An Ebola epidemic in Democratic Republic of Congo (DRC) is in danger of “spiralling out of control” amid a series of massacres blamed on a shadowy Islamist militia partially financed out of London, aid workers have warned.

With 155 deaths already confirmed since Ebola was declared in the country’s North Kivu region on August 1, fears of a cross-border epidemic are rising with new cases reported close to the Ugandan frontier.

But local and international efforts to contain the spread of what is seen as the most dangerous Ebola outbreak in the country's history have suffered repeated setbacks in conditions one Western aid worker described as “close to impossible”.

The DRC has experienced nine previous outbreaks, including one that killed 33 people in the Equateur region earlier in the summer, but this is the first to take place in an active conflict zone.

And just as Ebola has struck, the conflict has worsened, creating an atmosphere of paranoia in which the violence has grown not only deadlier but more opaque.

Government medical teams have reported coming under attack three to four times a week as they cross the region, while their foreign counterparts say they hear gunfire nearly every day.

Even more seriously, international aid agencies were forced to halt work this week after gunmen killed 15 people and abducted 12 children in an attack on Beni, the city at the epicentre of the outbreak, over the weekend.

A health worker prepares to administer an Ebola therapeutic drug to patients in DRC credit: REUTERS

Workers from the United States Centers for Disease Control (CDC) were ordered to leave the most high risk areas as a result.

A two-day suspension of control activities after a similar massacre in the city in late September had devastating consequences, with the number of Ebola cases doubling because aid workers lost track of the spread of the disease.

If the epidemic is to be brought under control, health workers must be able to track down everyone who has come into contact with an Ebola victim, monitor them and vaccinate hundreds of others in the vicinity around them them.

Taking often astonishing risks, health workers have administered nearly 20,000 vaccinations, a campaign that had slowed the spread of the virus before September’s attack.

But agencies warn that the number of new cases is again likely to rise after the second halt.

“It will be very hard to stop the outbreak if this violence continues,” said Peter Salama, head of emergencies at the World Health Organization, the United Nations body coordinating the international response to the epidemic.

The massacres, as well as other deadly if smaller attacks on villages and settlements outside Beni, have other serious repercussions.

Tens of thousands have fled the violence, joining one million people already displaced by two decades of conflict in North Kivu.

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With many fleeing into Uganda the risk is growing that some will bring the virus with them. Although Ugandan officials and the UN’s refugee agency have adopted stringent checks on Congolese nationals crossing the border, the frontier is porous and is also crossed daily by traders and smugglers.

Health workers, already struggling to reach potential victims in lawless areas, are also facing growing hostility from the very people they are trying to help.

Two Red Cross workers were seriously injured early this month when they were stoned by an angry crowd.

Anger has partly been prompted by the insistence of aid agencies on “safe burials”, under which Ebola victims are laid to rest by health workers operating under strictly sanitised conditions.

Congolese funerals are normally highly emotional occasions, during which the corpse is sometimes embraced by relatives. Resistance to “safe burials” has been high, and on at least one occasion a hearse carrying a dead Ebola victim has sped away from its police escort.

Ebola, whose symptoms include fever, muscle pain and, sometimes, haemorrhaging from bodily orifices, can be spread through contact with body fluids from both living and dead victims — making safe burials vital in stopping its spread.

Health workers at Mangina hospital prepare to conduct a safe burial in Beni, DRC credit: REUTERS

But a greater problem has been mounting rumours, particularly in the city of Beni, that government health workers and even foreigners are complicit in the recent massacres.

“There is a very real risk that this is going to be something we cannot cope with,” one aid worker said.

“I’ve never worked in such difficult conditions, conditions that are highly volatile, highly hostile and highly dangerous but which we really cannot begin to understand. I don’t want to sound unduly pessimistic but the situation is very close to spiralling out of control.”

That many of Beni’s 200,000 residents are so suspicious is perhaps understandable.

For years, the North Kivu region has been at the centre of a deadly, ethnically-tinged battle for political influence and the region’s resources, which include gold and timber, fought broadly by forces aligned to the government of Joseph Kabila, the president, and his opponents.

So murky is the conflict, which involves more than 100 often freelance armed groups, that even the survivors of mass killings do not know who their attackers are or why they are being attacked.

Mr Kabila’s government has blamed the Allied Democratic Forces (ADF), an Islamist outfit that fought against the government of Uganda in the 1990s but later moved into Congo, for a series of massacres that has killed more than 1,000 people in the past four years.

Diplomats, researchers and UN officials say the ADF has been involved in the killings. But Congolese government claims that the group is affiliated with foreign Islamist groups like al Qa’eda and Somalia’s al-Shabaab have been widely questioned.

An investigation by a UN Group of experts in 2015 reported that the only foreign funding they could find came from sympathetic Ugandans concentrated in the London districts of Barnes and Fulham who wired tens of thousands of dollars to the group.

A Home Office investigation turned up little, because the senders were careful to keep payments below £600, above which Western Union requires senders to reveal their identity.

There are also reports of elements within the Congolese army and opposition groups either masquerading as the ADF, or fighting alongside it.

Whatever the truth, many in Beni — where pro-opposition support has been galvanised over suspicion that the government favours non-indigenous tribes — hold the army responsible for the recent killings.

They see a plot by Mr Kabila, who is due to step down in December after a long-delayed election, to retain power and besmirch the opposition.

There is also anger towards Monusco, the 19,000-strong UN peacekeeping force in DRC, because it has fought unquestioningly alongside government forces in the conflict — a position one western diplomat described as “a mistake, even if there seemed no clear alternative”.

UN peacekeepers from Bangladesh escort a World Health Organisation convoy to Bunia, DRC credit: REUTERS

Given the precarious situation, Monusco announced this week that peacekeepers would be deployed to Beni to protect the anti-Ebola campaign.

That may prove a mixed blessing. Some aid workers believe hostility towards them has been worsened because they often venture out with a Monusco escort.

“A heightened Monusco presence in Beni risks angering people further,” the aid worker said. “The problem is we have no choice. Without them, our mission may well be doomed.”

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