Effective response depends on cooperation with communities and frontline workers, writes Zaeem ul Haq

The current Bundibugyo Ebola outbreak in the Democratic Republic of the Congo (DRC) and Uganda is exposing dangerous gaps in global health security. Experts warn that, amid the aid cuts and ongoing conflict in the region, the outbreak could become one of the deadliest Ebola epidemics to date. In the absence of an approved vaccine, the main tools for control are trust, community collaboration, and systemic empathy.

Systemic empathy describes how health systems care for people, including their own staff. It prevents stigma, which can catalyse a vicious cycle of contagion. In a stigmatised environment, symptomatic people and their families often avoid medical care out of fear of discrimination, forced isolation, and the denial of proper burial rites. At community level, the abrupt enforcement of coercive or heavily militarised measures intensify stigma, fuel rumours, and undermine cooperation.

The arson of an Ebola treatment centre in Rwampara, DRC, on 21 May 2026 is an example of how rapidly mistrust can destabilise response efforts. By contrast, keeping people informed about the risks of Ebola infection and adopting community centred approaches in the outbreak response improve trust and enhance participation in prevention and healthcare.

Collective government and community support for frontline health workers is equally important. In previous Ebola outbreaks, as well as the covid-19 pandemic, frontline workers were let down by instances of delayed or inadequate supply of personal protective equipment, failure to protect them from hostility, and unfulfilled promises of financial and emotional support. Frontline workers are the only defence between populations and the virus. A rift in frontline workers’ motivation can start a chain reaction of mistrust and stigma, disrupting the entire response.

With communities, it is vital to show that Ebola protocols are protective, not punitive. Steps can be taken to reduce tensions while preserving infection prevention and control standards. For example, building community care centres for patients awaiting test results—where families can monitor their loved ones from a safe distance—increases the likelihood that families will consent to patient isolation in specialised Ebola treatment units. Maintaining communication between patients in isolation and family through digital technologies and regular updates can further reduce the fear associated with treatment centres.

Safe and dignified burial involves informing the families at each step. Respecting religious practices, engaging families in customary prayers after the burial, and ensuring infection prevention throughout the process has proven more sustainable than rigid models that exclude families. If the deceased is a female, a trained female staff or family member should prepare the body for burial using full protective equipment.

Community engagement in outbreak settings should extend beyond traditional leadership structures to include women and young people, who are often central to caregiving and community mobilisation but remain excluded from decision making processes. The Rwampara incident is a stark example of the consequences of disengagement. The man who died was a popular footballer whose mother believed he had typhoid fever, and the crowd, upset by his death, reportedly believed the virus was a hoax.

To support frontline workers, it is critical that government and partner organisations are seen to fulfil their commitments rather than making empty promises. Health workers are already operating under extreme psychological and physical stress arising from exposure risk, shortages of protective equipment, insecurity, community hostility, and the deaths of colleagues. Government and health agencies must prioritise adequate protective equipment, psychosocial support, security arrangements, fair financial compensation, and meaningful community partnership through outreach activities.

Support and protection of frontline workers is especially important in areas such as Ituri province, DRC, where sustained conflict and insecurity complicate the outbreak operations.9 This needs to be balanced, since excessive militarisation of Ebola responses may itself erode public trust by creating perceptions that health operations are aligned with political or armed actors. Community-supported and locally negotiated protection mechanisms—such as engaging local volunteers in providing security to health workers moving to and from their health post—may be more effective than overt displays of force.3

In the absence of a licenced vaccine specifically for Bundibugyo Ebola, a community and its healthcare workers must be approached with systemic empathy. This is the core of outbreak response.

Footnotes

Competing interests: ZH is adviser to Gavi, the Vaccine Alliance (Eastern Mediterranean Constituency). He led Johns Hopkins University’s Health and Risk Communication Programmes in 2005-09 and 2014-18, and chaired Pakistan’s national task force on risk communication during the covid-19 pandemic.

AI statement: During the preparation of this work, the author used ChatGPT 5.2 (OpenAI) to improve spelling and ensure consistency in British English usage. After using this tool, the author reviewed and edited the content as needed and takes full responsibility for the content of the published article.

Provenance: Not commissioned, not externally peer reviewed.

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