Health officials responding to the ongoing Ebola outbreak in the Democratic Republic of Congo (DRC) report that patients are exhibiting milder symptoms than in previous epidemics, complicating efforts to control the spread of the virus. The outbreak, detected in mid-May 2026, has affected more than 1,000 individuals and resulted in over 250 deaths, though experts believe actual figures are likely higher.

According to Dr. Marie-Roseline Belizaire, who leads the World Health Organization’s (WHO) intervention in the region, approximately 90 percent of those infected do not develop the severe internal and external bleeding characteristic of the disease’s late stages. This contrasts with earlier outbreaks, such as the 2014 West Africa epidemic caused by the Zaire Ebola virus, where about half of the patients exhibited such hemorrhagic symptoms. Early data from the current crisis also suggest a potentially lower fatality rate.

The virus in this outbreak, identified as the Bundibugyo strain, differs from Zaire Ebola but follows a similar progression from initial “dry” symptoms—fever, fatigue, and body aches—to “wet” symptoms including diarrhea and vomiting. Both stages can resemble other common illnesses in the DRC, such as malaria or typhoid, making clinical diagnosis challenging. Experts warn that the absence of dramatic bleeding in most patients may enable continued transmission, as many remain undiagnosed and interact with others without seeking medical help.

Dr. Chikwe Ihekweazu, executive director of WHO’s Health Emergencies Program, expressed concern that the milder presentation could prolong the outbreak’s duration. “This might be an indicator for an outbreak that lasts a lot longer,” he said. Supporting this view, researchers have identified several unresolved clusters of viral hemorrhagic fever, including cases in neighboring Burundi and South Sudan, which could indicate the virus has circulated more widely and for a longer period than initially recognized.

Contact tracing has proven difficult, as patients typically report fewer contacts than expected, and only about half of these contacts have been located and monitored. Dr. Craig Spencer, a public health expert at Brown University, highlighted the risk posed by these “unfollowed contacts,” which may continue to propagate the outbreak.

Several factors hinder timely treatment and outbreak containment. Many patients arrive at healthcare facilities only when critically ill, often after mistaking Ebola symptoms for malaria or attributing signs to supernatural causes. Fear and misinformation also discourage individuals from seeking care, with some worried about isolation and rumors regarding organ harvesting. Some patients initially turn to traditional healers or under-resourced small clinics, delaying effective diagnosis and treatment.

Resources vary substantially by region. While Ebola treatment centers in Ituri Province—considered the outbreak’s epicenter—are relatively well equipped, facilities in neighboring North Kivu Province, including the towns of Beni and Butembo, face severe shortages of testing capacity and protective gear. Kate White, emergency medical coordinator for Doctors Without Borders in the DRC, described the health system as “extremely fragile,” with many clinics struggling to provide basic care and containment measures.

The situation underscores the challenges of responding to an Ebola outbreak with atypical presentations amid a fragile health infrastructure. Authorities continue to work to improve surveillance, expand testing, and engage communities to mitigate the spread of the disease.