标签： Africa

In the sweltering heat of Bunia, the epicenter of the Democratic Republic of Congo’s latest Ebola outbreak, one quiet act of service forms an unexpected backbone of the regional response effort. Arlette Basekawike, a volunteer with the United Nations World Food Programme (WFP), spends nearly every waking hour in a cramped open-air shed outside a local health facility, stirring large pots of food and planning menus for patients on the frontline of this public health crisis.

Clad in a protective pink bonnet covering her hair, Basekawike starts each day early, preparing porridge, fluffy omelets, and fresh bread for patients admitted to the Evangelical Medical Center. For afternoon and evening meals, she serves up seasoned fresh fish paired with fufu — the region’s beloved starchy staple made from mashed plantains — followed by ripe seasonal fruit. On a recent Monday, as she diced vegetables, potatoes and goat meat for a large batch of stew, she explained the quiet purpose that drives her work.

“Even though patients carry this terrible disease, a warm, good meal still lifts their spirits and helps them feel stronger,” Basekawike told the Associated Press. “And for the doctors and nurses working endless shifts, this food gives them the energy they need to treat patients and administer care. I’m here for them like a parent would be — I just want to make them feel as comfortable as possible through this.”

On paper, Basekawike’s work may look like a simple, unremarkable task. But public health officials say her contributions, and the work of the entire WFP nutrition team here, have emerged as critical support for a region grappling with the fast-moving spread of Bundibugyo virus — the rare Ebola species confirmed in eastern Congo back in May.

As of this week, the World Health Organization (WHO) has confirmed 321 total cases of Ebola disease across three eastern Congolese provinces: Ituri, North Kivu, and South Kivu, with 48 recorded deaths. Neighboring Uganda has detected nine cases and one fatality, prompting authorities to close the entire shared border between the two countries to slow transmission.

Long before this outbreak was declared, this already beleaguered region was grappling with one of the world’s most severe food insecurity crises. Years of ongoing armed conflict between government forces and rebel groups have displaced millions of people, leaving vast communities without reliable access to consistent, nutritious food. The emergence of Ebola has layered a new, deadly crisis on top of pre-existing fragility, creating a devastating cascade that the United Nations warns complicates every effort to contain the outbreak among a population already deeply strained by hardship.

“We operate in a region where huge portions of the population already face acute food insecurity tied directly to war and displacement,” explained Olivier Nkakudulu, head of WFP’s Ituri province operations. “These needs already existed — Ebola is just an additional crisis stacked on top of a crisis.”

Compounding these challenges, the already resource-strapped WFP now faces severe operational disruptions driven by major aid cuts from the United States and other key global donor partners. With global partners pulling back or reducing their funding pledges, the overall effort to contain the outbreak — which WHO has already classified as a Public Health Emergency of International Concern — has been severely hampered by the funding shortfall.

On top of funding gaps, responders also face persistent threats: attacks on health care workers by local residents suspicious of the outbreak response, and constant delays to aid delivery caused by ongoing fighting in the region have both worked together to slow efforts to curb transmission.

Even against these stacked obstacles, WFP and local health teams confirm they have managed to meet the basic nutritional needs of Ebola patients and frontline workers so far. Still, as case counts climb, that balance is becoming harder to maintain.

“Today we need to increase the volume of food we provide, because the number of patients has gone up,” said Esther Bao, a nurse and volunteer on the response team. She added that many patients, weakened by the progression of Ebola, require specialized, tailored meals that cannot follow a one-size-fits-all menu.

Unlike some more common Ebola species, the Bundibugyo virus has no approved vaccine or targeted treatment currently available. Care teams can only treat symptoms as they appear, but even that supportive care has yielded small victories: five patients have successfully recovered from the virus to date.

The scope of the outbreak continues to expand at an alarming rate. According to Congo’s Ministry of Health, what began with transmission limited to just three initial health zones has now spread to 22 affected zones as of last weekend.

To date, WFP has served 120 meals across four treatment facilities in a single recent Sunday, bringing the total number of meals provided since the nutrition program launched on May 28 to 404, according to Nkakudulu. But he stressed that the financial situation remains extremely precarious.

“Without additional emergency funding, we won’t be able to prioritize every suspected case for nutritional support,” Nkakudulu said. “We might be forced to only provide for some patients, and leave others with no food to help them through their treatment.”

This report was compiled by AP correspondents, with additional contribution from Adetayo reporting from Lagos, Nigeria.

