The Bundibugyo strain fuels deadliest Ebola outbreak in DR Congo’s history as health workers face mistrust from communities.

Confirmed Ebola cases have surpassed 9,000 in the Democratic Republic of the Congo (DRC) outbreak, according to Health Ministry data, as efforts to stifle transmission falter.

The ministry reported 9,066 confirmed cases and 4,381 deaths on Tuesday – a death toll of nearly half the known cases.

The outbreak, caused by the Bundibugyo strain of Ebola, has become the largest and deadliest in the DRC’s history. Globally, the toll is only second to the 2014 to 2016 West African epidemic, which saw 28,600 confirmed cases and more than 11,000 deaths across Guinea, ⁠⁠Liberia and Sierra Leone, according to the World Health Organization (WHO).

The Bundibugyo strain currently has no approved vaccines or treatments and has raised concerns over cross-border transmission.

Last week, Kenya reported its first imported case in which a Kenyan national who lived in the DRC travelled through Uganda before reaching Nairobi, where he died.

Uganda also reported 20 cases and two deaths earlier in the year, but the country was declared Ebola-free in August.

The current outbreak in the DRC was announced in mid-May, but some experts suspect it began as early as February. The virus, which is transmitted through contact with bodily fluids, has spread to seven provinces in the north and east.

Efforts to contain the virus face obstacles as health workers and other responders in the DRC face mistrust in local communities, with many believing the disease is a ruse for officials to siphon off money. The outbreak is also occurring amid an ongoing conflict between the M23 rebel group and government forces, making transport of healthcare resources to remote regions difficult.

A local politician in eastern DRC was beaten to death in September after he defended the government’s Ebola response on the radio, according to his political party.

A clinical trial to evaluate vaccine efficacy against the Bundibugyo strain is being prepared for the DRC in the coming weeks, WHO Health Emergencies Programme Executive Director Dr Chikwe Ihekweazu said on Tuesday.