Ebola Case Exposes Border Screening Gaps in Africa

Questions are mounting over health screening in the Democratic Republic of Congo, Uganda and Kenya after a businessman infected with Ebola travelled across all three countries before his illness was identified.

Patient dies after delayed diagnosis

The 40-year-old Kenyan businessman became the country’s first confirmed Ebola case after arriving seriously ill at a hospital in Nairobi. He died on 5 October, two days after his diagnosis. His infection went undetected during visits to healthcare facilities in DR Congo and airport screenings in Uganda and Kenya, raising concerns about disease surveillance during the ongoing outbreak. More than 4,000 people have reportedly died from Ebola in DR Congo this year, making it the second-deadliest known outbreak to date.

Journey through DR Congo

Africa CDC emergency director Dr Wessam Mankoula has reconstructed the businessman’s movements over nearly six weeks, identifying several opportunities when his infection might have been detected. The man, whose identity has not been disclosed, had lived in DR Congo for seven years and travelled through three provinces for business. His exact place of infection remains unknown, although Ebola was present in all three provinces he visited by early October, according to the World Health Organization. During late August and early September, he spent time in Bas-Uélé province, visiting towns including Buta, Aketi and Likati. The WHO had confirmed an Ebola case in Buta in August, but there is no evidence linking that case to his infection.

Early symptoms mistaken for another illness

The businessman reportedly began experiencing symptoms around 15 September. He received antibiotics and was sent home before being admitted to Tongo Etandi Health Centre in Bondo two days later. He remained at the facility until 19 September, experiencing fever and a rash. His condition was diagnosed as a skin infection, and no Ebola test was conducted during his journey. Health experts note that early Ebola symptoms can resemble those of other illnesses, including malaria, making diagnosis difficult without appropriate testing.

Crossing into Uganda undetected

On 1 October, the businessman boarded a domestic flight to Beni before travelling to Kasindi, a border town in North Kivu province. The region has recorded 1,755 Ebola infections and more than 1,000 deaths. He crossed into Uganda later that day, although it remains unclear whether he passed through an official health checkpoint. Uganda had introduced movement restrictions along its border with DR Congo after the outbreak began in May. The country has experience responding to Ebola through surveillance, contact tracing and isolation of suspected cases, and was declared free of the disease in August after recording cases earlier in the year. However, the extensive border, which runs through remote terrain, presents significant monitoring challenges.

Airport screening fails to detect infection

After travelling by road to Kampala, the businessman continued to Entebbe International Airport and boarded a flight to Nairobi on 3 October. Ugandan officials said his temperature was normal during airport screening. He was also not identified as a suspected case when he arrived at Nairobi’s Jomo Kenyatta International Airport. Health experts say the case demonstrates the limitations of relying on temperature checks and travellers’ self-declarations. Mankoula said investigators were examining whether medication taken by the businessman might have suppressed his temperature, although he may also have had no fever during screening.

Kenya confirms Ebola infection

After arriving in Nairobi, the businessman was collected by a relative and driven directly to Nairobi Hospital. By then, he was experiencing fever, chills, muscle pain, a sore throat and bleeding. Laboratory tests confirmed infection with the Bundibugyo species of Ebola, the same species responsible for the outbreak in DR Congo. He was isolated as his condition deteriorated and died on 5 October. His burial took place the following day under strict infection-control procedures. Kenyan authorities have identified 66 people who may have come into contact with him after his arrival. The WHO expects the number to increase as contact tracing continues in Kenya, Uganda and DR Congo.

Healthcare preparedness under scrutiny

Questions have also emerged about the handling of the patient at Nairobi Hospital, with some healthcare workers raising concerns about quarantine arrangements. Kenya’s health ministry says more than 652,000 travellers have been screened and nearly 5,000 healthcare workers trained to respond to Ebola. Five facilities have also been designated to manage cases. Ebola spreads through direct contact with the bodily fluids of an infected person after symptoms develop, or through contaminated materials. Its incubation period ranges from two to 21 days, meaning exposed individuals may take several weeks to become ill.

Health officials urge early reporting

Mankoula has urged travellers experiencing possible Ebola symptoms to seek medical attention promptly, warning that early reporting can protect both individuals and the wider public. The WHO has also warned that stigma and fear surrounding the disease may discourage people from reporting symptoms or seeking treatment, increasing the risk of undetected transmission. Misinformation remains a challenge in parts of DR Congo, where some health workers have faced attacks from people who deny the existence of Ebola. Health authorities are working to reduce fear and misinformation and encourage people to seek care when symptoms appear.