Near the Sudan-Central African Republic border, in the sweltering, dust-choked Birao refugee camp, Maude Ahmad Fadala’s story of childbirth encapsulates a growing public health catastrophe unfolding across conflict-stricken sub-Saharan Africa. Weakened by typhoid after fleeing Sudan’s ongoing civil war, Fadala went into labor at the camp that offered no obstetric care, and she had no money to pay for transport to the nearest medical facility. Staggering along rough dirt roads, stopping every few steps to ride out crippling contractions, she eventually could go no further. “I gave birth in the street,” she recalled. “There was no doctor, no midwife, and no one holding my hand.”

Fadala’s experience is far from an isolated tragedy. It is one of hundreds of thousands of preventable maternal deaths recorded every year across sub-Saharan Africa, a region home to the world’s fastest-growing population and 70% of all global pregnancy-related maternal deaths – roughly 182,000 fatalities annually. Data from the World Health Organization confirms that nearly two-thirds of all maternal deaths worldwide occur in nations grappling with armed conflict or systemic fragility. For women like Fadala, who cross borders to escape war, the danger of dying in childbirth does not end when they reach safety; displacement itself amplifies risk at every turn.

Displacement strips pregnant women of access to routine prenatal care, forces dangerous multi-mile journeys to access even basic health services, and strains already depleted health systems in host regions. The United Nations estimates that women in the Central African Republic, one of the world’s poorest nations, face a maternal mortality rate of 829 deaths per 100,000 births – 40 times higher than the rate recorded in the United States. Years of internal conflict have gutted the country’s health infrastructure, leaving critical care concentrated almost exclusively in major urban centers. Despite the Central African Republic’s extensive gold reserves, one in three residents survive on less than $2 per day, and health services remain nonexistent for many communities in remote border regions.

In 2024, the Central African government acknowledged the depth of its maternal mortality crisis and announced a plan to increase funding for skilled birth attendants and reproductive care, but officials have not responded to requests for updates on the initiative’s implementation. What has worsened the crisis dramatically in recent years is sweeping cuts to humanitarian aid from the world’s top donors, led by the United States. In Birao, the border camp where Fadala now lives, all four local midwives who had received support from the United Nations Population Fund (UNFPA) lost their jobs last year, after the Trump administration cut all U.S. funding for the UN’s sexual and reproductive health agency.

Before the funding cuts, UNFPA operated four “safe birthing spaces” across Birao that served nearly 50,000 women, providing emergency transport for pregnant people to the local district hospital. All of those facilities have closed, along with two additional U.S.-backed health clinics. Across the entire country, UNFPA’s operating budget has been cut in half over the past two years, falling to just $6.5 million. Before the cuts, the agency was the sole provider of reproductive health supplies across Birao. “The risk of maternal death is going to increase if there is no solution,” said Victor Rakoto, UNFPA’s country director for the Central African Republic. U.N. data underscores this warning: conflict-affected settings like Birao account for six in 10 maternal deaths globally.

A visit to Birao’s understaffed district hospital – the facility Fadala was never able to reach – reveals the full scale of the crisis. On a recent workday, dozens of pregnant women waited shoulder-to-shoulder on hard wooden benches in sweltering, unventilated waiting areas, many having walked for hours or risked complications by riding motorbikes over rutted dirt roads to reach care. Birthing assistant Delphine Zanabe moves between patients nonstop, saying most refugee women only arrive when labor is already well underway, skipping the eight prenatal checkups recommended by the World Health Organization.

For displaced women, survival mode in unfamiliar territory compounds the existing barriers of generational poverty and limited education, all of which increase the risk of life-threatening complications during pregnancy and childbirth. The hospital’s maternity ward houses eight beds crammed into a room so small the mattresses almost touch, and the ward serves 70,000 local residents plus 22,000 Sudanese refugees. Twelve hospital staff members – most from the maternity department – have already lost their jobs due to aid cuts.

That staffing shortage has already had fatal consequences. Amna Adam Hessen arrived at the hospital the day before her labor, burning with malaria fever. Her unborn child was in a breech position, a complication discovered far too late because she had been unable to attend prenatal appointments. Rushed to the hospital by motorbike from the camp, Hessen suffered severe hemorrhaging during labor and lost her baby. As her mother fanned her in the suffocating heat the next day, Hessen writhed on a bare foam mattress crying out in pain. “Giving birth here is exhausting,” her mother said.

Clara Abessendé, one of the four unemployed Birao midwives, described the guilt of leaving her post as demand for care surged after Sudan’s war broke out in early 2023. After the conflict began, the number of pregnant women arriving at the hospital tripled, and staff quickly ran out of critical supplies including antibiotics and malaria treatments. “As a result, there were more cases of infant and maternal deaths,” she said. “The children born in my hands … I abandoned them like that.”

