probable cases with 139 suspected deaths. WHO Director-General Tedros Adhanom Ghebreyesus warned that these numbers are almost certain to rise in the coming weeks, noting that the extended undetected circulation of the virus gives it a head start on containment efforts.

Multiple challenges are complicating the global health body’s response to the crisis. The outbreak is centered in hard-to-access regions of Ituri province, an area long disrupted by armed conflict that limits access for medical teams and contact tracers. Additionally, the outbreak is caused by the rare Bundibugyo Ebola strain, which is not detected by standard diagnostic tests designed for the more common Zaire strain, delaying confirmation of cases.

Over the weekend, Tedros declared the outbreak a Public Health Emergency of International Concern (PHEIC), the second-highest alert level under the binding International Health Regulations (IHR) that triggers coordinated international emergency response. Despite this escalation, Tedros emphasized that the outbreak does not qualify as a pandemic at this stage. “There are several factors that warrant serious concern about the potential for further spread and further deaths,” he noted, but confirmed the WHO’s formal risk assessment: high at national and regional levels, low globally.

The European Commission echoed this assessment, stating that the risk of Ebola transmission within the European Union remains “very low” and that no special protective measures are currently recommended for EU residents. So far, the WHO has not implemented mandatory international travel restrictions, only advising that confirmed cases and known contacts avoid travel. However, a number of countries have moved independently to implement border controls and screening. The United States announced this week that it would begin screening air passengers arriving from affected regions and suspend routine visa services, though it granted an exception for the DRC national football team ahead of their World Cup qualifying match in the U.S. Bahrain has gone further, enacting a 30-day entry ban on visitors arriving from the DRC, South Sudan and Uganda.

As of Wednesday, just 51 cases have been confirmed via laboratory testing, as the remote location of most outbreaks limits access to sample collection and processing. Two confirmed cases have been recorded in the Ugandan capital Kampala, one of which ended in death, and an American citizen working in the DRC tested positive before being transferred to Germany for treatment. Retracing the outbreak’s origins, the first reported symptomatic case was a nurse who presented at a Bunia, Ituri health facility on April 24, but the epicenter of the outbreak is now confirmed to be roughly 90 kilometers away in Mongbwalu, where public health officials believe the virus first began spreading. The WHO first received an alert about an unusual cluster of lethal illness on May 5, and the first positive Ebola test was returned on May 15.

In Wednesday’s briefing, Tedros pushed back against criticism from United States officials over the speed of the WHO’s response. The U.S., which initiated withdrawal from the WHO during the Donald Trump administration, had faced accusations from Secretary of State Marco Rubio that the organization was “a little late to identify this thing.” Tedros countered that the criticism stems from a “lack of understanding of how IHR work, and the responsibilities of WHO and other entities. We don’t replace the countries’ work, we only support them,” he explained.

A deadly Ebola outbreak has spread across hard-to-reach regions of eastern Democratic Republic of the Congo, leaving local communities and healthcare workers severely underprepared and facing a growing crisis as aid efforts move at a glacial pace. Rwampara, one of the outbreak’s current epicenters, illustrates the crippling gaps in the early response: at the area’s main hospital, a flimsy plastic strip is the only marker for a planned isolation ward that has yet to be constructed.

This outbreak marks the 17th recorded flare-up of the highly contagious haemorrhagic fever in the DRC, and it has hit a region already destabilized by decades of armed conflict and widespread displacement. Even though Rwampara sits just 7.5 kilometers from Bunia, the largest city in violence-ravaged Ituri province, critical supplies for isolating and treating Ebola patients only began arriving on Monday, several days after the outbreak was officially declared.

At the hospital entrance, a single masked guard struggles to monitor all visitor traffic. A small number of handwashing basins have been set up outside the blue-painted facility, which a local official confirms is already caring for around 100 suspected Ebola cases. Before Friday, even nursing staff on the front lines lacked full personal protective equipment (PPE) — and local residents performing high-risk tasks are far more exposed. Salama Bamunoba, a local youth organization representative, explained that community members have been digging and filling graves for Ebola victims without gloves or any protective gear at all.

The current outbreak is caused by the Bundibugyo strain of Ebola, for which no targeted vaccine or specific antiviral treatment exists. Congolese authorities have reported that over 130 people are already suspected to have died from the virus, with containment efforts relying almost entirely on basic preventive measures and rapid case identification. Bamunoba called the government and its international partners out for significant delays, noting that establishing a proper triage and isolation zone has been the community’s top priority for days, with little action to show for it.

Despite the escalating crisis, daily life continues on the dusty streets of Rwampara for the moment: markets remain open, motorcycles move through crowds, and schools have not been closed. But anxiety is rapidly spreading across Rwampara and surrounding villages, which are already home to more than a million permanent residents and tens of thousands of people displaced by ongoing conflict. Local resident Gims Maniwa said many residents initially dismissed the outbreak as a minor threat, but the situation has deteriorated quickly. “Here, in Congo, a lot of things are done carelessly and that’s not good,” he told reporters.

Congolese officials have pushed back against criticism, with Health Minister Samuel Roger Kamaba claiming authorities already have all the supplies frontline healthcare workers need. The government’s spokesperson also emphasized this week that the DRC has decades of experience responding to Ebola outbreaks, most of which have been managed without widespread vaccine access. The country’s deadliest recent outbreak, which struck eastern DRC between 2018 and 2020, killed nearly 2,300 people out of more than 3,500 confirmed cases.

In recent days, aid has finally begun moving into the affected region. At Bunia’s airport, dozens of World Health Organization (WHO) staff in high-visibility vests have been unloading 12 tonnes of medical supplies from cargo planes, including protective kits and temporary isolation tents, which the organization confirmed had arrived this Tuesday. Aid group Medecins Sans Frontieres (MSF) has also stockpiled tonnes of supplies, including critical PPE for frontline teams, in its Bunia warehouses.

The response effort is facing headwinds from broader aid cuts, however. International funding for humanitarian work in the region has dropped sharply over the past year, particularly from the United States following Donald Trump’s return to the White House. Even with the new supply delivery, Trish Newport, MSF’s emergency programme manager, said the situation remains extremely strained. “Every facility our team called said: ‘We are full of suspect cases. We don’t have any space’,” Newport explained. “This gives you a vision of how crazy it is right now. What is really important is that we get material on the ground as quickly as possible,” she added, noting that the arrival of PPE will be a huge relief for overstretched staff.