DR Congo's Ebola Supply Line Is Stretching From Entebbe to the Clinic Door

Eastern DR Congo is fighting the second-largest Ebola outbreak on record through a supply line that starts on the shore of Lake Victoria. Aircraft land the cargo at Entebbe, trucks carry it more than seven days into Ituri, and a warehouse in Bunia sends it out to clinics by road, air, motorbike and canoe. The strain, the rains, a payroll dispute and a divided east decide how much of it arrives in time.

Seven days from Entebbe

The trucks leave Entebbe, Uganda, loaded with tents, protective suits, chlorine and body bags, and cross into DR Congo at Mahagi–Rete. The International Federation of Red Cross and Red Crescent Societies (IFRC) puts the road trip to Bunia at “over seven days.” At the other end sits the response’s main distribution hub: 12,120 square metres of storage in Bunia, about the area of 1.7 football pitches, according to the UN-led Logistics Cluster.

The cluster has moved 2,284 tonnes into the outbreak zone since May, 2,101 by road and 183 by air, as of September 10. At about 15 tonnes a truck, that amounts to roughly 150 truckloads, by Xin.bz’s calculation from the cluster’s August figures. Entebbe is the upstream staging area. It had handled more than 1,124 tonnes and sent 776 into eastern DR Congo by August 16, from 11,040 square metres of warehouse space.

The goods reach Entebbe from global hubs. The World Health Organization (WHO) has shipped more than 330 tonnes from Nairobi, Dubai and Dakar. A Dubai Royal Air Wing Boeing 747, organised with the European Union’s humanitarian office, carried about 60 tonnes of UN cargo on June 9. UNICEF and the EU mobilised more than 100 tonnes from the EU stockpile in Copenhagen.

Leg	How cargo moves	Volume or time
Global hubs to Entebbe	Charters and humanitarian airlifts	1,124+ tonnes handled by August 16
Entebbe to Bunia, road	Trucks through Mahagi–Rete	7+ days; 197 tonnes in August
Entebbe to Bunia and Kisangani, air	C-130 rotations	111.5 tonnes in August
Bunia to 16 last-mile points	Trucks and UNHAS flights	36 tonnes in the week to September 13
Kinshasa to the east	Air, or road then river	2.5 hours by air; 14 to 24 days by road and river

The table shows where time accumulates. Air moves a fraction of the tonnage in hours. Roads move almost all of it in days, and the final kilometres take the longest.

A new strain and a fourteen-day clock

The outbreak began with a test that came back negative. The standard GeneXpert Ebola cartridge detects the Zaire strain, and a false negative in Bunia delayed confirmation until the National Institute of Biomedical Research (INRB) in Kinshasa ran a broader test on May 14. The samples travelled more than a thousand miles to get there. The virus was Bundibugyo, and every licensed Ebola vaccine and treatment targets a different strain.

The case count has climbed since. DR Congo’s National Institute of Public Health (INSP) reported 7,820 confirmed cases and 3,779 deaths on September 22, a fatality rate of 48.3%, across 63 health zones in seven provinces. Ituri holds 6,001 cases and North Kivu 1,449. The 2014–16 West African epidemic, at about 28,600 cases, remains the only larger outbreak.

Every countermeasure in use is experimental. The PARTNERS trial is testing Mapp Biopharmaceutical’s antibody cocktail MBP134 and Gilead’s remdesivir, and had enrolled more than 300 patients at five sites in Ituri by September 7. Vaccines designed for Bundibugyo are in their first human trials. Oxford’s ChAdOx1 BDBV is in 50 adults in Britain, with about 620,000 doses made by the Serum Institute of India, and Moderna’s mRNA-1469 is in 84 adults in Canada. Funding for Phase 3 trials was uncommitted at the end of July. WHO has since granted emergency listing to tests that detect the strain, including Cepheid’s hemorrhagic fever panel and Altona’s RealStar Filovirus assay.

The vaccine in use is Merck’s Ervebo, licensed against the Zaire strain. WHO’s vaccine advisers said on August 19 that it belongs “only within research protocols” against Bundibugyo. The International Coordinating Group released 70,000 Gavi-funded doses: 20,000 for a study run by Epicentre, Médecins Sans Frontières’ research arm, and 50,000 for frontline workers. The first 16,250 arrived at Kinshasa’s N’djili airport on August 21.