For women waiting to give birth, the uncertainty is crippling. Katidje Idrisse Tahire, a nine-month pregnant refugee who fled Sudan on foot four months ago, lost all her belongings to armed robbers at the border and has not seen her husband since they fled Darfur. Carrying one child on her back while leading two more to fetch water in the camp, Tahire said she constantly aches, feels exhausted and unwell, and has no way to pay for care when she goes into labor. “I don’t know if anyone will be there to help me,” she said. Currently, more than 40% of all births in the Central African Republic happen outside of medical facilities, a statistic that experts warn will only rise as more aid cuts take hold, turning avoidable complications into fatal outcomes for thousands of women.

As a rising tide of Ebola cases spreads across eastern Democratic Republic of the Congo (DRC), frontline health workers are locked in a desperate race against time to contain the outbreak, treat infected patients, and protect themselves from a pathogen with no targeted approved treatment. This current outbreak, caused by the rare Bundibugyo Ebola species, has already crossed provincial borders from its epicenter in Ituri to North and South Kivu, and even reached neighboring Uganda, fueled by early delays in case detection.

A rapidly spreading outbreak of a rare, lethal strain of Ebola, the Bundibugyo species, has sparked an urgent global push to develop targeted vaccines, with three leading research and industry groups racing to deliver viable candidates to stem a crisis that has already claimed nearly 250 lives. Public health experts warn this outbreak, which emerged undetected in a conflict-stricken region of the Democratic Republic of Congo (DRC) with severely limited healthcare infrastructure, could become the most devastating Ebola event on record, rivaling the 2014–2016 West African crisis that killed more than 11,000 people.

As of the latest update, more than 1,000 suspected Bundibugyo Ebola cases have been recorded in the DRC, with nine confirmed cases already detected in neighboring Uganda, raising fears of cross-border spread. Unlike the more common Zaire Ebola strain, for which an approved vaccine already exists, Bundibugyo is one of six known Ebola species that has only caused two documented outbreaks in history, and no licensed countermeasures currently exist for it.

The Coalition for Epidemic Preparedness Innovations (CEPI) is providing funding to all three ongoing vaccine development projects, with CEPI CEO Dr Richard Hatchett emphasizing that “every day counts” in the race to contain the virus. Each project leverages different cutting-edge vaccine technologies, many refined and proven during the global COVID-19 pandemic, to target the unique glycoprotein structure on the surface of the Bundibugyo virus.

The International Aids Vaccine Initiative (IAVI) is leading one effort, adapting the existing approved Zaire Ebola vaccine to target the new strain. Preclinical testing in non-human primates has already shown promising results: the modified candidate rapidly primes the immune system and delivered nearly 100% protection against Bundibugyo. IAVI president and CEO Dr Mark Feinberg noted that while early data leaves his team optimistic about the vaccine’s potential, the candidate currently remains seven to nine months away from entering human clinical trials, though researchers are working aggressively to shorten that timeline. Feinberg echoed widespread public health warnings, saying the outbreak “is clearly threatening to be as severe an outbreak as [the 2014–2016 West African event], if not even worse”, making vaccine development an urgent global priority. That assessment aligns with warnings from medical charity Médecins Sans Frontières, which has described the situation as “deeply alarming”, noting the outbreak has already produced more confirmed cases in its early stages than any previous Bundibugyo event.

A second candidate is being developed by US pharmaceutical giant Moderna, which is drawing on its mRNA technology that enabled rapid vaccine development during the COVID-19 pandemic. Moderna CEO Stéphane Bancel said the company would “move with urgency and scientific rigor to support the response and help bring a potential vaccine closer to the communities that need it most”.

The third candidate is being developed by the University of Oxford, which also adapted its established viral vector vaccine platform – first used at scale for COVID-19 – to create a new targeted Ebola vaccine. The Oxford team projects their candidate will be ready for human clinical trials in just two to three months, a significantly faster timeline than the IAVI project.

While all three candidates are designed to train the human immune system to recognize the Bundibugyo glycoprotein, they use distinct technological approaches: IAVI’s candidate uses a live, harmless engineered virus that displays the Ebola glycoprotein to teach the immune system to recognize the threat, while both Moderna’s mRNA vaccine and Oxford’s viral vector vaccine deliver a small fragment of genetic code that instructs the body’s own cells to produce the glycoprotein, triggering an immune response. Differences in how these technologies activate the immune system may impact the level of protection they provide or the number of doses required, so all candidates will require rigorous testing in human clinical trials to confirm safety and efficacy. The outbreak has already drawn widespread concern from global health bodies, with World Health Organization director general Dr Tedros Adhanom Ghebreyesus noting that a safe, effective Bundibugyo vaccine would not only help control the current crisis but also strengthen global preparedness for future outbreaks of this rare but deadly pathogen.