© GIZ

The Democratic Republic of Congo (DRC) has spent over three decades in a balancing act between political powers, armed conflicts and subsequent humanitarian and health challenges. Unfortunately, the situation today is no different, with multiple conflicts threatening already vulnerable populations in the eastern regions, at the center of Sub-Saharan Africa. Recent outbreaks of Ebola and Mpox have further challenged the region, but they have also highlighted the importance of effective procedures and guidelines to efficiently tackle such outbreaks. Of key importance for health care workers are proper measures for prevention and control of infections, including communication of risks tailored to the population and engagement of local communities in response activities.

The Mpox-related training was timely and well-received, with active and engaged participants. The workshops had a positive impact and contributed to reducing the spread of Mpox in the participants’ regions.

Representative of a faith-based partner organization

A Region in Distress

Sitting at the centre of Sub-Saharan Africa, DRC is a hotspot for epidemics with a variety of contributing factors, including social, political, and environmental aspects. The country has a long history of fighting disease outbreaks, ranging from zoonotic diseases like Ebola or Mpox, which can also spread between humans, to waterborne diseases, such as Cholera, vector-borne diseases, such as Chikungunya and Malaria, or highly contagious human-to-human infections, like Covid-19 or Measles.

First making its debut in DRC (then Zaire) in 1970, Mpox (formerly known as Monkeypox) has persistently challenged the region in waves for decades. In 2022, an Mpox outbreak reached a global scale, affecting the African region as well as countries that had minimal to no previous experience with the disease, like those in the WHO-regions of the Americas and Europe.  Germany was also affected at the time, experiencing an increase in infections in mid-2022, although the outbreak could be controlled quickly, and serious cases were rare. Cases of the variant clade IIb caused the outbreak in 2022 and continue to be a challenge around the globe. However, it is another variant that is particularly pressing in the DRC. After supposed zoonotic spillover in autumn of 2023, this new clade (Ib) triggered the current large outbreak in DRC and its non-endemic eastern neighbours. The variant has a new pattern of transmission, new risk groups, including children, and it has proved to be a challenge for the already threatened health facilities in the region. Although other countries have also been affected, such as Uganda, Burundi and Sierra Leone, the highest burden of disease has by far been carried by the DRC, which accounted for 90-96% of all cases in 2024.

Security threats in DRC in the spring of 2025 forced nearly all Mpox activities to be terminated or paused, despite a peak in cases in January. Particularly in North Kivu, the already strained healthcare system was made nearly inoperable due to destruction and looting of health facilities. In the first four months of the year, there were over 37,000 cases of clade Ib Mpox in DRC, bringing the case load to 96,500 since the outbreak began. Meanwhile, deaths from Mpox disproportionately affected children under 15 years of age. To further complicate the circumstances, in the first five months of 2025, DRC also experienced over 24,000 cases and 513 deaths from Cholera, and over 23,000 cases and 357 deaths from Measles. This situation explicitly demonstrates how conflict perpetuates disease. Additionally, it shows the necessity of a One Health approach to address the complex interactions between human, animal, and environmental health in order to contain a virus in its early stages before it evolves into a deadly pandemic.

Equipping healthcare workers with necessary tools

In response to a spike in Mpox cases in 2024, the German Epidemic Preparedness Team (SEEG) planned collaborative workshops with local and international partners in June, September, and November of 2024, promoting a platform for knowledge-sharing, exchange of experiences and joint learning. Held in the eastern cities of Bukavu, Goma, and Uvira, the trainings aimed to bolster the theoretical and practical skills of healthcare providers and local community leaders to manage and prevent the spread of infectious diseases like Mpox and Ebola. This collaborative initiative was led by SEEG in partnership with GIZ, Charité – Universitätsmedizin Berlin, and Panzi Hospital in Bukavu, and it was supported by the local WHO office, the East African Community and the Robert Koch-Institute.

