Ethiopia’s Marburg Crisis: What Every Citizen Must Know

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An Ethiopian Tribune Special Report

By Our Health Correspondent

Ethiopia stands at a critical juncture. The nation’s first-ever Marburg virus outbreak, confirmed on 14th November in the remote Jinka district of South Ethiopia Region, has claimed six lives and infected at least nine people. Now, unconfirmed reports emerging from St Paul’s Hospital Millennium Medical College in Addis Ababa suggest the deadly pathogen may have reached the capital, a development that, if verified, would transform a regional emergency into a national crisis of the first order. The Ministry of Health has yet to confirm or deny these reports, maintaining that all confirmed cases remain concentrated in the Omo region near the South Sudan border. Yet in an age of rapid population movement and interconnected cities, the possibility of urban transmission cannot be dismissed out of hand. This newspaper has a duty to inform the public whilst avoiding unnecessary alarm, and it is in that spirit we present this comprehensive guide to understanding and preventing Marburg virus disease.

On 14th November, Ethiopian health authorities officially confirmed the country’s first Marburg outbreak following molecular testing at the Ethiopia Public Health Institute. Health Minister Mekdes Daba announced on Monday that laboratory tests had confirmed six deaths from the Ebola-like pathogen, whilst another three deaths exhibiting symptoms remain under investigation. The virus strain shares genetic similarities with those identified in recent East African outbreaks in Rwanda and Tanzania, suggesting a worrying regional pattern of emergence. Authorities have placed 129 contacts under medical surveillance. In a statement on Monday, the Minister reported that no active symptomatic cases had been detected since Friday, though this assertion requires careful monitoring given the unconfirmed reports from the capital and the disease’s incubation period of up to 21 days.

The World Health Organisation Director-General, Dr Tedros Adhanom Ghebreyesus, has moved swiftly to support Ethiopia’s response. On Friday, Dr Tedros praised the Ethiopian government’s “fast action” and “commitment to bringing the outbreak under control quickly” via social media, announcing that WHO would collaborate closely with the Ministry of Health, the Ethiopian Public Health Institute, and regional health authorities as part of a rapid response. The WHO has released $300,000 from its Contingency Fund for Emergencies to bolster Ethiopia’s response capacity. This emergency disbursement funds critical supplies: personal protective equipment for healthcare workers, infection-prevention materials, laboratory consumables, and a rapidly deployable isolation tent to bolster clinical care and management capacity. An 11-member WHO technical team specialising in viral haemorrhagic fever outbreak response has been dispatched to support Ethiopian authorities, with Dr Tedros confirming that samples from the outbreak have been received for laboratory testing and that contact tracing in affected areas would be supported.

The Africa Centres for Disease Control and Prevention released a statement on 15th November acknowledging the outbreak and praising the Ethiopian government’s swift action and transparent communication. Africa CDC Director-General Dr Jean Kaseya stated that the outbreak was of particular concern because South Sudan, sharing a porous border with the affected region, “isn’t far and has a fragile health system.” In their statement, Africa CDC noted that it would work with Ethiopia’s Ministry of Health to integrate Marburg virus response efforts with ongoing mpox preparedness and surveillance, a joint approach designed to optimise resources, accelerate early detection, and reduce the risk of regional spread. The Africa CDC has maintained a robust partnership with the Ethiopia Public Health Institute since 2016, providing genome-sequencing equipment and Marburg-specific detection kits, investments that have proven prescient in this hour of need. As a leading Ethiopian research institution, the Armauer Hansen Research Institute has also seen its research and genomics capacity significantly strengthened through Africa CDC’s support, positioning it to play a central role during this outbreak.

South Sudan has issued urgent health advisories urging residents in border counties to avoid contact with bodily fluids, and over the weekend convened an emergency meeting to coordinate the national response. Dr Mabior Kiir Kudior, Chief of Planning and Information at South Sudan’s Public Health Emergency Operations Center, stated that response teams would be deployed on Tuesday to high-risk counties including Kapoeta East, Akobo, Pochalla, and Greater Pibor Administrative Area to conduct risk assessments and monitor population movement. Kenya has activated surveillance protocols, with Kenya National Public Health Institute Director General Kamene Kimenye noting on Tuesday that the strong travel, trade, and migration ties between Kenya and Ethiopia make Kenya vulnerable to the virus. The United States Embassy in Addis Ababa issued a health alert on 18th November, noting that the U.S. Centers for Disease Control and Prevention had issued a Level 1 Travel Health Notice for Marburg in Ethiopia, and that the embassy has limited official travel to the South Ethiopia Regional State except for personnel providing assistance to the Ministry of Health. The international community understands what Ethiopia faces: a pathogen that kills, on average, half of those it infects, with mortality rates documented as high as 88 per cent in previous outbreaks.

