A ROW of health workers in blue gowns and face masks sit at tables outside the tin-roofed bungalow that was home to Kambale Vincent, one of 75 people who have died from Ebola in the Democratic Republic of Congo this month. His widow, a hunched, 60-year-old in a black cardigan, pulls her arm out of her sleeve and winces as a needle pierces her skin. She is receiving an experimental Ebola vaccine, fresh from trials in west Africa, that is being offered to anyone who may have touched her late husband.

Getting vaccines to the centre of this outbreak, the scrubby village of Mangina in the North Kivu province of Eastern Congo, is no easy task. The area is in infested with about 40 armed militias, most of which have been hiding in the forests since the end of a war in 2003 that claimed the lives of between 1m and 5m people.

Just a day after the outbreak was declared on August 1st, machete-toting militiamen sprang out of the bush and abducted 16 people in a field around 30 kilometres from Mangina. In broad daylight they dragged ten men, four women and two teenage boys—who were walking back from a day’s farming—into their forest hideout. Fourteen of the villagers’ hacked-up bodies were found in shallow scrubland graves five day later. The two boys were probably taken as recruits.

The attacks have been blamed on the Allied Democratic Forces (ADF), a group of Islamist ideologues originally from Uganda. In recent years the anti-government rebels have gone from attacks on the Congolese army and UN peacekeeping troops, to indiscriminately abducting citizens. Each time they strike, frightened families rush through the porous border into Uganda nearby—exactly the kind of hurried, untraceable movement that makes it harder to contain the Ebola virus. “We have a toxic mix of factors,” says Mike Ryan, of the World Health Organisation (WHO), which is trying to get 9,300 vaccinations to those who need them. “We are dealing with security problems, a weak health system and disease. We have to balance access with security all the time.” Health workers risk more than exposure to a virus. Médecins Sans Frontières, an international charity running the Ebola treatment centre in Mangina, had four of its staff abducted by the ADF in 2013. Though one escaped after 13 months, the rest have not been seen since. Other factors may also have contributed to the spread of the disease, including a strike by local nurses who were not paid for three months. The virus may have reached Mangina as early as May 11th when a man with Ebola-like symptoms died in the local clinic. But the first deaths were reported only in late July. Josephine Kahambu, a nurse, alerted the officials in the capital, Kinshasa, after two men with bloodshot eyes, diarrhoea and fevers came to her clinic. Although she was on strike she decided to see to them and recognised signs of the deadly virus.

This particularly deadly strain of the disease, known as “Zaire Ebola”, has killed 78% of those it has touched. It is transmitted through bodily fluids and can be passed on with as little as a sweaty handshake. Thankfully some lessons learned in the west African outbreak, which killed 11,310 people between 2014 and 2016, seem to be helping. Instead of barking at frightened villagers through a megaphone about how they should protect themselves from infection, workers from the WHO talked to the village chief. “The chief is more listened-to than we are,” says Frizzia Safari, a Congolese doctor. “We talk to him and then he talks to the people.”

If nurses can prick enough arms quickly then it may be possible to halt this outbreak before it spreads much further. But they are finding it difficult to outrun the virus because of poor roads and the threat of attack from armed rebels. So new cases keep cropping up each day.