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With the Ebola outbreak outpacing response efforts and the disease continuing to spread, experts have warned North African countries to be on high alert.

On May 17, the World Health Organization (WHO) declared the Ebola outbreak in the Democratic Republic of the Congo (DRC) and Uganda a public health emergency of international concern. The disease, caused by a strain of the Bundibugyo virus for which there is no vaccine or treatment, has spread to major population centers in the DRC and the international travel hub of Kampala, Uganda. As of May 24, both countries had reported 906 suspected cases and 223 suspected deaths.

The WHO has warned that the east of the DRC was at the center of a “catastrophic collision of disease and conflict,” with the Ebola outbreak in Ituri province outpacing the response. 

In a statement to Medscape News Middle East, a WHO spokesperson said, “There are significant uncertainties to the actual number of infected persons and geographic spread of this outbreak, with limited understanding of the epidemiological links with known or suspected cases. Ituri’s role as a commercial and migratory hub and proximity to Uganda and South Sudan further increases the risk of regional exportation and cross-border transmission.”

Low Risk, But Real

Experts told Medscape News Middle East that North African countries should be vigilant without panicking.

“Although the current risk of Ebola spreading to the region is still considered low, it is real and cannot be ignored,” said Hazem Ramadan, PhD, professor of zoonotic diseases in the Faculty of Veterinary Medicine at Mansoura University in Mansoura, Egypt.

“Despite the geographic distance, North African countries remain connected through international air travel, particularly via major airports, creating potential pathways for imported cases,” he told Medscape News Middle East. “For this reason, clinicians and public health authorities across North Africa should maintain vigilance, particularly when assessing febrile patients with recent travel history to affected regions.”

Professor of virology in the Faculty of Veterinary Medicine at the University of Tripoli in Tripoli, Libya, and deputy head of the scientific committee at Libya’s National Center for Disease Control (NCDC), Ibrahim Eldaghayes, told Medscape News Middle East that in today’s interconnected world, no region can consider itself isolated from emerging infectious diseases.

“At present, I would say North Africa should remain vigilant and prepared, but there is no reason for panic,” he said.

“The main concern for North African countries is not endemic circulation of Ebola virus, but the possibility of imported cases through international travel, migration routes, humanitarian movements, or cross-border healthcare referrals. Therefore, preparedness remains critically important, [but] preparedness should be viewed as a continuous process rather than a response only during outbreaks.”

He added that most countries in North Africa had strengthened their surveillance and public health capacities since the COVID pandemic, with greater awareness and capacity for infection prevention and control, laboratory diagnostics, rapid response coordination, and risk communication. However, he warned that preparedness varied between countries and that continued investment was required, especially for border health measures.

Ramadan agreed that preparedness across the region was uneven and that there are gaps warranting urgent attention.

“Countries such as Egypt benefit from a relatively robust public health infrastructure and prior experience with emergency health responses,” he said. “However, a systematic and coordinated regional approach is still needed.”

“Key preparedness priorities should include strengthening hospital readiness through isolation capacity, PPE [personal protective equipment] training, and dedicated Ebola response teams, alongside improving clinicians’ ability to recognize early symptoms and routinely assess travel history in febrile patients. Continuous monitoring of WHO and Africa CDC [Centers for Disease Control and Prevention] updates is also essential,” Ramadan added.

Preparedness Levels Vary

Egypt’s Ministry of Health and Population has raised its preparedness levels across quarantine departments at all airports, seaports, and land crossings, including screening travelers arriving from affected areas and monitoring them for 21 days. Tunisia has tightened health surveillance at airports, ports, and land border crossings.

Eldaghayes said Libya’s NCDC surveillance teams, epidemiologic investigation units, and rapid response teams remain on alert and that “preventive measures and health monitoring systems have also been strengthened to ensure the prompt detection and management of any suspected case according to approved technical protocols.”

Bahrain and Jordan have implemented 30-day entry suspensions and travel bans on individuals arriving from countries affected by Ebola.

But Amira Roess, PhD, professor of global health and epidemiology at the College of Public Health at George Mason University, Fairfax, Virginia, urges against border closures, saying they are a last resort that is not politically or economically feasible.

Instead, she said the region should have robust protocols in place to screen passengers who are coming from affected regions — particularly those who spent a lot of time in the areas that have ongoing transmission.

“Many countries around the world do not have the resources or the political will to support robust preparedness and response infrastructure,” she said.

“Robust screening includes identifying individuals at high risk for infection and ensuring that they quarantine and are easy to reach in case follow-up is needed. Resources for quarantine and follow-up are needed…. Screening is nuanced, and personnel need to be trained well to conduct it. A good response process ultimately saves resources and lives in the long run, but it is very difficult to convince decision-makers to invest in prevention.”

The WHO has said that cross-border transmission risks remain elevated due to insecurity, humanitarian crises, high population mobility, urban/semi-urban transmission hotspots, and porous borders. But temporary recommendations from the first meeting of the international health regulations emergency committee did not include the suspension of flights from countries with documented Ebola detection or the denial of entry to travelers arriving from such countries.

The experts cited in this article had no relevant disclosures.