The World Health Organization (WHO) on Oct. 28 published public health advice on building gender considerations into Ebola preparedness and response, as the Bundibugyo Ebola epidemic centered on the eastern Democratic Republic of the Congo (DRC) approached 10,000 confirmed cases and the agency condemned the killing of a nurse who was responding to an Ebola alert.
WHO’s most recent Disease Outbreak News update, published Oct. 23, reported 9,704 confirmed cases and 4,687 deaths in the DRC as of Oct. 20, a crude case fatality ratio of 48.3%, across 66 health zones in eight provinces. That included 976 new confirmed cases and 482 deaths since WHO’s previous update on Oct. 8. Of 30,130 contacts under follow-up, 79.7% had been seen in the previous 24 hours, below WHO’s 95% threshold.
The outbreak was declared on May 15, 2026, and WHO declared it a public health emergency of international concern in May. WHO describes it as the second documented Bundibugyo outbreak in the country, after 2012, and “the largest Ebola disease outbreak ever recorded in the Democratic Republic of the Congo irrespective of virus species.” No approved vaccines or specific treatments exist for Bundibugyo virus. A phase 2/3 vaccine trial, TUMAINI, enrolled its first participants in Bunia on Oct. 23, WHO said.
The epidemic has crossed borders. Kenya reported its first imported case on Oct. 6, in an adult man who had traveled from the DRC and died on Oct. 5. By Oct. 20 Kenya had nine cases, including one death, all linked to the index case; four are health and care workers, and WHO said there was no evidence of wider community transmission. Nigeria confirmed its first case on Oct. 20 in Abuja in a patient who had traveled from Uganda, developed symptoms on Oct. 7, four days after arrival, and sought care on Oct. 11; 44 contacts, most of them health workers, are being monitored.
Olajumoke Babatunde, director of the public health laboratory service at the Nigeria Centre for Disease Control, said the strain matched the DRC outbreak, Al Jazeera reported: “We did three levels of tests, but all molecular. The strain was Bundibugyo.” Uganda, which declared its own outbreak over in July, has announced 21-day quarantines for citizens returning from the DRC with recent travel history. WHO advises against any restriction of travel to, or trade with, affected countries.
WHO Director-General Dr. Tedros Adhanom Ghebreyesus said on Oct. 25 that a nurse had been killed and another health worker severely injured in an attack while responding to an Ebola alert in Bafwasende, in Tshopo province, Al Jazeera reported. “Everyone working to protect communities from this deadly disease must be able to work in dignity and safety,” Tedros wrote on X. Dr. Mohamed Yakub Janabi, WHO’s regional director for Africa, wrote: “Health is NOT a target.” Reports differ on whether the attack took place on Friday, Oct. 23, or Saturday, Oct. 24.
Reuters reported that the victim was a longtime nurse at Bafwasende’s general hospital, that a colleague survived and that other health workers were sheltering at the hospital under police guard. Julien Harneis, the United Nations’ senior Ebola coordinator, wrote on X: “The killing of a nurse yesterday in Bafwasende is a loss to the Ebola response and an even greater loss to patients.”
WHO’s new guidance, titled “Public health advice on gender considerations during Ebola disease outbreaks,” is aimed at governments, national and local authorities, health and social service providers, and response personnel, including those working at community level. It sets out practical actions on gender analysis, cross-pillar response, protection of pregnant and breastfeeding women, engagement with caregivers, protection risks including gender-based violence and sexual misconduct, and cultural acceptance, with an emphasis on risk communication, equitable access to services, protection and participation.
Why it matters
Health workers are both the front line and among the victims. Four of Kenya’s nine cases are health and care workers, and in the DRC attacks on responders, which officials say are hampering the response, have now cost a nurse’s life. A contact follow-up rate of about 80%, against a 95% target, means a share of exposed people is going unobserved each day in a disease with a fatality ratio near 50%.
The gender guidance addresses a response that depends heavily on caregivers and community engagement. By directing responders to identify gender-specific differences in risks, needs and barriers, WHO is asking national programs to design services around who provides care and who faces obstacles reaching it.
What to watch
WHO said its Aug. 14 risk assessment, which rated the risk very high nationally, high for neighboring countries and low globally, is being revised. Africa CDC Director-General Jean Kaseya said the outbreak is “no longer one country’s fight” and that he would convene Africa’s health ministers to strengthen the cross-border response, Al Jazeera reported.
The caveats
Case counts differ by source and date: WHO’s 9,704 is as of Oct. 20, while Al Jazeera cited later ministry data of more than 9,800 cases and 4,700 deaths. Accounts of the nurse’s killing differ on the day of the attack, and local authorities had not commented on the attack or the suspects. The published summary of WHO’s gender guidance lists its themes but not the detailed actions under each.
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