WASH Infrastructure for Ebola Treatment Units: What the DRC and Uganda Outbreak Means for Field Procurement Right Now

Four health workers at Mongbwalu General Referral Hospital in Ituri Province, DRC, died within four days of each other in late April 2026. Their deaths triggered an outbreak investigation, and on 15 May laboratory confirmation arrived: Bundibugyo virus disease, a species of Ebola with a case fatality rate of 30–50%. The following day, WHO Director-General declared a Public Health Emergency of International Concern. By 21 May, 746 suspected cases and 176 suspected deaths had been reported in DRC, with confirmed cases crossing the border into Kampala, Uganda.

For WASH officers and procurement managers working in the Great Lakes region and East Africa, this outbreak changes the near-term planning calculus. Ituri Province borders both South Sudan and Uganda, and sits less than 500 kilometres from Kampala. Bunia, the provincial capital already at the outbreak's epicentre, is an active humanitarian hub with 273,403 displaced people and 1.9 million people listed as needing assistance under the DRC Humanitarian Response Plan 2026. This is not a contained, remote event. It is moving, and it is moving through populated corridors.

The WASH and IPC requirements for an Ebola Treatment Unit (ETU) are radically different from those for a standard health facility or displacement camp. Unlike cholera response — where the focus is on safe water distribution and oral rehydration — Ebola response generates enormous, sustained demand for water as a decontamination input. Understanding those requirements before an ETU needs to be stood up is the difference between a three-day activation and a three-week one.

Unlike previous outbreaks of Ebola virus disease, there is no licensed vaccine or specific therapeutics against Bundibugyo virus. Response control rests entirely on early detection, IPC, safe and dignified burials, contact tracing, and quality supportive care — every one of which requires substantial water and sanitation infrastructure.

Quick answers for field teams:

• ETUs require up to 400 litres of water per bed per day, far exceeding Sphere's 15 L/person/day threshold for standard emergencies.

• WHO IPC guidelines specify 0.5% chlorine solution for decontaminating surfaces and equipment, and 0.05% for skin and hand washing in ETU settings.

• HTH Calcium Hypochlorite — available in drum quantities — is the standard bulk input for producing these chlorine concentrations at scale in field conditions.

• A minimum of three days' water storage should be pre-positioned at any ETU before it receives its first patient.

• Flexible water storage (bladders and pillow tanks) is preferred over rigid storage for ETU sites that must be stood up rapidly in locations without existing infrastructure.

Why ETU Water Demand Is So High

The 400-litres-per-bed-per-day figure, cited by International Medical Corps WASH adviser Syed Yasir Ahmed following the West Africa outbreak, surprises most field teams the first time they see it. The Sphere Handbook's minimum standard is 15 litres per person per day. Even cholera treatment centres, which require additional water for patient rehydration and safe waste management, do not approach these volumes.

The explanation lies in the mechanics of Ebola IPC. A study of WASH operations at two International Medical Corps ETUs in Sierra Leone, published in PLOS ONE (Levine et al., 2018), recorded approximately 150 litres per patient per day plus a further 85 litres per staff member per day. In the years since, operational standards have increased: the current IMC benchmark of 400 litres per bed per day accounts for decontamination of the high-risk zone after every staff shift, chlorinated water for PPE doffing stations, safe waste disposal, continuous hand-washing at all zone boundaries, and dedicated water for laundry of reusable gowns.

Healthcare workers in ETU high-risk zones are limited to 40-minute shifts because of the physiological toll of wearing full PPE in hot, humid conditions. That means multiple shift changes per worker per day, and each transition requires a full doffing procedure using chlorinated water. IPC teams use spray wands connected to canisters of chlorinated water to disinfect every surface a healthcare worker touches as they exit the high-risk zone — boots, outer gloves, outer gown, face shield — all sprayed sequentially before removal. This is not a discretionary procedure. It is the primary barrier preventing nosocomial transmission, which is how the current DRC outbreak is suspected to have amplified.

WHO's disease outbreak report notes that the infection and death of four healthcare workers "underscores critical breaches in IPC protocols" at the outbreak's primary health facility.

For a 20-bed ETU running at capacity, daily water demand reaches 8,000 litres minimum. For a 50-bed unit — the scale being mobilised for a declared PHEIC — the daily requirement exceeds 20,000 litres. These volumes must be stored on-site to buffer against supply interruptions. The three-day storage rule is operational doctrine, not a recommendation.