Marburg virus disease belongs to the same family as Ebola the filoviruses and presents with similarly devastating symptoms. After an incubation period of two to 21 days, patients develop sudden high fever, severe headache, and profound malaise. By the third day, watery diarrhoea, abdominal pain, and nausea commence. The clinical picture deteriorates rapidly: severe haemorrhagic manifestations appear between days five and seven, with patients bleeding from multiple orifices whilst descending into confusion and aggressive behaviour. Death typically occurs eight or nine days after symptom onset, preceded by severe blood loss and shock. Those who survive face a protracted recovery, with documented cases of arthritis, hepatitis, asthenia, and vision problems persisting for months. The virus can remain sequestered in immune-privileged sites, the eyes and testicles, for extended periods, creating ongoing transmission risks. The Egyptian rousette bat serves as the natural reservoir, inhabiting caves and mines across Ethiopia and the broader East African region. Human infection typically begins through prolonged exposure to these bat colonies, after which person-to-person transmission occurs through direct contact with blood, secretions, organs, or other bodily fluids of infected individuals.

History repeatedly demonstrates that healthcare workers bear disproportionate risk during haemorrhagic fever outbreaks. Without proper personal protective equipment and strict barrier nursing protocols, doctors, nurses, and auxiliary staff become patients themselves. Among the six confirmed deaths in Jinka is at least one healthcare worker, a grim reminder of the occupational hazards faced by medical professionals during viral haemorrhagic fever outbreaks. The unconfirmed reports from St Paul’s Hospital raise particular concern, if true, they suggest possible nosocomial transmission, the nightmare scenario in which healthcare facilities become amplifiers rather than controllers of disease. Those whose livelihoods depend on entering caves or mines face direct exposure to infected bat colonies. Evidence from Democratic Republic of Congo outbreaks indicates that mining work increases infection risk nearly fourteen-fold. Artisanal miners in southern Ethiopia and subsistence communities exploiting cave resources must exercise extreme caution.

In Ethiopian culture, as elsewhere in Africa, family members typically provide intimate care for the ill. This admirable tradition becomes perilous during Marburg outbreaks. Direct contact with bodily fluids blood, vomit, diarrhoea, saliva during caregiving creates high transmission risk. Traditional burial practices involving washing and preparation of bodies have historically served as super-spreader events. The virus shows particular cruelty towards expectant mothers. Foetal loss rates approach 100 per cent, even when the mother survives. Pregnant women infected with Marburg face catastrophic outcomes and require specialised medical attention. Those handling biological specimens from suspected cases work with extreme biohazard material. Without maximum biosafety containment BSL-4 protocols laboratory-acquired infections can occur, potentially seeding outbreaks in urban centres far from the initial focus. Male survivors can harbour viable virus in semen for up to seven months post-recovery. Sexual transmission represents a documented risk, requiring survivors to practise safer sex or abstain for extended periods whilst undergoing regular testing.

In the absence of licensed vaccines or curative treatments, prevention becomes our most potent weapon. Every Ethiopian has a role to play in containing this outbreak. Members of the general public should avoid all unnecessary contact with individuals displaying symptoms of acute febrile illness, particularly if accompanied by bleeding, vomiting, or diarrhoea. This is not callousness but prudent public health practice. Stay away from caves and mines known to harbour bat colonies. If such entry proves essential for your livelihood, wear protective clothing and avoid touching bats, bat excrement, or surfaces contaminated with guano. Ensure thorough cooking of all meat products. Fruit should be washed carefully and peeled before consumption, as fruit bats may contaminate produce with virus-laden saliva. Practice meticulous hand hygiene using soap and water or alcohol-based sanitiser, particularly after any potential exposure to contaminated surfaces or before eating. Report suspected cases immediately to health authorities via the Ministry’s emergency hotline: 8335 or 952. Early detection saves lives and prevents onwards transmission.

Healthcare workers must implement strict barrier nursing techniques without exception. All suspected or confirmed Marburg patients must be isolated immediately, with dedicated staff using comprehensive personal protective equipment: waterproof gowns, double gloves, face shields, and N95 respirators at minimum. Treat all bodily fluids and contaminated materials as extreme biohazards. Use autoclave sterilisation or chemical disinfection (0.5 per cent chlorine solution) for all reusable equipment. Maintain heightened surveillance amongst colleagues. Healthcare workers who develop fever must immediately cease patient contact and undergo testing. The reported suspension of Dr Biniyam Asrat of Jinka General Hospital for “unauthorised disclosure” sends a chilling message at precisely the wrong moment. An investigative report examining the suspension notes that despite the Ministry of Health’s acknowledgment of six deaths, including a healthcare worker, official statements publicly disputed laboratory confirmation for three cases, raising concerns about political interference and suppression of outbreak information. Healthcare workers must be empowered, not intimidated, to report suspected cases. Transparent communication between clinical staff and public health authorities represents the cornerstone of outbreak control. Head of the South Ethiopia Regional Health Bureau, Endashaw Shiberu, told The Reporter that whilst authorities are taking necessary measures to contain the spread, woredas and zones in the region have been instructed not to release any information regarding the outbreak without authorisation from the Ministry of Health.

