Children are left behind in the current Ebola outbreak response

According to Epicentre, the Doctors Without Borders/Médecins Sans Frontières (MSF) epidemiological research center, nearly 1 in 4 confirmed Ebola cases in North Kivu province is a child under 5. MSF is deeply concerned by the disproportionate impact on children and is calling for the medical and research response to ensure that they are no longer left behind in access to vaccines, treatments, and clinical research.

Children are often getting infected at health facilities, not at home

The impact on children is particularly stark In North Kivu, where 24 percent of confirmed cases are among children under 5 years old; more than half on them — 54 percent — are infants under 1. In Ituri, by comparison, children under 5 account for 13 percent of confirmed cases, of whom 46 percent are under 1 year old. 

While Ebola remains a deadly disease for all age groups, the youngest children face the highest risk of death. At the Ebola treatment center in Butembo, North Kivu, MSF teams have recorded a particularly high fatality rate among children. Between June and September 2026, 24 out of 30 children admitted to the center died from Ebola disease — most of whom were under the age of 5. The rapid spread of the disease in communities and limited access to specialized care in health facilities are contributing to these alarmingly high fatality rates. 

“Primary health facilities often lack the specialized expertise, equipment, and infection prevention and control measures needed to identify and safely manage suspected cases,” explains Stéphanie Hoffmann, project coordinator for MSF in Butembo. “Most of the [children] admitted to our Ebola treatment center in Butembo had already been hospitalized for other illnesses in several facilities during the days or weeks before their admission. Their family members did not have Ebola themselves, and it is highly likely that these children contracted the disease inside health care facilities.” 

To maintain access to essential non-Ebola health services while reducing the risk of Ebola transmission in health care facilities, infection prevention and control measures must be urgently strengthened in health facilities. This includes ensuring the availability of personal protective equipment (PPE) and strengthening training for health care workers in non-Ebola health centers across at-risk areas. 

Isolation during treatment brings mental stress for children

Efforts have been made to reduce the emotional toll of isolation on children in Ebola treatment centers, including the creation of visibility areas where parents can see and communicate with their hospitalized children. But admission to an Ebola treatment center remains a deeply distressing experience for children, many of whom are too young to understand what is happening and why. 

MSF has recruited and trained caregivers to provide daily support and comfort to children inside several MSF-supported Ebola treatment centers while wearing full PPE. These caregivers have a range of experience, including caring for Ebola survivors. Today, 13 caregivers are supporting children at Kitatumba Ebola treatment center in Butembo. While not a perfect solution, this initiative provides essential human contact and emotional support for children suffering from the disease.

A child-centered approach is critical for patient care 

Historically, children have often been excluded from clinical research or included only after significant delays, creating dangerous gaps in the evidence available to guide and improve their care and delaying access to potentially lifesaving interventions. 

"On top of enormous challenges caring for young patients, medical [teams] are dealing with a lack of pediatric dosing guidance and limited availability of child-friendly formulations of investigational medicines," said Dr. Guyguy Manangama, epidemiologist and deputy director of operations at MSF. "A child-centered approach must be at the heart of medical care, operational planning, and research efforts." 

"Treatments, vaccines, and other preventive tools should be evaluated for use in children from the outset of research efforts and made available to them without delay," added Dr. Manangama. "Yet in the current outbreak, children are still being left behind, with very limited access to vaccination trials and campaigns, as well as the latest therapeutic innovations — despite bearing a significant burden of disease. Children cannot continue to wait for data generated from adults before benefiting from advances in Ebola care and prevention." 

MSF urges national authorities, research institutions, pharmaceutical developers, and international funders to prioritize the inclusion of children in all ongoing and future Bundibugyo virus studies. Ensuring equitable access to research and new medical tools, including vaccines, is essential to reducing preventable deaths and improving outcomes for one of the most vulnerable groups.

The impact of the outbreak on children extends beyond Ebola infection itself. Disruptions to essential health services can rapidly increase the risks of vaccine-preventable diseases, malnutrition, and other common childhood illnesses. Preserving routine immunization, nutrition programs, and access to primary health care — while reducing the risk of Ebola transmission in health facilities — must be considered a core component of the outbreak response, not an afterthought.