Chlorine Concentration and Supply Chain

WHO's Infection Prevention and Control Guideline for Ebola and Marburg disease (2023) specifies two primary chlorine concentrations for ETU operations: 0.5% chlorine for decontaminating surfaces, equipment, and contaminated waste; and 0.05% chlorine for washing hands and skin. These are prepared from a concentrated stock solution — typically HTH Calcium Hypochlorite at 65–70% available chlorine — diluted to working concentrations on-site.

HTH Calcium Hypochlorite in 45 kg drums is the field standard for bulk chlorination at scale. Unlike liquid bleach, it is stable at tropical temperatures, relatively safe to transport, and carries a long shelf life when stored correctly. For an ETU producing several hundred litres of 0.5% solution per day, a single 45 kg drum of HTH (at 65% available chlorine) yields approximately 130 litres of concentrated stock, from which roughly 26,000 litres of working 0.5% solution can be produced. At a 20-bed ETU running decontamination protocols at WHO standards, a drum is consumed roughly every three to four days. Procurement managers should plan for consumption rates well above that during high-flux periods.

UNICEF mobilised nearly 50 tonnes of IPC supplies — including disinfectants and water purification tablets — to Bunia within days of the DRC outbreak being confirmed. That rapid mobilisation was possible because the supplies were pre-positioned in the regional pipeline. For national or sub-national health emergency stockpiles and NGO responders working in the DRC-Uganda-South Sudan corridor, replicating that readiness at the programme level requires maintained stock of HTH, not just procurement plans. You can browse available stock and configurations of WASH products, including HTH Calcium Hypochlorite drums, through Specialized Logistics Solutions (SLS).

Water Storage: Flexible Systems for Rapid Deployment

Ebola Treatment Units are not always sited near existing water infrastructure. The outbreak's origin in Mongbwalu — a high-traffic artisanal mining zone — and its spread to Rwampara and Bunia are a reminder that response teams must establish water supply at sites that may have no connection to any formal network. Trucked water is often the only option during the initial response phase, and that water must be stored on-site in sufficient volume.

Flexible bladder tanks and pillow tanks are the standard solution. They can be transported flat, inflated in hours, and positioned in configurations that match the ETU layout. For a 50-bed facility requiring three days' storage at 400 L/bed/day, total on-site storage must reach at least 60,000 litres. That is typically achieved with a combination of large (10,000–20,000 litre) collapsible bladder tanks for primary storage and smaller (1,000–5,000 litre) units positioned at specific functional zones within the ETU — the doffing station, the high-risk zone boundary, the laundry area, the waste management point.

Butyl Products (UK) water bladders and tanks, which Specialized Logistics Solutions (SLS) distributes in East Africa, are specifically designed for field deployment in high-demand applications. They are constructed from heavy-duty butyl rubber, which is resistant to the chlorine concentrations used in Ebola decontamination protocols — a specification that matters, because standard PVC tanks degrade rapidly under continuous exposure to 0.5% chlorine solution.

Water pumping to maintain pressure and fill elevated tanks within the ETU typically requires small, reliable pump sets. Pumps and equipment suitable for ETU and field hospital applications — including Aussie Pumps and Multiquip units capable of handling chemically treated water — are available from SLS with pre-positioned Juba stock and Kampala dispatch capability.

Shelter and Physical Infrastructure for Rapid ETU Stand-Up

Ebola Treatment Units require clearly demarcated zones — a suspect zone, a confirmed zone, a triage area, a staff support area, and waste management facilities — with physical barriers controlling access between them. In a declared PHEIC, that infrastructure needs to be operational in days, not weeks.

Modular shelter systems designed for field hospital and emergency use provide the structural backbone for a field ETU. The key requirements are: rapid assembly without specialised equipment, materials that can withstand repeated decontamination with chlorine solutions, and configurations flexible enough to support the ETU zoning model. Hallgruppen modular warehouses and shelters — available through Specialized Logistics Solutions (SLS) — meet these criteria, providing flat-packed, quick-erect structures used in humanitarian logistics and field health applications across East Africa. Where space allows, a combination of hard shelter structures for clinical zones and tarpaulin-covered framing for support areas provides the most cost-effective configuration.

