An Ebola treatment unit in Butembo, in the eastern Democratic Republic of the Congo, has 30 beds. All of them are now occupied as doctors struggle to care for some of the youngest and most vulnerable patients in an outbreak. The outbreak has moved with extraordinary speed.

Dr. Rupa Narra, a U.S. pediatrician who arrived in August to work with Doctors Without Borders, says the experience has been unlike any medical crisis she has encountered before. During one recent week, the unit lost eight patients, all younger than 5.

The latest outbreak has been driven by the Bundibugyo strain of ebolavirus. Unlike Ebola virus disease caused by the Zaire species, Bundibugyo virus disease does not currently have a licensed vaccine or approved specific treatment. The World Health Organization says research is underway to evaluate candidate vaccines and treatments. Meanwhile, supportive care remains a critical part of managing patients. WHO guidance on Ebola vaccines

Narra describes the pediatric burden as particularly severe. Children account for roughly one-quarter of confirmed cases in the outbreak but about one-third of deaths. Newborns face an especially high risk when infected. In addition, younger children can deteriorate rapidly as their bodies struggle to fight the virus.

“I don’t know how this is going to slow down,” Narra says. “It’s the most devastating thing I’ve ever seen in my life.”

Ebola Treatment in Children Leaves Doctors With Few Options

The 30-bed unit in Butembo is divided between patients who are suspected of having Ebola and those whose infections have been confirmed. Fifteen beds are normally reserved for people who are sick and awaiting test results. The remaining 15 are for confirmed cases.

That distinction has become increasingly difficult to maintain as more patients arrive. Some quarantine beds have been reassigned to confirmed patients, Narra says, but the additional capacity is still not enough.

The problem begins with diagnosis. Bundibugyo virus disease can initially resemble malaria and other illnesses, making laboratory testing essential before doctors can determine whether a patient has Ebola. That creates a constant flow of patients who require isolation and medical attention while their results are pending.

Once patients are admitted, Narra and her colleagues largely depend on supportive care. They administer intravenous fluids, provide oxygen and blood transfusions when necessary, manage fever and hypothermia, and treat secondary infections while the patient’s immune system attempts to control the virus.

The approach is particularly demanding for children and newborns. Narra is also helping train about a dozen doctors and nurses in Butembo to adapt supportive treatment for pediatric patients and infants.

The limitations of the environment make that work even harder. Medical workers must enter the treatment area wearing fully disinfected protective equipment. The heat, weight and risks associated with the gear restrict the amount of time clinicians can safely spend with patients.

Narra says she has had to change the way she thinks about the purpose of treatment.

“I had to change my mindset, that we were going to save kids,” she says. “Now, it’s — we’re going to minimize suffering, and we’re going to let the Congolese staff know that they did everything they could to save that baby’s life.”

The absence of an approved vaccine for Bundibugyo virus disease also creates a difficult problem when very young children need prolonged care. In some circumstances, an Ebola survivor could provide care because of previous infection and immunity. However, finding survivors who can safely remain with infants is difficult, particularly when treatment teams are already stretched.

CDC clinical guidance for Ebola disease emphasizes infection-control precautions and supportive care for patients with Ebola diseases for which approved vaccines and therapeutics are not available.

One case remains particularly vivid for Narra. Shortly after she arrived in Butembo, a young mother died after giving birth inside the Ebola unit. Her newborn daughter was left without an exposed family member who could care for her.

Narra did not know what would happen to the baby. Then she entered the room and found a woman holding the newborn.

The woman was an Ebola survivor who did not know the family but had agreed to care for the child.

The baby survived for 10 days before dying from the virus. The caregiver remained with her throughout those final days.

MSF’s response to the 2026 DRC Ebola outbreak describes the particular challenges created by the Bundibugyo virus, including limited diagnostic capacity and the absence of approved vaccines and treatments.

Conflict and a Fragile Health System Compound the Crisis

The medical crisis in eastern Congo is unfolding alongside a broader humanitarian emergency. The affected region lies near the borders with Rwanda and Uganda and has experienced prolonged conflict and displacement.

Families forced from their homes have sought refuge in cities such as Butembo. This increases pressure on health facilities that were already treating other serious conditions.

Hospitals and clinics in the region regularly care for children suffering from malnutrition as well as patients affected by malaria and measles. At the same time, conflict and reductions in foreign assistance have disrupted routine vaccination programs and other health services.

That combination makes Ebola more difficult to contain. Healthcare workers must respond to a rapidly expanding outbreak. Meanwhile, they must maintain essential services for people who need treatment for diseases unrelated to Ebola.

The wider outbreak has also required a large-scale response from international and Congolese health workers. For Narra, however, the most difficult part of the work is often not the complexity of the medicine. It is the distance that protective equipment creates between a frightened child and the person trying to help.

Before entering the treatment area, she puts on a complete hazmat suit. Only her eyes remain visible.

“You’re 5 years old, and these people walk in with what looks like a spacesuit. Of course you’re going to scream!” she says.

A pediatrician would normally have countless simple ways to comfort a frightened child. For example, a doctor might bring in a toy, make a joke, wear a funny hat or pick up a small patient and carry them around the room.

Inside an Ebola treatment unit, those ordinary gestures are largely impossible.

Narra cannot sit beside a critically ill child throughout the night or simply hold a patient’s hand when fear and illness become overwhelming.

“That’s been the very difficult part for me — is I can’t be at the bedside of this critical child,” she says.

Her experience with epidemics stretches back more than a decade. She worked as an epidemiologist during the 2014 West Africa Ebola outbreak, which killed 11,310 people. She later worked as a pediatrician in a Brooklyn emergency department during the COVID-19 pandemic. She also served with Doctors Without Borders in Haiti.

Even with that background, she says the current outbreak has been different because of its speed and the weaknesses of the surrounding healthcare system.

“I’ve never seen anything like this,” she says. “The speed of transmission, along with other aspects of a fragile healthcare system.”

One Child’s Smile Offers a Brief Respite From the Outbreak

The emotional strain of treating children is not limited to those who die. Narra also remembers the patients who eventually test negative for Ebola after days of isolation and uncertainty.

One of them was a 5-year-old girl who was being kept in quarantine while waiting for her test results. Her father stayed beside her and used his smartphone to play Bollywood movies.

Narra, whose family is from southern India, recognized one of the songs. It came from the romantic comedy Desi Boyz.

After finishing her shift, she removed her protective equipment and went outside to the girl’s window. For the first time, the child could see Narra without the protective suit that had made her look like a stranger.

Narra began dancing to the song, improvising the moves from the movie.

“And then, she was smiling, laughing and clapping,” Narra says. “I was like — I don’t even know these moves but I will make them up for you!”

A few days later, the girl’s test results arrived. She did not have Ebola.

For Narra, that negative result became a rare moment of relief during a summer dominated by critically ill children, exhausted healthcare workers and a disease that has placed extraordinary pressure on eastern Congo’s already fragile health system. NPR’s report on Dr. Rupa Narra