The Democratic Republic of Congo’s deadly Ebola outbreak is now the second largest in history, behind the devastating West Africa outbreak that killed thousands a few years ago, according to the World Health Organization.
A total of 426 cases of the virus have now been reported in and around the town of Beni, taking the outbreak past that recorded in Uganda in 2000.
Beni is in the middle of a conflict zone and operations have been affected by rebel attacks.
Almost 200 people have died in this outbreak of Ebola.
But it is still much smaller than the epidemic in West Africa between 2013 and 2016 which killed 11,310 people.
This is the second Ebola outbreak in the country this year. The previous outbreak, in the west of the country, killed 33 people, according to the government.
Dr Peter Salama, WHO’s emergencies chief, called it a “sad toll” as DR Congo’s health ministry announced the number of cases has reached 426.
That includes 379 confirmed cases and 47 probable ones.
So far this outbreak, declared on August 1, has caused 198 confirmed deaths, DR Congo’s health ministry said.
The crisis is centred around the restive eastern city of Beni in North Kivu, a region which has been blighted by armed conflict, which has hampered efforts to curb the outbreak.
Attacks by rebel groups and open hostility by some wary locals have posed serious challenges to health workers that Ebola experts say they have never seen before.
Many venture out on critical virus containment missions only accompanied by UN peacekeepers in areas where gunfire echoes daily.
We will continue to stand shoulder-to-shoulder with the Congolese health ministry to do whatever it takes to bring the outbreak to an end,” the World Health Organization’s Deputy Director-General for Emergency Preparedness and Response has said in a tweet.
The current outbreak in eastern DR Congo began in July and is the 10th to hit the country since 1976.
Health workers hope that the first multi-drug Ebola treatment trial, announced by DR Congo’s health ministry on Monday, will help to contain this and future outbreaks.
Explaining the World Health Organization-backed initiative, WHO Director-General Dr Tedros Adhanom Ghebreyesus said “randomised control trial” in DR Congo was a “giant step that would “bring clarity about what works best, and save many lives in years to come”.
Insecurity in the east of the country has affected the Ebola response.
A deadly rebel attack in September forced health workers to halt vaccinations and the tracing of people who have been in contact with suspected Ebola patients.
The previous month, the WHO’s Peter Salama warned of such a “dreaded” scenario coming to pass.
Peter Jay Hotez, from Baylor College of Medicine, told Al Jazeera the violence has contributed to the collapse of the healthcare infrastructure, so efforts by health workers are seriously hampered.
“The good is we have a vaccine now. But the problem is, working in such an unstable area, you have to assure to safety of the vaccinators, and you have to be able to trace potential contacts, and get them vaccinated.”
Salama of WHO predicted that the outbreak in the northeastern part of the country will last at least another six months before it can be contained.
West Africa’s Ebola outbreak killed more than 11,000 people from 2014 to 2016.
More than 37,000 people have received Ebola vaccinations, and DR Congo has begun the first-ever trial to test the effectiveness and safety of four experimental Ebola drugs.
Yet, the risk of Ebola spreading in so-called “red zones” – areas that are virtually inaccessible because of the threat of rebel groups – is a major concern in containing this outbreak.
“This tragic milestone clearly demonstrates the complexity and severity of the outbreak. While the numbers are far from those from West Africa in 2014, we’re witnessing how the dynamics of conflict pose a different kind of threat,” said Michelle Gayer, senior director of emergency health at the International Rescue Committee.
In a major concern for health workers, many new cases have been unconnected to known infections as the insecurity complicates efforts to track contacts of those with the disease.
The alarmingly high number of infected newborns in this outbreak is another concern, and so far a mystery.
In a separate statement on Thursday, WHO said so far 36 Ebola cases have been reported among newborn babies and children under 2.
As the need for help in containing the outbreak grows, two of the world’s most prominent medical journals this week published statements by global health experts urging the Trump administration to do more.
In the Journal of the American Medical Association, one group noted that the US government weeks ago ordered all Centers for Disease Control and Prevention personnel – “some of the world’s most experienced outbreak experts” – from DR Congo’s outbreak zone because of security concerns.
A separate statement published in the New England Journal of Medicine said: “Given the worsening of the outbreak, we believe it’s essential that these security concerns be addressed and that CDC staff return to the field.”
Ebola is a serious infectious disease that can spread rapidly through small amounts of bodily fluid, causing internal bleeding and potentially death.
DR Congo is in the throes of a major campaign ahead of a December 23 election to choose a successor to President Joseph Kabila, who has ruled the vast central African country since 2001.