Behind the rapidly rising Ebola case count lies another grim statistic: hundreds of children are dying. UNICEF says that by August 2, the Bundibugyo outbreak had infected 743 children aged between zero and 17 years, claiming the lives of 330 of them.
While children make up nearly a quarter of all confirmed infections, they account for almost one-third of Ebola deaths, a stark reminder that the outbreak is exacting its heaviest toll on the youngest patients. For health experts, however, the tragedy extends beyond those infected, as fear of the virus continues to keep families away from hospitals, exposing even more children to preventable illnesses.
Before Ebola arrived in eastern Democratic Republic of Congo, Mongbwalu General Hospital rarely had a quiet day.Every month, nearly 500 patients streamed through its doors. Mothers queued with babies for routine immunisations. Pregnant women attended antenatal clinics before delivering safely under the watch of skilled health workers. Others sought treatment for malaria, diarrhoea and respiratory infections he everyday illnesses that continue to claim thousands of young African lives.
Today, the wards are eerily quiet.
"Before the epidemic, we had an average of 500 patients per month. When the Bundibugyo Ebola virus epidemic was declared, we saw a complete drop in patients," says Dr Lokudu Richard, a physician at Mongbwalu Hospital in Ituri Province.
His experience reflects a growing crisis unfolding far beyond the virus itself.
As the Democratic Republic of Congo's Bundibugyo Ebola outbreak surpasses 4,000 confirmed cases to become the country's largest Ebola epidemic ever recorded and the second-largest in global history, fear is driving families away from health facilities.
Health experts warn that the consequences could erase years of progress in child survival and maternal healthcare.
Many of the children most affected by the outbreak may never contract Ebola.
Instead, they risk dying from diseases that are preventable or easily treatable because parents are too afraid to seek medical care.
It is a reality Kenyan paediatric nurse Zeddy Chepchirchir Komen understands all too well.
When Kenya deployed 170 volunteer doctors, nurses and public health officers to Liberia and Sierra Leone in 2015 as part of the African Union Support to Ebola Outbreak in West Africa (ASEOWA), she witnessed firsthand how an Ebola epidemic can cripple an entire health system.
"Pregnant mothers stopped coming to hospitals to deliver or even attend antenatal clinics," she recalls.
"Because of cultural beliefs, many women feared caesarean sections, even though they were often recommended to reduce the risk of infection. They chose instead to give birth with unskilled attendants. That put both mothers and babies at greater risk."
In many communities, she explains, a woman was only considered a "true" mother if she delivered vaginally.
Accepting a caesarean section carried social stigma, even when doctors believed it was the safest option during the outbreak.
The memories remain vivid more than a decade later.
She remembers children dying in isolation because parents, relatives and even some health workers feared physical contact.
"We could not even hold some of the babies the way nurses normally would," she said.
Those scenes unfolded during the world's deadliest Ebola epidemic between 2014 and 2016, when more than 28,600 people were infected and 11,325 died across Guinea, Liberia and Sierra Leone.
More than 3,000 children contracted the virus, while UNICEF estimates that over 22,000 children lost one or both parents or their primary caregivers.
Today, eastern Congo is showing worrying signs of repeating that painful history.
New data released by UNICEF shows that between April and June this year, utilisation of essential health services fell by 42 per cent across the outbreak hotspots of Bunia, Mongbwalu, Nizi and Rwampara.
Across Ituri Province, where the epidemic is concentrated, the use of primary healthcare services declined by nearly 13 per cent.
"The data suggests that fear of infection, combined with disruptions to services, is deterring lots of children and their families from seeking care," said John Agbor, UNICEF Representative in the Democratic Republic of Congo.
"One doctor told our team that before the current outbreak, his facility saw an average of 500 patients a month but that has dropped to almost nothing."
Routine childhood immunisation has been among the hardest-hit services.
Across the four hotspot health zones, childhood vaccinations have fallen by more than half within just three months. In Mongbwalu, the epicentre of the outbreak, first-dose measles vaccinations declined by 69 per cent.
Across Ituri Province, administration of the third dose of the pentavalent vaccine fell by 22 per cent, while second-dose measles vaccinations dropped by 18 per cent. Within only two months, health facilities administered more than 23,000 fewer routine vaccine doses than they had April.
Maternal healthcare has suffered a similar decline.
Facility-assisted deliveries fell by 13 per cent across Ituri Province, while some of the worst-hit health zones recorded even sharper drops. Deliveries declined by 38 per cent in Bunia, 30 per cent in Rwampara and an alarming 70 per cent in Nizi. First antenatal care visits also dropped by about 28 per cent across the three hotspot health zones.
