Bunia, Democratic Republic of the Congo – When three members of his hospital team died within days of treating the same patient, Dr Richard Lokudu suspected Ebola had been spreading before authorities detected the outbreak.

The patient had arrived at Mongbwalu General Hospital in Ituri Province for surgery in early April, weeks before the Democratic Republic of the Congo (DRC) officially declared an Ebola outbreak.

“Before the outbreak was declared, we discovered at the hospital that there was a patient who had been admitted on 2 April and who was due to undergo surgery performed by our team on 7 April,” Lokudu told Al Jazeera.

“Almost a month later, we recorded the deaths of the surgical assistant, the anaesthetist, and a member of the post-operative care team.”

The deaths were among the first warning signs of an Ebola outbreak that would become the deadliest in the DRC’s history.

Three months after authorities declared the outbreak, more than 4,900 confirmed cases have been recorded, and more than 2,300 people have died, according to health authorities and international agencies.

The death toll has surpassed the previous record set during the 2018–2020 Ebola outbreak, caused by the Zaire strain, which killed 2,299 people.

The current outbreak is caused by Bundibugyo virus disease (BVD), a rare form of Ebola first identified in Uganda in 2007. Unlike the Zaire strain, for which vaccines and some treatments have been developed, there are currently no licensed vaccines or specific approved therapies for Bundibugyo.

Health workers are relying on early detection, supportive care, infection-prevention measures, and community engagement to limit transmission.

The World Health Organization (WHO) says the outbreak was first identified in Ituri Province and later spread to other areas. The agency has warned that armed conflict, population movement, and delays in identifying cases have complicated efforts to contain the virus.

For people living in affected communities, the figures represent personal losses.

“Only God can spare us from this disaster,” says Furaha Gisèle, 35, whose uncle died of Ebola in Rwampara, about 10km (6.2 miles) from Bunia, the capital of Ituri Province.

“Coping with insecurity, poor governance, and poverty all at once is difficult, and I fear we will also suffer from this deadly epidemic.”

Health officials say transmission was already taking place before the outbreak was officially declared on May 15. By the time authorities identified the virus, it had spread through communities, allowing chains of infection to grow before response teams were fully deployed.

WHO said the outbreak was initially concentrated in Mongbwalu Health Zone in Ituri before expanding to other provinces.

Racing against transmission

The DRC has recorded Ebola outbreaks since 1976, and has developed extensive experience responding to the disease.

But in Ituri, health workers say experience alone cannot overcome the challenges they face: conflict, difficult terrain, delayed detection, and mistrust among some communities.

Congolese authorities have acknowledged that delays in identifying cases contributed to the spread of the virus.

Professor Pierre Akilimali, head of the DRC’s Ebola response, says laboratory capacity has expanded in Ituri since the outbreak hit.

“When we first started, we didn’t have any laboratories. Today, we have more than 12 laboratories here in Ituri Province,” he told Al Jazeera.

He said reliance on laboratory facilities outside the province slowed confirmation of cases during the early stages of the outbreak.

Conflict and mistrust

In Ituri, Ebola response teams are operating in a province that has endured decades of armed conflict.

Armed groups have fought for influence and control over mineral-rich areas, making movement difficult and limiting access to some communities.

The Africa Centres for Disease Control and Prevention (Africa CDC), the continent’s public health agency, says it is supporting the response through surveillance, laboratory work, infection prevention, patient care and community engagement.

“As for Ituri, the situation is not very favourable. We are in a war zone, and the province is under a state of siege,” Dr Justus Nsio, Africa CDC’s field incident manager for the DRC’s Ebola response, told Al Jazeera.

“We are making do with what we have to show our solidarity with the communities.”

Dr Thierno Balde, WHO incident manager for Bundibugyo virus disease in the DRC, says movement between affected areas has helped the virus spread.

“The geographical spread of the outbreak is mainly linked to the uncontrolled movement of people, particularly those who are ill, between localities that are already affected and neighbouring areas,” he told Al Jazeera.

For health workers in Ituri, stopping Ebola is not only a medical challenge; it is also a race against conflict and access.

“When there are problems, particularly gunfire, nobody can hold their position,” says Dr Charles Kashindi, head of Nyakunde Hospital, nearly 40km (25 miles) southwest of Bunia.