MSF Warns Children Face Deadly Ebola Risks

Children account for nearly one in four confirmed Ebola cases in North Kivu province of the Democratic Republic of the Congo (DRC), with children under five facing a particularly high risk of death, Médecins Sans Frontières (MSF) has warned.

The medical humanitarian organisation said children were bearing a disproportionate share of the ongoing Bundibugyo virus outbreak in northeastern DRC while remaining inadequately represented in research into potential treatments, vaccines and other medical interventions.

In North Kivu, children have been particularly affected by the current outbreak: 24% of confirmed cases are among children under five years of age, compared with 13% in Ituri province, while infants under one year old account for 13% of cases, compared with 6% in Ituri.

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MSF said the high death toll among young patients was particularly evident at its Ebola treatment centre in Butembo, North Kivu.

Between June and September 2026, 24 of the 30 children treated for the infection at the facility died, most of them under five years old.

The organisation attributed the high fatality rate partly to the rapid progression of the disease in communities and limited access to specialised medical care.

Stéphanie Hoffmann, MSF’s project coordinator in Butembo, said many general health facilities lacked the expertise, equipment and infection prevention measures required to identify and safely manage suspected Ebola cases.

She explained that most children admitted to the Butembo treatment centre during the summer had previously received care for other illnesses at several health facilities in the days or weeks before their transfer. Their family members did not have Ebola, raising concerns that the children may have contracted the virus within healthcare facilities.

“General health facilities often lack the specialised expertise, equipment, and infection prevention and control measures needed to identify and safely manage suspected cases,” Hoffmann said.

“Most of the paediatric cases admitted in our ETC in Butembo, North Kivu, over the summer, had already been hospitalised 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 healthcare facilities.”

MSF Warns Children Face Deadly Ebola Risks. Credit: Unicef.

MSF called for stronger infection prevention and control measures, adequate supplies of personal protective equipment and improved training for healthcare workers in non-Ebola facilities across areas at risk. The measures, it said, would help prevent transmission within hospitals while allowing essential health services to continue.

The organisation also highlighted the emotional distress children experience when admitted to Ebola treatment centres, where isolation can be particularly difficult for young patients who may not understand their condition or be able to meet their own basic needs.

Although measures have been introduced to reduce the impact of isolation, including designated areas where parents can see and communicate with hospitalised children, MSF said more support was needed.

The organisation has recruited and trained caregivers to provide daily assistance and emotional comfort to children in several MSF-supported treatment centres. The caregivers come from different backgrounds, including some who have survived Ebola, and provide support while wearing full personal protective equipment.

At the Kitatumba treatment centre in Butembo, 13 caregivers are currently assisting children. MSF said the initiative offers young patients human contact and emotional support during an otherwise distressing experience.

Beyond the challenges of caring for children, the organisation warned that medical teams also faced limited guidance on appropriate drug doses for paediatric patients and shortages of child-friendly formulations of investigational medicines.

Guyguy Manangama, an epidemiologist and MSF deputy director of operations, said children’s needs must be central to medical care, operational planning and research.

He warned that children were often excluded from clinical studies or included only after considerable delays, leaving gaps in evidence and limiting their access to potentially life-saving interventions.

“On top of enormous challenges caring for young patients, medical facilities are dealing with a lack of paediatric dosing guidance, and limited availability of child-friendly formulations of investigational medicines,” Manangama said.

“A child-centred approach must be at the heart of medical care, operational planning, and research efforts.”

Manangama called for treatments, vaccines and other preventive tools to be evaluated for children from the earliest stages of research, rather than requiring them to wait for evidence generated through adult studies.

He also raised concerns about children’s limited access to vaccination trials, campaigns and emerging treatments during the current outbreak, despite the significant burden of the disease on them.

“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,” Manangama said.

“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 in adults before benefiting from advances in Ebola care and prevention,” he added.

MSF urged the DRC authorities, research institutions, pharmaceutical developers and international funders to ensure that children are included in all ongoing and future studies of the Bundibugyo virus, which is responsible for the outbreak.