For teams planning ETU infrastructure in preparedness mode — before an outbreak reaches their corridor — the time to assess shelter configurations and logistics lead times is now. Ituri Province borders South Sudan, and Bunia is an active transit point for movement into and out of South Sudan's Western Equatoria and Central Equatoria States. WHO's risk assessment for the current outbreak explicitly identifies cross-border transmission risk into South Sudan and the broader region as a priority concern. Reviewing warehouses and shelters options and establishing provisional procurement frameworks ahead of a trigger event is standard preparedness practice.

What This Means for Your Programme

The Bundibugyo Ebola outbreak in DRC and Uganda is the first PHEIC declared in the Great Lakes region in this outbreak cycle, and it is occurring in a humanitarian context already stretched by conflict, displacement, and ongoing cholera burden. For WASH officers, IPC coordinators, and emergency logistics managers in the DRC-Uganda-South Sudan corridor, the operational question is not whether to prepare for potential ETU support requirements — it is how much stock to hold and where.

The non-negotiable inputs are chlorine (HTH in drum quantities for bulk solution production), flexible water storage (butyl bladder tanks in configurations from 1,000 to 20,000 litres), reliable water pump sets for site pressure and filling, and modular shelter capable of withstanding repeated chlorine-based decontamination. Each of these supply lines can be established in advance. None can be improvised under outbreak conditions at the speed the PHEIC demands.

Specialized Logistics Solutions (SLS) holds pre-positioned stock of HTH Calcium Hypochlorite, Butyl Products water bladders and tanks, Aussie Pumps, and Multiquip generator-pump sets in Juba and Kampala, available for rapid dispatch. Contact the team at sales@maji-safi.org.

Frequently Asked Questions

How much water does an Ebola Treatment Unit need per day?

Current operational benchmarks from International Medical Corps set daily ETU water demand at approximately 400 litres per bed. This figure incorporates patient care, IPC doffing procedures, surface decontamination, waste management, and staff hygiene. A 20-bed ETU requires a minimum of 8,000 litres per day, and three days of storage — 24,000 litres — must be available on-site before the first patient is admitted.

What chlorine concentration is used for Ebola decontamination?

WHO's IPC guideline for Ebola and Marburg disease specifies 0.5% chlorine solution for decontaminating surfaces, medical equipment, and contaminated waste. A lower concentration of 0.05% is used for hand and skin washing at zone boundaries. Both concentrations are produced by diluting concentrated stock made from HTH Calcium Hypochlorite or equivalent high-strength calcium hypochlorite product.

What is Bundibugyo virus and how is this outbreak different from previous Ebola outbreaks?

Bundibugyo virus (BDBV) is one of the Orthoebolavirus species, first identified in Uganda in 2007. It carries a case fatality rate of 30–50%, similar to other Ebola species. Critically, there is no licensed vaccine against Bundibugyo virus — unlike the Ebola Zaire strain for which the rVSV-ZEBOV vaccine exists. This means outbreak control depends entirely on IPC, contact tracing, safe burials, and quality supportive care. WASH infrastructure quality in treatment facilities is therefore a higher-order determinant of health worker safety and outbreak containment than in previous Zaire Ebola responses.

Why are flexible bladder tanks preferred over rigid tanks for ETU water storage?

Flexible butyl rubber bladder tanks can be transported flat and erected in hours, making them practical for rapid ETU deployment at sites without existing infrastructure. They are also resistant to the chlorine concentrations used in Ebola decontamination (0.5%), whereas standard PVC tanks degrade under sustained chlorine exposure. Butyl tanks can be configured in multiple sizes — from 1,000 litres for point-of-use stations within the ETU to 20,000 litres for primary on-site storage.

Should WASH teams in South Sudan be preparing for potential Ebola response?

WHO's risk assessment for the current DRC/Uganda outbreak explicitly identifies South Sudan — which shares a border with Ituri Province — as a cross-border transmission risk. WASH officers in South Sudan operating near border areas should review ETU WASH supply requirements, audit current chlorine stock levels, and confirm logistics lead times for additional HTH, bladder tanks, and pump sets. Establishing procurement frameworks now, while the outbreak is still in its early phase, is the appropriate preparedness posture.