Uganda’s fight against the Bundibugyo Ebola strain is increasingly being shaped by the majority being imported cases, now standing at 15 out of the country’s 20 confirmed cases originating from the Democratic Republic of Congo (DRC), compared to only five cases resulting from local transmission.
The figures have reinforced concerns that Uganda’s battle against Ebola could continue prolonging the outbreak even as local transmission appears largely under control.
Health authorities say the majority of recent patients have crossed into Uganda seeking treatment, forcing the country to repeatedly activate costly surveillance systems, contact tracing operations and emergency response measures.
The latest developments have prompted Uganda and DRC to launch a joint 90-day cross-border Ebola response plan aimed at tackling the outbreak at its source rather than waiting for infected individuals to enter Uganda. The bilateral framework was launched on Tuesday.
“Uganda and the DRC have launched a bilateral framework to strengthen cross-border collaboration in controlling and mitigating the Bundibugyo Ebola Virus outbreak starting with Aru Territory, Ituri Province where residents frequently cross between the two countries for trade, healthcare and social interactions,” a statement by the Ministry of Health, reads .
Speaking on the rationale behind the intervention, the Permanent Secretary in the Ministry of Health, Dr Diana Atwine, acknowledged that Uganda may never completely stop infected people from crossing into the country as long as the outbreak continues in Democratic Republic of Congo.
“We believe we will not be able to stop the inflow of patients because they are looking for care. The best is to make sure we go to the source and work with our counterparts in DRC,” Dr Atwine said.
She said the movement of patients across the border has significantly complicated Uganda’s response efforts.
‘Many patients arrive after interacting with numerous people during their journey, creating extensive contact-tracing workloads for health teams. It is giving us a lot of work to track all those people,” Dr Atwine noted.
“Ebola’s magic bullet is not big science. It is simply to test quickly the potential person who is sick, isolate them and ensure there is less contact with patients. Establishing laboratories closer to outbreak hotspots will reduce delays in diagnosis and help contain the epidemic more effectively,” she added.
She added that the strategy offers a second benefit by reducing the number of Congolese patients travelling into Uganda for treatment.
“It will help us prevent people travelling long distances from DRC to come to Uganda for care and, therefore, causing even more people here to fall sick because they come through taxis and the border,” she said.
Under the arrangement, Uganda plans to deploy approximately 40 health workers at each treatment centre, with two centres expected to become operational initially.
‘One facility will be established in Aru, while another will be located in Kasenyi along the Lake Albert corridor in Rwampara, areas identified as major routes used by travellers crossing into Uganda. A third treatment centre may be established depending on the evolution of the outbreak,’ Dr Atwine explained.
Beyond the public health threat, continued transmission in DRC is also carrying economic consequences for Uganda.
Dr Atwine noted that cross-border trade, transport and business activities have already been affected as authorities intensify control measures.
“Even business along those districts is affected because markets have been suspended, flights are suspended and human traffic has significantly reduced around the border,” she said.
She argued that investing resources in controlling the outbreak inside the DRC would ultimately cost less than dealing with prolonged disruptions to trade and economic activity.
However, perhaps no group has felt the impact of imported Ebola cases more directly than health workers.
Several imported cases sought treatment in Ugandan health facilities before Ebola was confirmed, exposing doctors, nurses and support staff and forcing authorities to place large numbers of healthcare workers under quarantine.
Dr Joseph Gavin Nyanzi, the chairperson for Ethics and Professionalism at the Uganda Medical Association, said the outbreak has created anxiety among health workers despite government efforts to support those affected. “A number of our colleagues, doctors and nurses, have been exposed.
Fortunately, government responded by putting all these who had contact with the first Ebola patients under quarantine,” Dr Nyanzi said. Although official figures remain unavailable, he estimated that more than 100 health workers linked to one private health facility alone may have been affected by quarantine measures.
“Several hospitals and clinics where Ebola patients sought treatment have tightened access controls, intensified screening measures and carried out extensive disinfection exercises to prevent further transmission,” Dr Nyanzi said.
Dr Nyanzi said the disruptions have raised concerns among patients seeking routine healthcare services as facilities balance service delivery with infection prevention requirements.
‘The exposure of health workers has disrupted service delivery in some facilities, with hospitals limiting access to non-emergency cases and carrying out extensive disinfection exercises.’
Unlike previous Ebola outbreaks where vaccination played a role in protecting frontline responders, health workers are now relying heavily on prevention and control measures.
He warned that shortages of personal protective equipment remain a concern, particularly in private health facilities.
“Where these protective gears are not available, our colleagues are not really comfortable attending to patients until they are protected,” he said.