The World Health Organization (WHO) described the combination of military conflict and civilian distress as a potential "perfect storm" that could lead to a rapid worsening of the outbreak.

[22] In October, the United Nations Security Council stressed that all armed hostility in the DRC should come to a stop to better fight the ongoing EVD outbreak.

[29] As of mid-October the transmission of the virus had significantly reduced; by then it was confined to the Mandima region near where the outbreak began, and was only affecting 27 health zones in the DRC (down from a peak of 207).

[44][45] On 1 August, just after the Ebola epidemic had been declared, Doctors Without Borders/Médecins Sans Frontières (MSF) arrived in Mangina, the point of origin of the outbreak, to mount a response.

[47] On 4 August, the WHO indicated that the current situation in the DRC, due to several factors, warranted a "high risk assessment" at the national and regional level for public health.

[61][50] On 24 September, it was reported that all contact tracing and vaccinations would stop for the foreseeable future in Beni due to a deadly attack by rebel groups the day before.

[62] On 25 September, Peter Salama of the WHO indicated that insecurity was obstructing efforts to stop the virus and believed a combination of factors could establish conditions for an epidemic.

[68] On 29 December 2018, the DRC Ministry of Public Health announced that there had been "0 new confirmed cases detected because of the paralysis of the activities of the response in Beni, Butembo, Komanda and Mabalako" and no vaccination had occurred for three consecutive days.

[83] The 12 May 2019 issue of WHO Weekly Bulletin on Outbreaks and Other Emergencies, indicates that "continued increase in the number of new EVD cases in the Democratic Republic of the Congo is worrying...no end in sight to the difficult security situation".

[85] On 14 July 2019, the first case of EVD was confirmed in the capital of North Kivu, Goma, a city with an international airport and a highly mobile population of 2 million people located near the DRC's eastern border with Rwanda.

[102] According to the International Red Cross, a "most likely scenario" entailed an asymptomatic case entering the country of Uganda undetected among the numerous refugees then coming from the DRC.

[110] On 12 February, it was reported that 13 individuals had been isolated due to their contact with a suspected Ebola case in Uganda;[111] lab results came back negative several hours later.

[118] In regards to possible EVD cases in Tanzania, the WHO stated on 21 September 2019 that "to date, the clinical details and the results of the investigation, including laboratory tests performed for differential diagnosis of these patients, have not been shared with WHO.

[247] In September 2018, the WHO's Deputy Director-General for Emergency Preparedness and Response described the combination of military conflict and civilian distress as a potential "perfect storm" that could lead to a rapid worsening of the outbreak.

[250][251] Yet another attack reported on 17 November, in Beni by an armed rebel group forced the cessation of EVD containment efforts and WHO staff to evacuate to another DRC city for the time being.

[270] A significant part of the actual EVD infection is based on immune suppression along with systemic inflammation, leading to multiple organ failure and shock.

[271] Systemic inflammation and fever may damage many types of tissues in the body but the consequences are especially profound in the liver where Ebola wipes out cells required to produce coagulation.

Genetic sequencing had already identified another unrelated strain of Zaire ebolavirus that was implicated in the 2018 outbreak in Équateur province which had ended only a week previously.

[275] Ebola virus is found in a variety of bodily fluids, such as breast milk, saliva, stool, blood, and semen, rendering it highly contagious due to ease of contact.

[283] Even with the advances made in vaccine technology and treatment options during previous Ebola outbreaks, effective control of the North Kivu Epidemic continued to rely on traditional public health efforts including the timely identification and isolation of cases, control measures in hospital settings, identification and follow-up of contacts, community engagement, and safe burials.

The volume of contacts and the duration of monitoring presented challenges in Ebola surveillance as it required careful record-keeping by properly trained and equipped staff.

[287] In North Kivu and Ituri, outbreaks of sporadic violence and suspicion of the response in parts of some affected communities impacted heavily on disease surveillance.

Additionally, the high degree of mobility of affected populations, combined with occasional mistrust of the response has meant that contacts that had been identified have sometimes been lost to follow-up for extended periods.

[290] Additionally, people from the affected region reported that their perception of security and trust in the government, as well as humanitarian workers, declined over the course of the outbreak, complicating an already complex response.

[300] On 12 August 2019, it was announced that two clinical trial medications were found to improve the rate of survival in those infected by EVD: atoltivimab/maftivimab/odesivimab, a cocktail of three monoclonal Ebola antibodies, and ansuvimab.

[324][325] A fourth Ebola Treatment Center (after those in Mangina, Beni and Butembo) was inaugurated in September in Makeke in the Mandima Health Zone of Ituri Province.

In terms of prognosis, aside from the possible effects of post-Ebola syndrome,[335] there is also the reality of survivors returning to communities where they might be shunned due to the fear many have towards the Ebola virus,[336][337] hence psychosocial assistance is needed.

[363][364] Following the confirmation of Ebola crossing into Uganda, a third review by the WHO on 14 June 2019[24] concluded that while the outbreak was a health emergency in the DRC and the region, it did not meet all three criteria required for a PHEIC.

The UK DfID minister, Rory Stewart, visited the area in July 2019, and called for other western countries, including Canada, France and Germany, to donate more financial aid.

[369][370] On 1 June 2020, the Congolese health ministry announced a new DRC outbreak of Ebola in Mbandaka, Équateur Province, a region along the Congo River.