Affected communities must modify traditional burial practices during this outbreak period. Bodies of Marburg victims remain highly infectious. Trained burial teams with proper protective equipment should handle all suspected cases, whilst families observe from a safe distance. This difficult sacrifice honours the deceased whilst protecting the living. Support survivors and their families. Stigmatisation hampers outbreak response by driving cases underground. Survivors require regular medical follow-up, psychological counselling, and community reintegration support. Engage with contact tracers. Those who cooperate with surveillance teams protect not only themselves but their entire community. Hiding potential exposures allows the virus to spread silently. Male survivors should follow safer sexual practices for twelve months post-recovery or until two consecutive semen samples test negative for viral RNA. Use barrier contraception consistently. Understand that whilst you feel recovered, your body may harbour virus capable of infecting partners.

The unconfirmed reports from St Paul’s Hospital warrant serious attention. If Marburg has indeed reached Addis Ababa, the outbreak response must scale dramatically. The capital’s dense population, extensive informal settlements, and role as transport hub create conditions for rapid transmission. St Paul’s Hospital Millennium Medical College serves as a referral centre, drawing patients from across the country. A confirmed case there could represent either a patient transferred from Jinka for specialised care, a healthcare worker infected whilst treating the original cases, or an independent chain of transmission originating elsewhere. Each scenario carries different implications for outbreak control. The Ministry of Health must urgently clarify this situation. If cases exist in Addis Ababa, the public deserves immediate notification alongside clear guidance. If the reports prove false, equally swift denial prevents unnecessary panic. Silence serves no one.

Ethiopia need not face this crisis alone or uninformed. Rwanda’s 2024 Marburg outbreak, though initially alarming, was contained within three months through decisive action. Rwandan authorities implemented aggressive contact tracing, isolating over 400 individuals. Experimental vaccines were deployed to 1,700 high-risk individuals, primarily healthcare workers. Whilst 15 people died of the virus, 51 recovered,a case fatality rate of 22.7 per cent, one of the lowest ever recorded in the history of viral haemorrhagic fevers. Rwanda didn’t just rely on vaccination the response also used therapeutics like remdesivir and monoclonal antibodies to treat symptoms. Whilst these vaccines and treatments remain unlicensed and unavailable for general use, Rwanda’s experience demonstrates that even highly lethal pathogens can be contained through coordinated public health measures. Tanzania’s outbreak in early 2025 was brought quickly under control without use of the vaccine, although all ten patients who tested positive for Marburg died. Ethiopia possesses capable epidemiologists, well-trained laboratory personnel, and international support. What remains essential is political will, transparent communication, and public cooperation.

Ethiopia’s Marburg outbreak arrives at a challenging moment. The nation faces economic pressures, political tensions, and the ongoing aftermath of recent conflicts. Yet infectious diseases care nothing for our other concerns. Marburg will exploit every lapse in vigilance, every delay in response, every gap in communication. The coming weeks will test our public health infrastructure and our collective resolve. Healthcare workers require not only proper equipment but political backing to report cases without fear of reprisal. Communities need accurate information, not rumours or reassurances disconnected from reality. The public deserves transparency from authorities who understand that trust, once lost, proves nearly impossible to rebuild.

This outbreak can be contained. The virus, though deadly, does not spread through casual contact or airborne transmission. It requires direct exposure to bodily fluids—a condition that proper precautions can prevent. Rwanda contained its outbreak; so can Ethiopia. But containment requires honesty about where cases exist, rapid isolation of patients, protection of healthcare workers, modification of high-risk cultural practices, and sustained community engagement. It requires that we acknowledge fear whilst refusing to let it paralyse us. It requires that we protect the vulnerable whilst avoiding the stigmatisation of survivors. The Ministry of Health must address the reports from St Paul’s Hospital without delay. The international community must sustain its support beyond the initial emergency response. Healthcare workers must be empowered to speak truth without professional repercussion. And every Ethiopian must understand that in an outbreak, individual actions carry collective consequences.

Six families in Jinka mourn their dead. One hundred and twenty-nine individuals endure the anxiety of medical surveillance, uncertain whether they carry the virus. Healthcare workers throughout the south labour under extraordinary stress. If Marburg has reached Addis Ababa, thousands more may soon join them in vigilance and worry. This is Ethiopia’s first Marburg outbreak. With wisdom, courage, and cooperation, it can also be our last.

For more information or to report suspected cases, contact the Ministry of Health emergency hotline: 8335 or 952. Readers experiencing sudden fever, severe headache, muscle pain, or unexplained bleeding should immediately seek medical attention whilst minimising contact with others.