Nigeria: The Anatomy of an Outbreak in a Conflict Setting & Nigeria's Preparedness for Ebola

The latest Ebola outbreak in DRC is unfolding in a conflict-affected region where insecurity, displacement, and fragile trust are complicating containment efforts. What does this reveal about Nigeria's preparedness for outbreaks in its own most challenging settings?

When the World Health Organization (WHO) declared the Ebola outbreak in the Democratic Republic of Congo and Uganda a Public Health Emergency of International Concern, it was issuing the highest level of alarm available under the International Health Regulations for the ninth time in history, the third involving Ebola, and the first for an outbreak caused by the Bundibugyo strain, for which no licensed vaccine exists.

The declaration reflected growing concern about an outbreak unfolding in a conflict-affected region where insecurity, displacement, and fragile community trust are making containment significantly harder. As WHO Director-General Dr Tedros Adhanom Ghebreyesus stated at the recent media briefing on the Ebola outbreak: "The key to ending this outbreak is not biomedical. It's leadership, ownership, partnership and trust."

Nigeria responded with familiar and necessary measures, activating an Emergency Operations Centre (EOC), designating laboratories, and completing a risk assessment, placing national preparedness at 59%. These essential steps are a standard minimum response that most countries with functional public health systems would be expected to mount, but they answer the easier question.

The harder question is what happens if Nigeria's potential index case does not arrive at an international airport, as in 2014, but instead appears in one of the country's conflict-affected communities, where years of insecurity have weakened healthcare infrastructure and institutional trust?

Nigeria's track record of responding to concurrent outbreaks justifies its preparedness measures. A swift response contained the 2014 Ebola outbreak within weeks through rapid contact tracing, a unified command, and political leadership, lessons that shaped how Nigeria approached subsequent outbreaks.

Years of Lassa fever surveillance coordinated through NCDC's National Reference Laboratory strengthened diagnostic systems that would prove critical during COVID-19, when the NCDC built directly on that foundation to achieve a record expansion of testing laboratories, train more than 35,500 health workers on infection prevention, and develop genomic sequencing capacity now extended across multiple pathogens.

More recently, investments in clinical trial readiness for Lassa fever across high-burden stat