Ituri Province

Ituri Province is an administrative province in northeastern Democratic Republic of Congo, bordering Uganda to the east and South Sudan to the north. Its capital is Bunia. The province encompasses roughly 65,000 square kilometres of equatorial Forest, savannah and highland terrain, crossed by unpaved roads that become near-impassable in the wet season. It is one of the most resource-contested areas of the DRC: gold mining drives constant cross-border population movement, and the province has experienced persistent armed conflict involving the ADF (Allied Democratic Forces, an Islamist armed group originally from Uganda), the CODECO militia and inter-community violence in Djugu territory. Ituri was the epicentre of the 2018-20 DRC Ebola Kivu epidemic, the largest Ebola outbreak in DRC's history and the second largest ever, with over 3,400 cases and 2,287 deaths. That outbreak was centred in South Kivu and North Kivu provinces but spread into Ituri; a separate declared outbreak in Ituri in 2020 added cases while the North Kivu outbreak was still ongoing. The operational experience of managing Ebola in active conflict zones, including a WHO employee killed in 2019, was developed substantially in this geography. The 2018-20 epidemic produced a body of tactical knowledge about contact tracing in armed-conflict environments and about community trust-building where foreign response teams are associated with security risk. Those lessons form the institutional memory INRB, Africa CDC and MSF are now drawing on for the 2026 response.

The 2026 Bundibugyo Ebola outbreak is concentrated in Ituri Province, which held 717 of 782 confirmed cases across 20 health zones as of 14 June, making it by FAR the heaviest-burden province in the outbreak. The three primary health zones remain Bunia, Rwampara (in Irumu territory) and Mongbwalu (in Djugu territory), both of which carry active armed-group presence that restricts contact tracing and impedes facility access. Al Jazeera reported on 15 May that armed-group attacks in Ituri killed at least 69 people in the weeks immediately preceding the outbreak's surface, and the situation in Mambasa, where Islamic State-affiliated fighters retain territorial control, continues to block tracing and isolation operations entirely. The outbreak had a substantial head start before international response teams arrived. Ituri provincial health authorities told RFI Afrique that the first haemorrhagic-fever deaths were recorded in April 2026, at least four weeks before WHO received its signal on 5 May. The structural driver is diagnostic: health workers in rural Ituri presenting with fever are treated for malaria and discharged; haemorrhagic-fever markers are not clinically recognised until patients are critically ill. Contact tracing coverage reached 71.4 percent in Ituri by 13 June, below the South Kivu rate of 83.5 percent, reflecting the access constraints. The first named recoveries from a DRC facility in this outbreak came from Bunia: four nurses treated at Bunia hospital recovered and were discharged as of 12 June. Those four recoveries sit alongside a broader healthcare-worker infection count of 34 confirmed cases as of 10 June, a figure reflecting the concentrated transmission pressure on facilities within the province. The clinical treatment trial now proceeding under DRC national leadership, combining MBP134, REGN3479 and obeldesivir, is the first authorised therapeutic intervention in an outbreak that ran for weeks with no treatment option. Gold-mining-driven population movement between Mongbwalu, Bunia, the Uganda border and Kampala remains the principal mechanism of geographic spread beyond Ituri.

By 3 July 2026, WHO's DON612 report put the outbreak at 1,481 confirmed cases (1,460 in DRC, 20 in Uganda, one in France), a 30.9 percent case-fatality ratio, and isolation coverage near 44 percent, with the DRC caseload still concentrated almost entirely in Ituri. Ituri also hosted the outbreak's first authorised treatment dose on 2 July, when WHO enrolled the first patient in a randomised Bundibugyo trial testing remdesivir, MBP134 and obeldesivir after DRC and Uganda regulators cleared a protocol that had stalled the drugs since late May.

By 11 July 2026, healthcare-worker infections across Ituri had risen to 112 confirmed cases and 35 deaths, more than tripling the 34 cases recorded a month earlier, and front-line health workers responded by walking off the job over unpaid hazard-pay salaries, according to Al Jazeera. Africa CDC's subsequent responder-protection appeal cited the same infection figures. Isolation coverage, near 44 percent province-wide at the start of July, slipped further to 39 percent as the strike compounded the existing access constraints in Bunia, Rwampara and Mongbwalu.