Participants from healthcare facilities across North and South Kivu received a combination of intensive and tailored theoretical instruction and hands-on trainings in measures to prevent and control infections (Infection, Prevention and Control-IPC) in health facilities and communities. This comprehensive approach equipped participants with practical skills to manage infectious diseases such as Ebola and Mpox, including the use of specific gear for personal protection (personal protective equipment), clinical management of patients, safe waste handling, and environmental decontamination.  The program also focused on developing locally adapted risk communication strategies and included practical exercises to apply these skills in real-world settings. Each training gave participants the opportunity to create simple, actionable response plans that were tailored to their communities and emphasized rapid implementation in low-resource environments.

Many of the workshops used a “training-of-trainers” approach to help the participants to further disseminate their new skills and knowledge. As a result, additional healthcare professionals (480 and counting) have since received follow-up trainings and over 40 sensitisation campaigns were run by local community leaders over the last months, amplifying its impact. This multiplier effect is crucial in regions like North and South Kivu, where healthcare resources are scarce and the ability to reach rural populations remains limited.

Persistent challenges: Limited resources, misinformation, conflict and displacement

Although Mpox remains a threat in the area, the trainings and follow-up activities in DRC have been well received, helping healthcare workers to be better equipped and less affected by Mpox than before. Despite the success of the workshops and the positive steps taken to strengthen IPC and risk communication, significant challenges remain. The healthcare system, particularly in eastern DRC, is still under-resourced. Hospitals and clinics often lack basic supplies, including protective equipment, disinfection materials, and medications. This shortage of resources makes it difficult for healthcare workers to fully implement the IPC measures they have learned. Moreover, misinformation and cultural resistance to medical interventions, particularly in relation to Mpox, complicate efforts to contain outbreaks. For instance, many communities perceive Mpox as a “man-made” disease or associate it with witchcraft, leading to reluctance in adopting preventive measures like vaccination and isolation protocols.

The ongoing conflict, displacement and challenges with disease prevention did not simply appear from nowhere, however. Years of political tug-of-war escalated in 2024 with the rise of the rebel group, Mouvement du 23 Mars (M23) and intensified conflict in the mineral-rich eastern provinces (North Kivu and South Kivu). This culminated in early 2025 with the seizure of Goma, the capital of North Kivu, followed shortly by Bukavu, the capital of South Kivu. This conflict has cascaded into the displacement of millions of people, which in turn, leads to further disruption of health services. Displaced people and migrants are at higher risk of contracting or spreading infectious disease due to overcrowded living conditions, destroyed infrastructure, and limited access to health care services. The constant flow of displaced persons between cities such as Goma, Beni, and Butembo heightens the risk of disease transmission, further straining the already fragile healthcare system. Case-in-point: DRC in early 2025 was battling active outbreaks of Mpox and Cholera as well as the threats of Ebola Virus Disease, Malaria, and Measles.

Collaboration and local engagement are key to managing outbreaks

SEEG’s work in the DRC illustrates how outbreak preparedness can be achieved even in fragile, high-risk settings. The integrated and collaborative approach – combining expertise from local and international partners – is key to its success. By working closely with organisations like Africa CDC, the WHO, local health authorities and local experts, e.g. from Panzi Hospital or faith-based organizations, SEEG ensures alignment with national guidelines and addresses the specific needs of the region.

Risk communication and IPC are not parallel efforts but mutually reinforcing pillars of a resilient health response. Technical knowledge alone is not enough without trust and cooperation at the community level. At that same time, risk communication must be backed by sufficient capacities to diagnose, treat, and contain infections. By addressing both fronts, SEEG and its partners have laid the groundwork for more resilient health systems in one of the world’s most complex crisis regions. The training-of-trainers approach has proven especially effective in this setting, enabling rapid knowledge transfer and a multiplier effect that strengthens local ownership.

Looking ahead, the situation in eastern DRC remains highly volatile and hardly predictable. Armed conflict continues to disrupt health service delivery, displace communities, and create new risks for disease transmission. While the SEEG trainings have demonstrated strong local momentum and commitment, many structural gaps persist, ranging from the lack of essential medical resources to insufficient diagnostic capacity and limited mobility for trained staff. In such a context, flexibility, local adaptability, and sustained knowledge-sharing are critical. To build up real resilience, health systems must be able to function, respond, and be flexible to adapt even when conditions change rapidly.

Lisa von Stebut, Tina Bohnes, Evelyn Keeney-Ritchie and the German Epidemic Preparedness Team (SEEG)
August 2025