Attacks on Health Care Raise Economic and Development Risks in Congo’s Bundibugyo Outbreak

WHO warns that conflict, attacks on health facilities, misinformation and declining community trust are threatening the 2026 Bundibugyo virus disease response in eastern DRC. The guidance calls for governments, development partners and businesses to invest in safer health systems, resilient infrastructure, community participation and adaptive risk management to protect essential services and long-term economic development.

The World Health Organization (WHO), with technical contributions from experts associated with UNICEF, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), the International Federation of Red Cross and Red Crescent Societies (IFRC), national health authorities and humanitarian partners, has issued operational guidance for protecting health care during the 2026 Bundibugyo virus disease (BVD) outbreak in eastern Democratic Republic of the Congo. Its central finding is straightforward: an outbreak in a conflict zone cannot be controlled through medical interventions alone. Violence, weak infrastructure, disrupted supply chains, misinformation and declining community trust can quickly turn a health emergency into a wider economic and development crisis.

Following the declaration of the outbreak as a Public Health Emergency of International Concern on 17 May 2026, attacks on health care became an increasingly serious operational problem. By 31 July, more than 30 reports of attacks had been received, including 21 incidents verified through WHO's Surveillance System for Attacks on Health Care. Incidents included physical violence, obstruction of services, abduction, arrest and detention of health personnel, armed searches of facilities and interference with the civilian nature of health services. WHO warns that reporting difficulties mean the true scale may be higher.

Health Insecurity Carries a Wider Economic Cost

The damage does not end with an attacked facility or interrupted BVD operation. Insecurity can disrupt maternal and newborn care, immunization, malaria treatment, trauma services, nutrition programmes and treatment of chronic diseases. Previous Ebola emergencies have shown that reduced care-seeking and delayed treatment for other illnesses can generate substantial additional sickness and deaths.

For governments, this means health insecurity can create costs across several sectors. Interrupted services place additional pressure on public budgets, while damaged infrastructure and disrupted medical supply chains increase operating costs. Families may lose income when illness prevents people from working or when they must travel farther for treatment. The WHO guidance does not calculate these losses in monetary terms, leaving an important evidence gap for finance ministries, donors and development institutions.

WHO therefore promotes a "protection-by-design" approach. Risk assessment, prevention and mitigation should be incorporated into health operations from the beginning instead of being introduced only after an attack or disruption.

Community Trust Is Becoming a Policy Priority

One of the strongest messages is that community trust can determine whether technically sound health interventions succeed. Rumours, misinformation, stigma and perceptions of coercion can discourage people from seeking care and increase resistance to response teams. Perceived unfairness in recruitment, incentives, assistance or resource allocation can deepen existing grievances.

WHO recommends involving communities directly in planning, implementing and monitoring interventions. Local leaders, community health workers, women's and youth groups, religious leaders, survivors, civil society organizations, and affected households can help identify problems before they become serious operational risks.

Governments and development partners should therefore treat community engagement as part of programme design rather than simply a communications exercise. Feedback systems must also lead to visible action. Special attention is needed to ensure participation by women, young people, persons with disabilities, displaced populations and other underserved groups.

Governments, Donors and Businesses Face New Risks

Health facilities should remain clearly civilian and neutral spaces. WHO recommends no-weapons protocols in clinical areas and warns that inappropriate armed protection can sometimes increase risk by making health services appear connected to military or political actors.

Mobile surveillance, investigation and burial teams require security and access assessments before deployment. Organizations must also protect their workforce through training, communication systems, confidential reporting mechanisms and psychosocial support, while avoiding the transfer of disproportionate risks to local employees and volunteers.

For development partners, this creates a case for financing resilient health systems rather than focusing only on short-term outbreak activities. Investments are needed in referral networks, medical supply chains, communications, local emergency capacity, community-feedback systems and incident monitoring.

The private sector also faces both opportunity and exposure. Logistics, telecommunications, medical technology, construction, transport, energy and digital-health companies could help strengthen operations in fragile environments. Demand may increase for decentralized energy, reliable communications, resilient supply chains, emergency transport and health-data systems. However, businesses face security, reputational and operational risks if their activities are poorly coordinated or perceived as politically aligned.

From Emergency Response to Long-Term Resilience

WHO proposes a four-stage decision cycle: understand the context, plan the activity, implement and monitor operations, and review and adapt. Its assessment framework uses green, amber and red categories across areas including community trust, security, humanitarian access, health facilities, health-system functionality and coordination.

Importantly, a red rating does not automatically mean stopping an operation. Decision-makers should first determine whether risks can be reduced. Activities may continue with stronger safeguards, or they may need to be modified, delayed, relocated or temporarily suspended.

After an incident, WHO recommends four immediate actions: secure people, notify responsible authorities, escalate serious problems and record the event. Documentation should then be used to understand underlying causes and improve future operations.

For policymakers, the longer-term opportunity is to connect incident information with data on facility closures, service disruption, staffing, supply chains and economic losses. This could help governments and donors measure the real cost of health insecurity and direct investment toward prevention.

The broader lesson from eastern DRC is that health resilience depends on more than hospitals, medicines and laboratories. It also depends on whether workers can reach patients safely, communities trust health institutions and essential services continue during insecurity. With more than 30 reported attacks and 21 already verified by the end of July, WHO's guidance makes the development case clear: protecting health care is not simply an emergency requirement but an investment in human capital, institutional resilience and economic stability.