During an Ebola outbreak, a funeral can protect a community—or spread infection. This study found that getting a burial team there quickly was possible, but safety also depended on whether families and neighbours trusted the response.

Between July 2018 and April 2020, the Democratic Republic of the Congo experienced an Ebola epidemic in eastern provinces. Despite improved knowledge, vaccines, and treatments, the epidemic proved difficult to control. Response efforts were hampered by insecurity, political tensions, misinformation and public distrust.

The response was also criticised as not inclusive and insufficiently responsive to community feedback and the lived experience of affected populations. Transmission of Ebola occurs through direct physical contact with an infected person, infected body fluids or contaminated objects.

Corpses of Ebola cases are particularly infectious, because the virus can remain viable for days after death. That makes washing, dressing, touching and burying the dead high-risk. In the Democratic Republic of the Congo, these practices are customarily performed by family members and the local community.

So a safe and dignified burial works like replacing a dangerous handoff with a carefully managed relay: it protects people while allowing families and communities to take part. Supporting these burials is a recognised pillar of Ebola epidemic responses.

The service was evaluated to assess its performance during the Ebola epidemic in eastern Democratic Republic of the Congo and to inform improvements for future outbreaks. The evaluation assessed how well burial activities met service standards and identified factors affecting the intervention’s performance.

Once a death was reported, an alert was activated. For confirmed deaths in a treatment centre, an alert went directly to a burial team. For suspected deaths in the community or other health facilities, a health investigation team first determined whether the person met the definition of a suspected Ebola case.

If so, the closest burial base sent a team to the location. The service answered ninety-nine percent of burial requests, and eighty-nine percent were answered within twenty-four hours. That meant the response was usually fast. But overall, sixty-one percent of burials were successful, below the eighty percent target, and failures clustered during a period of high insecurity.

Unsuccessful burials were associated with community or family nonacceptance, insecurity, interruptions to the Ebola response, low health-facility coverage and high coverage of radio and telephone services. Eighty-nine percent of responses were completed within twenty-four hours, exceeding the eighty percent target, while almost all were completed within seventy-two hours.

Timeliness improved in Ituri and North Kivu, but the proportion of successful burials changed greatly from month to month. Overall, sixty-six percent of all alerts were successfully handled, below the eighty percent target. Insecurity reduced access to communities.

But burials supported by local authority teams, or by local community teams supported by the Red Cross, were associated with lower odds of failure. Burials supported by Civil Protection or community-based teams were associated with lower failure odds, suggesting benefits from empowering local authorities and localising services.

Strong community engagement has been shown to contribute to the effectiveness of the Ebola response during the West African epidemic. There was a complication: local authority teams sometimes travelled with armed escorts, which may have made the Ebola response seem militarised and affected trust and acceptance.

The evidence shows that a large-scale, timely and moderately effective safe-burial service was feasible despite the difficult conditions of the Ebola response in eastern Democratic Republic of the Congo. When burials failed because teams could not secure the body or supervise the burial, that suggested weaknesses in community engagement.

When Ebola status remained unclear, it indicated gaps in testing or reporting results. Safe burial services can work at large scale during a crisis, but the strongest results came when local people and authorities helped lead them.

In practice, trust is part of infection control.