Mothers and children waiting for the start of routine vaccinations at the Bikoro health centre, in the Equateur province of Congo. — ©2025 The New York Times Company
WERRA Maulu Botey could not bear to close his daughter’s coffin. Waiting to bury her, he slid the rough wooden lid back, again and again, to adjust her small head and smooth the cloth cradling her cheeks.
Olive, aged five, had died of measles the evening before. She was the first child to die that weekend in an emergency treatment centre in Bikoro, northwest Congo. The second was her cousin, just one year old.
Measles is a recurring scourge in Congo, flaring across the vast country every couple of years. Despite the availability of a vaccine since 1963, it continues to claim lives, especially in remote, underserved regions.
Congo reported over 97,000 measles cases in 2023, with more than 2,100 deaths. This represented a troubling increase in lethality, though reasons for this trend remain unclear.
Globally, the World Health Organisation (WHO) reported a 20% rise in cases in 2023, with 10.3 million infections and over 107,000 deaths.
While outbreaks in wealthier nations like the United States and Canada are fuelled by vaccine hesitancy, in Congo, the challenge is access.
Olive’s story illustrates the immense barriers families face to vaccinate and treat their children.
A heartbreaking journey
Olive lived in Ikoko Ipenge, a village 45km from Bikoro, where there is no health centre. Her father worked in Bikoro, and her mother, far off in Mbandaka, left Olive in her grandmother’s care.
When Olive’s breathing turned shallow on the morning of Nov 19, her grandmother carried her to a neighbouring village on a bicycle – a gruelling four-hour journey. From there, they hired a motorbike for the final hour to Bikoro.
The measles treatment centre they reached was hastily set up by Doctors Without Borders. Made of wood and tarpaulin, it was struggling to handle the influx of cases. Olive was one of 18 new patients that day.
She needed oxygen and a blood transfusion, but Bikoro had no blood bank. Her aunt held her hands to stop her pulling out the oxygen tube, but by 7pm, Olive was dead.
Her mother, Gisele Mboyo Ekongo, had travelled through the night to reach Bikoro. She first learned of her daughter’s illness through the news of her death.
“The vaccines don’t come; the care is so far away,” she lamented.
Hidden toll of measles
Measles is a severe illness anywhere, causing fever, vomiting, diarrhoea and a telltale rash.
But in regions like Congo, with poor medical infrastructure and widespread malnutrition, the virus is especially lethal.
“Measles causes immune amnesia, wiping out resistance to other infections,” explained Dr Eric Mafuta from the University of Kinshasa.
In Olive’s case, pneumonia likely delivered the final blow.
Diarrhoea, another common complication, often kills malnourished children. Some 4.5 million Congolese children are acutely malnourished, making measles outbreaks even deadlier.
Severe cases can also lead to blindness, deafness or encephalitis, but many children die before such complications arise.
Health workers consulting new patients in the triage tent for suspected measles cases at the Doctors Without Borders treatment centre in Bikoro, Congo. — ©2025 The New York Times Company
Barriers to vaccination
Measles is preventable with two doses of a vaccine that costs less than a dollar. However, Congo’s vaccination coverage is just 52%, far below the 95% needed to halt outbreaks.
“Even in the poorest provinces, only 13% of children have measles antibodies,” said Mafuta. The reasons are many: logistical hurdles, underfunded health workers and ongoing conflict that leaves millions displaced.
Congo is roughly the size of Western Europe but has only about 2,900km of paved roads. During the rainy season, even these become impassable.
Vaccines must also be kept chilled, a challenge in a hot climate with a fragile electrical grid.
Nurses, often unpaid, are expected to run vaccination campaigns and travel to remote communities on motorbikes. Outreach workers, who use megaphones to summon families, rely on stipends from aid agencies, which are inconsistent.
Conflict compounds these issues.
Over seven million Congolese are internally displaced due to decades of fighting, and last year alone, 740,000 people fled their homes.
Aid organisations attempt to vaccinate children in displacement camps, but many remain unreachable.
Even when vaccines arrive, families often miss them. Agricultural labourers like Olive’s parents leave home at dawn and return after dark.
“In some villages, you only find elderly people and small children,” Mafuta said.
Glimmers of hope
Efforts to tackle measles in Congo face steep challenges, but progress is possible. Rapid diagnostic tests, expected within two years, could help identify outbreaks more quickly.
Another promising innovation is the vaccine patch, currently in clinical trials. It eliminates the need for refrigeration and simplifies distribution, which could be transformative in remote regions.
For now, the tragedy of Olive’s death is a stark reminder of the urgent need to strengthen healthcare systems.
“Measles is not just a health issue,” said Dr Natasha Crowcroft of the WHO. “It’s a measure of how we care for our children.”
In Congo’s vast and challenging terrain, that care remains heartbreakingly out of reach for too many families. — ©2025 The New York Times Company
