The death toll in the Democratic Republic of Congo’s latest Ebola outbreak has risen to more than 1,000, according to the country’s health ministry, with a volatile security situation and deep community distrust complicating efforts to beat back the nine-month-old epidemic.

The Ministry of Public Health said in its latest update on Friday that 14 new deaths from the virus were recorded, taking the toll to 1,008 deaths from more than 1,450 confirmed cases registered since the epidemic erupted in August.

The ministry’s update came after the World Health Organization (WHO) warned earlier on Friday that health officials were “anticipating a scenario of continued intense transmission” after 126 confirmed cases were reported over a seven-day stretch ending on Sunday, a record for the current outbreak.

Health ministry spokeswoman Jessica Ilunga said the surge in cases was the result of attacks on health workers and treatment centres disrupting “response activities” in recent weeks.

“Security has been a big issue, and every time we have an incident, essential response activities such as contact tracing, vaccination and safe burials are suspended for an indefinite period of time, giving time and space for the virus to spread,” Ilunga told Al Jazeera.

Repeated attacks

The DRC‘s current Ebola outbreak, its tenth to date, emerged in eastern North Kivu province last year before spreading to the neighbouring Ituri province.

In a bid to contain the outbreak, health workers have inoculated more than 109,000 people to date as part of a government-backed vaccination programme. The vaccine is experimental, but is estimated to be 97.5 percent effective.

More than 1,450 confirmed cases of Ebola have been registered since the epidemic erupted in August [File: Goran Tomasevic/Reuters]

Efforts to beat back the virus have been hampered by ongoing unrest in the eastern DRC, however, and widespread distrust among elements of the local population towards both the central government, which postponed presidential and legislative elections in parts of the region blaming the Ebola outbreak, as well as the medical strategies deployed by emergency responders.

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Scores of armed groups operate in the conflict-wracked region, including in the areas surrounding the North Kivu cities of Beni and Butembo, where the current outbreak is concentrated.

Ebola treatment centres and health workers have repeatedly been subject to attacks, with 119 such incidents recorded since January, according to WHO.

On Friday, Michael Ryan, WHO’s emergencies chief, warned at a press conference in the Swiss city of Geneva that insecurity had become a “major impediment to ensuring that we can access, engage with and serve the communities we wish to serve in Ebola control”.

In April, heavily armed assailants raided a hospital in Butembo and killed Richard Mouzoko, a Cameroonian WHO doctor working on the Ebola response.

The assault came after unidentified attackers in February torched two of Doctors Without Borders’ (MSF) treatment facilities in North Kivu, prompting the organisation to suspend operations in the area and warn soon after that “a climate of deepening community mistrust” was taking a grip amid “various political, social and economic grievances” and an allegedly overly militarised response by authorities to the outbreak.

Widespread mistrust

Christoph Vogel, a former UN expert on the DRC and a researcher with the UK-based London School of Economics’ Conflict Research Programme, said there were a “host of different factors” complicating the medical response and warned the recent attacks showed the climate on the ground was “extremely poisoned”.

“It (the outbreak) is happening in an area that has witnessed entrenched armed conflict, massive violence and all sorts of distrust between different actors, communities and elites; this is probably the central factor that makes the outbreak so hard to tackle compared to other ones,” Vogel told Al Jazeera.

Health workers have inoculated more than 109,000 people to date as part of a government-backed vaccination programme [File: Baz Ratner/Reuters]

Vogel cautioned it was not clear who was behind the attacks on health centres and medical professionals, but said international actors and DRC authorities should have done more to try and build trust with communities affected by the epidemic, pointing to widely held local views that the outbreak was fabricated to benefit business-owning local elites or further destabilise the region.

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According to a recent study by the Lancet Infectious Diseases journal, some 32 percent of respondents in Ebola-hit regions of the eastern DRC said they did not believe the virus existed and was instead invented for financial gains. More than 36 percent believed the epidemic was fabricated to destabilise the area.

Fewer than two-thirds of the nearly 1,000 respondents said they would take a vaccine for Ebola.

Ilunga, for her part, admitted some people in the “historically neglected” eastern DRC “didn’t believe” Ebola existed and said there were “several types of attack” being committed against health workers, all of which were “detrimental” to efforts to defeat the virus.

“The majority of violence against the medical response is community violence, for instance when Ebola responders go to family homes because they have been alerted someone has died … but when responders arrive some people chase them away,” Ilunga said.

“But the attacks on the Ebola treatment centres are more coordinated, by some kind of organised armed groups,” she added. “It is worrying, especially because the future of the outbreak depends on factors outside of our, the Ministry of Health’s control.”

The failure to overcome the outbreak so far has seen it evolve into the second-deadliest in recorded history, trailing an epidemic between 2013-2016 that killed about 11,300 people in West Africa as it surged through Guinea, Sierra Leone and Liberia.