Cross-border healthcare-seeking behavior among Bundibugyo Ebola virus disease cases during the Uganda outbreak, May to June 2026

Background: Cross-border population mobility can complicate case detection and outbreak control when persons with severe infectious illness seek care across national borders. During Uganda’s 2026 Bundibugyo Virus Disease (BVD) outbreak, several affected persons from the Democratic Republic of Congo (DRC) sought healthcare in Uganda. We explored cross-border healthcare-seeking experiences and pathways, factors shaping care-seeking decisions, the role of social networks, and potential exposure opportunities before BVD recognition and isolation.

Methods: We conducted a secondary qualitative analysis of outbreak case-investigation narratives and key-informant interviews from 18 outbreak-linked participants, including cases, caregivers, healthcare workers, local leaders, and a community liaison. Narratives recorded in languages other than English were transcribed verbatim and translated into English. Two investigators independently coded the data using an inductive, semantic thematic-analysis approach guided by Braun and Clarke’s framework. Codes were compared, refined through consensus, and organized into themes describing healthcare-seeking pathways, decision-making, social networks, and potential exposure interfaces.

Results: Four interrelated themes emerged: Cross-border healthcare-seeking as a strategy for accessing preferred care; Families and social networks as healthcare navigators; Fragmented and escalating healthcare-seeking trajectories before BVD recognition; And caregiving, transport, and healthcare encounters as pre-diagnostic exposure interfaces. Participants described Uganda as a preferred destination for perceived higher-quality or more specialized care. Families and trusted intermediaries organized transport, selected facilities, and accompanied patients. Patients often moved through multiple healthcare providers as illness progressed, with early symptoms commonly interpreted as familiar febrile illnesses. These movements and repeated interactions with caregivers, transporters, healthcare workers, and other patients created multiple opportunities for exposure before diagnosis and isolation.

Conclusion: Cross-border healthcare mobility was closely linked to social networks, repeated care-seeking, and delayed BVD recognition. Future outbreak response should focus on safer healthcare mobility rather than border screening alone, with emphasis on early detection, coordinated referral, and rapid cross-border communication.