Ervebo is stored and shipped frozen at −80 °C to −60 °C and keeps five years in that state. Once thawed, it keeps 14 days at 2 °C to 8 °C, and the label rules out refreezing. That clock is now visible in the ledgers. On September 22, Tshopo province held 626 thawed doses. Of those, 126 expire on September 24 and 500 on October 5.

Tshopo has vaccinated 3,874 of a target 11,703 frontline workers, and the provincial report records “low uptake.” Bas-Uélé reports a need for more doses and has yet to draw up a vaccination plan for its six priority health zones. The rollout reached Bunia and Mongbwalu, the epicentre, on September 19.

Supplies pile up short of the clinics

The warehouses are filling faster than they empty. In the week to September 13, the cluster’s hubs received 213 tonnes and dispatched 36 tonnes to 16 last-mile locations, with occupancy at 37%. A new hub is under construction at Nia-Nia to shorten the run into Tshopo.

The clinics show the gap. In Tshopo, 37 of 97 health facilities had infection-prevention kits on September 21, and two of 93 scored above 80% on infection control in mid-September. Most facilities in Bafwasende lacked protective equipment on September 15. Lita reported a shortage of protective gear on the same day. At Fataki and Mandima, 10 bodies went unswabbed — supplies and teams were short, and families refused. Bas-Uélé has seven cases and has yet to open a treatment centre or field an ambulance.

Beds follow the same pattern. Ituri’s treatment centres ran at 42% occupancy on September 22, while North Kivu ran at 90.9% with every bed at Butembo and Katwa full. A quarter of North Kivu’s patients were treated outside standard facilities. WHO counts about 1,400 beds across 59 treatment centres and is planning for 3,000.

Waste closes the loop. Every entry into a patient area uses a single-use protective set, and every set becomes infectious waste. The incinerator at Kisangani’s general hospital has been out of service since at least September 18 for want of a technician, according to provincial reports.

Rain, fuel and a broken bridge

The rains arrived with the peak of the epidemic. Bad weather cancelled flights to Buta, Kisangani and Isiro in early August, and the Logistics Cluster reports poor roads and high transport costs. Bas-Uélé’s roads are impassable. On the RN44 between Mambasa and Biakato, about 170 kilometres from Bunia, the Teturi bridge has been down since early June, and people cross the river by canoe.

Air bridges the gaps. The UN Humanitarian Air Service (UNHAS) had flown 876 flights, 6,918 passengers and more than 100 tonnes of cargo in Ituri by September 9, and raised Bunia–Kinshasa service from three to five flights a week. “Without UNHAS, this response would not have been possible,” said Thierno Balde of WHO. Kinshasa sits about 1,800 kilometres from the east: 2.5 hours by air, or four days by road to Kisangani and another 10 to 20 by river.

Fuel and runways set the limits. A shortage of Jet A-1 in Kisangani puts UNHAS flights in Tshopo at risk of suspension, the cluster warned on September 10. Bunia’s runway takes aircraft up to the C-130, so wide-body cargo lands at Entebbe. Goma’s international airport has been closed since M23 rebels took the city in January 2025.

The payroll and the strike

WHO counts about three health workers per patient. Reaching 3,000 beds means training 9,000. “We have nearly 4,000 healthcare workers currently working inside the treatment centres,” WHO’s Luca Fontana said on September 8. “So it means we need 5,000 more.” Anne Ancia, WHO’s representative in DR Congo, puts one treatment centre at about 300 staff, including anaesthetists, hygienists and nurses. “The human resources gap is one of the biggest gaps,” said WHO’s Catherine Smallwood on September 23.

The staff in place are going unpaid. In Damas health zone in Ituri, doctors, nurses, hygienists and community relays suspended all response work on September 14. They are demanding three months of risk allowances and a regular supply of protective equipment. In Beni, community engagement and psychosocial staff went on strike on September 21 and lit a fire outside the zonal coordination office. “For four months now we haven’t been paid even though the government says it has already disbursed all funds,” striker Nick Junior Vusindi told Actualite.cd. In Sud-Ubangi, the seventh province to report cases, doctors left off the payroll began a strike on September 16.

