the bundibugyo strain of ebola spread from dr congo into uganda, with 515 confirmed cases and 91 deaths in congo and 19 cases including 2 deaths newly reported across the border. case totals are climbing toward 600 and a lancet study estimates true numbers may exceed double the reported figure, with documented spread inside islamic-state-controlled areas where burial and healthcare teams are being attacked. an active outbreak overlapping armed-conflict zones removes the surveillance and response capacity that normally contains it.