Congolese customs agents gather at a border crossing point with Rwanda. (Djaffer Sabiti/Reuters)

The 12th month of an Ebola outbreak that is relentlessly spreading through eastern Congo was filled with cause for alarm. 

New cases in a border city of over 1 million people. Vicious attacks by militias operating near the outbreak’s epicenter. Alarm bells being rung by international health institutions, saying not enough is being done to prevent a regional catastrophe. And Thursday, the first anniversary of the outbreak’s declaration, neighboring Rwanda briefly shut its border crossings with Congo, threatening trade on which hundreds of thousands of people are dependent. 

Despite a massive campaign of awareness-raising, vaccinations and a constellation of field hospitals and health checkpoints, the outbreak is only getting worse.

The figures are already deeply worrisome. Around 2,700 people have been infected, according to official statistics, and around two-thirds of them have died. Almost 150 of those infected have been health workers. 

It is Congo’s 10th outbreak and the world’s second-worst, trailing only the epidemic that killed more than 11,000 across West Africa between 2014 and 2016. If just this July were considered on its own, it would be the fourth-
biggest outbreak in history, with more than 350 cases confirmed. 

In private, health officials express concern that official numbers underestimate the true scale of the crisis, as much of the affected region remains inaccessible because of conflict or remoteness.

Ebola is not the most contagious virus — it spreads only through contact with bodily fluids — but it kills its victims mercilessly, causing internal bleeding and soaring fevers. 

In a joint statement, World Health Organization Director General Tedros Ghebreyesus, head U.N. emergency relief coordinator Mark Lowcock, UNICEF Executive Director Henrietta Fore and World Food Program Executive Director David Beasley described in detail how Ebola is ravaging communities in eastern Congo.

“Almost one in three ‘cases’ is a child. Every single ‘case’ is someone who has gone through an unimaginable ordeal,” they wrote. “Ebola passes from mother to child, husband to wife, patient to caregiver, from the dead body of a victim to the mourning relative. The disease turns the most mundane aspects of everyday life upside down — hurting local businesses, preventing children from going to school and hampering vital and routine health services.”

Two weeks ago, the WHO declared that the outbreak was a “public health emergency of international concern,” a designation designed to bring more international attention to a health crisis — and a characterization that has been used only four times before. 

After the declaration, the World Bank offered $300 million to aid the response, and the United States, the biggest donor so far, increased its previous contributions by $38 million. It was unclear if the financial support was spurred by the WHO’s declaration.

Meanwhile, the ground response, which is being led by Congo’s Health Ministry, has undergone significant changes. A public confrontation between the health minister, Oly Ilunga, and other health officials close to Congo’s new president, Félix Tshisekedi, led Ilunga to resign in July. 

He was replaced by an official who will report directly to ­Tshisekedi. Ilunga personally had overseen the response and was respected by many health workers, even as the outbreak seemed to be getting out of hand under his leadership.

A look at the Health Ministry’s daily report for Wednesday, the 365th day of the outbreak, was typical in its bearing of grim news, offering a snapshot of the daily toll.

The day saw hundreds of vaccinations, bringing the total since August 2018 to above 180,000. But 11 new cases also had been confirmed, two of them health workers. Ten were in the northern stretches of North Kivu province, where transmission of the virus has been especially difficult to control. 

The last case, however, was even more troubling: It was the second to be found in Goma, a sprawling city of more than 1 million people on the Rwandan border, and home to two border posts where 40,000 to 70,000 people cross by foot daily. The infected man died Wednesday, and later that night authorities announced a third confirmed case in the city, his 1-year-old daughter.

On Thursday morning, Rwanda announced it was closing border crossings with Congo. Many of Goma’s residents rely on cross-border trade with Rwanda for their livelihoods. The border was reopened in the afternoon, after protests from the Congolese government.

“This latest case in such a dense population center underscores the very real risk of further disease transmission, perhaps beyond the country’s borders, and the very urgent need for a strengthened global response and increased donor investment,” the response leaders said in their joint statement.