The Congolese national public health institute has recorded 1,003 cases and 254 deaths from the current Ebola outbreak, giving an average case fatality rate of 25.3 percent.

Nearly all patients are reported in the remote northeastern province of Ituri, which accounts for 91.3 percent of cases and 80.7 percent of deaths. The region is plagued by armed group violence.

The Democratic Republic of Congo’s testing capacity, very weak at the start of the epidemic, has improved, partly explaining the rise in documented cases.

But international humanitarian organisations and NGOs on the ground unanimously believe official figures remain underestimated.

A total of three provinces are affected: Ituri, neighbouring North Kivu, and South Kivu. Together they are home to an estimated 15 million people. The virus has also spread to neighbouring Uganda, where 20 confirmed cases and two deaths have been reported.

Response efforts underway but hampered

In Ituri, the health response, based on isolating patients and tracing contacts, has been strengthened but still struggles to organise effectively.

There is currently no vaccine or treatment for the Bundibugyo virus causing this epidemic. Existing vaccines only work against the Zaire virus, responsible for the largest known Ebola outbreaks.

Local hospitals were quickly overwhelmed early in the outbreak. Ebola treatment centres later set up with World Health Organization and NGO teams are already over 80 percent occupied, according to health authorities.

Health facilities, often operating with minimal resources in one of the world’s poorest countries, still lack protective equipment and chlorine more than a month after the epidemic was officially declared. Some 78 healthcare workers have been infected and 18 have died.

Healthcare workers and humanitarian staff also face strong distrust from local communities. Reluctance to accept post-mortem sampling leads to undercounting of cases. Incidents at hospitals have been reported in recent weeks, including angry residents demanding the bodies of relatives who died from the disease.

Humanitarians and epidemiologists say the peak of the epidemic has not yet been reached, and fear the health crisis could last between six months and a year.

“The epidemic was declared about two months after the first suspected deaths reported around March 20. During that time the disease spread unchecked in proportions we don’t know,” a representative of an international humanitarian organisation speaking on condition of anonymity explained.