MSF warned that the Ebola response in the Democratic Republic of Congo remains out of control despite substantial funding, with money failing to reach patients, communities and frontline workers.

Since the outbreak was declared in May, more than 5,400 people have died and 11,000 have been infected, making it the second-deadliest Ebola outbreak on record.

British epidemiologist Neil Ferguson said more than half of cases are going undetected and predicted the outbreak could continue for another year.

The outbreak is centred in conflict-affected eastern DR Congo, where poor roads and rebel control hamper access; cases have also been reported in Kenya, Uganda and Nigeria.

The outbreak is caused by the relatively rare Bundibugyo species of Ebola, for which no vaccine or treatment is approved, although trials are underway.

MSF reported that some healthcare workers are unpaid or inadequately trained, ambulances have run out of fuel, and essential supplies and staff support are lacking.

Contact tracing and surveillance remain deeply problematic, with some teams existing only on paper and two-thirds of deaths occurring in communities rather than treatment centres.

MSF said response efforts were slow in North Kivu and Haut-Uélé was severely neglected; facilities in both provinces lack basics such as water, chlorine and triage systems.

MSF warned that poorly equipped health facilities can become sources of Ebola transmission instead of places of care.

The warning followed an Africa CDC estimate that $700 million of the $962 million disbursed to response organizations was unaccounted for; Africa CDC chief Jean Kaseya called it a serious transparency and financial-reporting failure, while saying it was too early to call it embezzlement.

MSF urged the Congolese government and UN agencies to strengthen oversight, ensure response workers are trained, paid and supported, and direct resources to areas with the greatest needs.