Health officials say no comparable seasonal decline was recorded during the same period last year, suggesting the Ebola outbreak is driving families away from health facilities.
Despite the anxiety surrounding the outbreak, some women are still choosing to seek skilled medical care.
"It is with great courage that we came here. We were well received. The care was free. I thank God that my baby and I are alive," says new mother Asobe after safely delivering her baby at a health facility.
Her decision may have saved two lives.
Many other expectant mothers, however, are delaying treatment or giving birth at home, increasing the risk of complications that can prove fatal for both mothers and newborns.
Children have emerged among the outbreak's biggest victims.
According to UNICEF, as of August 2, the Bundibugyo Ebola outbreak had infected 743 children aged between zero and 17 years, claiming the lives of 330 of them. While children account for nearly one in four confirmed Ebola infections, they represent almost one in three deaths, highlighting the disproportionate toll the virus is taking on the youngest patients.
The danger is even greater for younger children. More than 60 per cent of confirmed Ebola infections among children under the age of five have proved fatal, compared with fewer than 30 per cent among adults aged 18 years and above.
The outbreak has now become the largest Ebola epidemic ever recorded in the Democratic Republic of Congo and the second-largest in global history, surpassed only by the devastating West African epidemic of 2014 to 2016.
For health experts, however, the figures tell only part of the story.
The indirect consequences of Ebola have historically claimed thousands of additional lives long after the virus itself has been contained.
During the 2014-2016 West African epidemic, more than 28,600 people were infected and 11,325 died across Guinea, Liberia and Sierra Leone. According to UNICEF, more than 22,000 children lost one or both parents or their primary caregivers, while nearly five million children had their education disrupted as schools remained closed for months.
The collapse of already fragile health systems proved equally devastating.
A landmark study published in The Lancet estimated that interruptions to routine healthcare resulted in an additional 10,600 deaths from malaria, HIV/AIDS and tuberculosis across the three countries. Separate research estimated that disruptions to maternal and newborn healthcare contributed to as many as 3,600 additional maternal, neonatal and stillbirth deaths.
Routine immunisation programmes also stalled, leaving millions of children vulnerable to vaccine-preventable diseases such as measles long after Ebola transmission had ended.
Public health specialists say these indirect deaths demonstrate that Ebola's impact often extends far beyond those infected by the virus.
Eastern Congo is now showing worrying signs of following the same trajectory.
Declining vaccination coverage increases the likelihood of future outbreaks of measles and other preventable diseases. Reduced antenatal care raises the risk of pregnancy complications going undetected, while fewer hospital deliveries expose mothers and newborns to avoidable deaths.
UNICEF warns that the current emergency has evolved into much more than an Ebola outbreak.
"The Ebola outbreak is severely disrupting the entire health system, with inevitable consequences for cases of malaria, diarrhoea and other treatable illnesses that are the biggest killers of children," Agbor said.
"Ensuring that health posts remain open, safe and trusted is essential to saving lives today and preventing future outbreaks tomorrow as we invest in a more resilient health system."
To restore public confidence, UNICEF, working alongside the Ministry of Public Health, the World Health Organization and Africa CDC, has trained and deployed about 13,000 frontline community workers and influential local leaders.
Together, they have reached more than 2.4 million people with information on Ebola prevention and early detection while carrying out over 505,000 household visits aimed at dispelling misinformation and encouraging families to seek treatment promptly.
The agency has also supplied infection prevention materials to eight Ebola treatment centres and equipped 45 health facilities with water, sanitation and hygiene supplies, infection control equipment and screening materials. Essential medicines, malaria treatment kits and obstetric supplies continue to be distributed to priority health facilities, while more than 21,000 people, including over 5,100 children, have received mental health and psychosocial support.
Despite these efforts, UNICEF warns that the response remains dangerously underfunded.
The agency has expanded its emergency operations from 21 to 51 affected and high-risk health zones, revising its six-month appeal to US$113.45 million. So far, only US$23.5 million has been mobilised, leaving a funding gap of US$89.9 million.
For Dr Lokudu Richard, however, the crisis is measured not only by rising case numbers or funding shortfalls, but by the empty benches outside his consultation room.
Every missed antenatal visit, every skipped childhood vaccination and every family too frightened to seek treatment represents another preventable tragedy waiting to happen.
If that fear continues to keep families away from healthcare, experts warn the deadliest legacy of Congo's Ebola outbreak may not only be the lives claimed by the virus itself, but also the countless mothers and children lost to diseases that modern medicine already knows how to prevent.
As it stands, the total number of infections in DRC is 4,053 cases, with 694 hospitalised or under isolation. 1 850 deaths recorded, that is 45.7% fatality rate.