Health Minister Roger Kamba says payroll checks followed the discovery that “non-responders were added to lists,” and has promised pay through professional bank cards. Health workers carry the risk: at least 155 were infected and 45 had died by August 12, WHO reported. The director of Bunia’s university hospital told WHO that lax infection control “led to so many healthcare workers falling ill.” The 2018–20 North Kivu outbreak showed where pay disputes lead: the belief that “Ebola is a business” fed attacks on responders.

Two governments, one virus

The east is split. M23 rebels hold Goma and Bukavu and run their own Ebola response, supplied from Rwanda. Goma’s airport and banks remain closed. The UN humanitarian coordinator links the two sides’ case reporting. Two peace tracks are stalled. The 2025 Washington Accords between DR Congo and Rwanda await a Rwandan troop withdrawal, and the Doha process with M23 produced a roadmap on August 23 with six of seven protocols unsigned.

Most Ebola cases sit in government-held Ituri and North Kivu, where the threat comes from armed groups and local violence. The Islamic State-aligned Allied Democratic Forces (ADF) operate across Irumu, Mambasa and Beni and are expanding into Haut-Uélé, according to the conflict monitor ACLED. WHO counted 12 attacks on health care between May 17 and August 14. Mambasa’s former treatment centre burned on the night of September 21.

The money is short. The government’s six-month plan costs $1.3 billion and was 49% funded on September 15, according to UN News. UNICEF’s appeal was 71% unfunded at the end of July. US aid to DR Congo fell from $715 million in fiscal 2025 to $67 million in the last quarter of 2025, after the dismantling of the US Agency for International Development.

The cost shows in the outcomes. About 60% of Ebola deaths occur in communities, outside treatment centres, and in August 15% to 20% of new cases came from known contacts. New confirmed cases fell from 593 in the week to September 8 to 416 in the week to September 22, a Xin.bz calculation from INSP totals. “We are now starting to see encouraging signs that we are gaining ground,” WHO’s Tedros Adhanom Ghebreyesus said on September 16. “But make no mistake. The epidemic continues to grow and continues to kill.” “The outbreak is not shrinking, it is moving,” said Anthony Kergosien of Médecins Sans Frontières on September 18.

What executives should watch

• Cargo dispatched from Bunia against cargo received. The weekly Logistics Cluster update shows whether supplies reach the 16 last-mile points or accumulate in the hub.
• Jet A-1 stocks in Kisangani. A suspension of UNHAS flights in Tshopo cuts the fastest route into the province where vaccination began.
• Thawed Ervebo doses and expiry dates. Tshopo’s 500 doses expiring on October 5 measure whether uptake catches the cold chain.
• Risk-allowance payments in Damas and Beni. A settlement restores tracing, burials and screening in two hotspot zones.
• The Nia-Nia hub and the Teturi bridge. Both shorten the road from Bunia into Tshopo and southern Ituri.
• Treatment beds in North Kivu. Occupancy above 90% at Butembo and Katwa sets the pace of new centres.
• Phase 2 funding for Bundibugyo vaccines. A commitment for the Oxford or Moderna candidates starts the path to a strain-matched vaccine.
• Goma airport. A reopening lets one response replace two.
• Funding for the $1.3 billion plan. The share committed by October decides how many of the 5,000 extra workers are hired.

The Xin.bz view

The supply line works at the scale of tonnes. Entebbe stages the cargo, the trucks cross at Mahagi–Rete, and Bunia’s warehouse holds space to spare. More than 2,000 tonnes have moved since May.

The outbreak is decided at the scale of kilograms and days. A clinic in Bafwasende needs a box of protective suits this week. A vaccination site in Tshopo needs thawed doses for the people in line. A nurse in Damas needs three months of risk pay. Each of those gaps sits downstream of the warehouse, where rain, fuel, a broken bridge and a payroll list set the pace.

The new strain raises the stakes on every link. Every vaccine is experimental, and the Zaire-strain Ervebo remains under research protocols. Isolation, safe burial and contact tracing carry the load a proven vaccine would. Those three depend on people being paid and protected, and on supplies arriving at the clinic door.

DR Congo’s Ebola response has built the supply line to Bunia. The outcome now depends on the last mile beyond it: paid staff, thawed doses on the day they are needed, and protective gear at every clinic door before the rains close the roads.