In the Democratic Republic of the Congo’s Bunia, overwhelmed hospitals are spilling into nearby yards and fields amid spiralling patient admissions – with the city at the epicentre of what is feared could potentially become the worst Ebola outbreak in history.

“Case numbers are rising significantly, it’s going super fast,” Karen Ruts, an intensive care nurse working at Elykia private hospital in Bunia, tells The Independent. “We’re getting more and more positive test results, and the labs are struggling.”

The capital city of Ituri Province, Bunia, has a population of almost a million and the number of confirmed Ebola cases is rising rapidly. Since the outbreak was officially declared on 15 May, there have been at least 127 deaths and 635 confirmed cases in the DRC across three provinces.

The true toll could be much higher, as the virus could have been spreading for weeks before it was detected. Investigators hunting for “patient zero“ or the earliest infection are looking into the funeral of 44-year-old Pastor Paluku Makundi Denis, which was on 4 February.

The outbreak has spread to Uganda and sparked fears for other neighbouring countries if it is not contained.

Several buildings of the Elykia hospital have been allocated for Ebola care, but are now full. So are the temporary treatment tents that were set up across the garden. A construction team is now working to set up a new health centre in a nearby field.

The facility is currently caring for 40 confirmed cases, as well as testing suspected patients. In the 10 days since international organisation Médecins Sans Frontières (MSF) arrived to help with the response, 60 have died.

“I don’t think we’re at the peak yet, but we need to stop the transmission,” says Ruts. “As an intensive care nurse, I have already seen a lot, but this disease is quick, nasty and brutal. You admit people and the next day they’re dead. Even the young.”

Caused by the rare Bundibugyo strain of the Ebola virus, officials have said the current outbreak went undetected for weeks, leaving health authorities struggling to bring it under control. Efforts are also being hampered by a fragile health system, widespread misinformation and compounded by cuts to international aid, according to health officials.

On Tuesday, UK development minister Jenny Chapman admitted the response has been undermined by foreign aid cuts, including from the UK.

Ebola typically begins with a “dry phase” of fever, headache, muscle pain and weakness and progresses to a “wet phase”, marked by severe vomiting and diarrhoea. The symptoms can easily be mistaken for something else, hampering containment efforts as people don’t always seek help. In severe cases, it leads to bleeding, organ failure and death.

There is no treatment and no vaccine for this strain. “We can only do symptom care, so rehydrate them or treat pain,” says Ruts.

Among the dead are two babies from a Bunia orphanage, one of whom had contracted Ebola from their mother, who had died in late May.

Ruts and other health workers say a significant number of patients are women due to their increased likelihood to take on caring roles, as well as doctors and nurses who were largely exposed before the outbreak was detected.

“We have a nurse who tested positive and she visits other patients to encourage them and give them support. That’s so beautiful to see,” says Ruts.

On Wednesday, the US State Department said it would provide an additional $20m to help fight the outbreak, bringing its ⁠total direct support to more than $220m (£164m). It is part of a major international response aimed at containment that includes a $518m emergency plan to scale up surveillance, contact tracing, lab testing and treatment centres.

Hospital teams are engaging with local communities to rebuild trust and combat misinformation, which has prevented people from reporting cases because some have blamed international NGOs for the outbreak. Treatment centres have been set on fire, allowing infected patients to flee. One in three people does not believe the virus is real.

The crisis is also challenged by conflict, unfolding in regions – Ituri, North Kivu and South Kivu – under the influence of armed groups, with poor roads and population movement across porous borders.

Ebola was first discovered in 1976 in Sudan and the DRC, with its deadliest outbreak killing 11,000 in West Africa between 2014 and 2016. The US Centers for Disease Control and Prevention has warned that this outbreak could surpass that, with more than 20,000 cases within months if containment efforts fail.

It is highly infectious through direct contact with the blood, bodily fluids, or contaminated materials of an infected person. The Bundibugyo strain kills 30 per cent to 50 per cent of those infected.

“They get really weak quickly until they can’t move any more. Some people get confused; the whites of their eyes bleed. When it goes fast, it’s really hard to keep them alive,” said Ruts. Yet more terrified people arrive for testing each day, with relatives scared to leave “because they might not see them again”.

“It’s heartbreaking,” says Ruts.

This article has been produced as part of The Independent’s Rethinking Global Aid project