“On public transport, in bars and at mass gatherings, everyone is talking about Ebola,” said Gloire Mumbesa, a resident of Mongbwalu, a mining town in the Democratic Republic of the Congo. He said cases of the disease had been reported locally and panic was engulfing the area because of the lack of a vaccine for the Bundibudyo strain. “The fear is that this disease may spread to many other areas.”

Residents of Ituri province in eastern DRC, where the World Health Organization announced an outbreak of Ebola last week, are living in growing fear of the possible continued spread of the disease and its deadly impacts, nearly six years after the last outbreak in the region ended.

“We’re stunned by the resurgence of Ebola in our region,” said Dieudonné Lossadekana, a resident of Bunia city, where the first suspected case was reported. “We’ve already recorded several dozen deaths. For us, it’s heartbreaking.”

The economic impacts of the outbreak are a serious worry, and residents are concerned that authorities may impose restrictions that would hinder them from earning a living in a region plagued by armed conflict and where people are already struggling financially.

“We live in a region where poverty is rife and people live from hand to mouth,” said Claude Kasuna in Irumu territory. “When a health emergency like this one strikes, it hits us hard economically.”

The WHO director general, Dr Tedros Adhanom Ghebreyesus, declared the outbreak a “public health emergency of international concern” after more than 300 suspected cases and 88 deaths were reported in the DRC and two deaths in neighbouring Uganda.

The majority of the deaths and suspected cases have been reported in Ituri province, a business centre and migratory hub that borders Uganda and South Sudan. The gold-rich province is the centre of a long-running conflict between militias allied to the Hema and the Lendu, who are fighting over land and the mineral. The fighting has killed more than 50,000 people since 1999.

A health worker who was the first suspected case reported fever, haemorrhaging, vomiting and other symptoms on 24 April and died at a medical centre in Bunia, according to WHO.

Jean Pierre Badombo, a former mayor of Mongbwalu, which is at the centre of the outbreak, told Reuters that people started falling ill in mid-April after a large open-casket funeral procession arrived from Bunia. “After that, we experienced a cascade of deaths,” he said.

On Monday the Congolese health minister, Samuel Roger Kamba, said the government would open three treatment centres for Ebola in Ituri.

The WHO regional office for Africa said on Sunday that 35 experts from the organisation and seven tonnes of emergency medical supplies and equipment had arrived in Bunia.

Elsewhere in eastern DRC, where fighting between government and rebel forces has persisted for years, one case was reported in rebel-controlled Goma – that of a woman who travelled to the city from Bunia where her husband had died of the disease.

Heather Kerr, the DRC country director at the International Rescue Committee, said the conflict in the region made containing the Ebola outbreak “all the harder.” “Eastern DRC’s years of conflict and displacement have left health systems on their knees,” she said. “With dozens of lives already lost and an already overstretched health system, we need to act fast.”

Manenji Mangundu, the DRC country director at Oxfam, said the outbreak was “hitting a country already stretched to breaking point” due to ongoing conflict and years of aid cuts.

First identified in 1976 in what is now the DRC, Ebola is a highly contagious and often fatal viral disease that affects humans and non-human primates. It spreads through body fluids or contaminated materials and causes organ damage, blood vessel impairment and sometimes severe internal and external bleeding.

WHO has said the current outbreak involves the rare Bundibugyo variant, which has no approved treatment or vaccine. It is named after the district in western Uganda where it was first discovered in 2007.

Dr Jean Kaseya, the director general of Africa CDC, said he was in “panic mode” due to the lack of a vaccine and highlighted the need for manufacturing capacity on the continent.

Jean-Jacques Muyembe-Tamfum, the director general of the National Institute of Biomedical Research in the DRC and a co-discoverer of the Ebola virus, said some candidate compounds for a Bundibugyo vaccine were expected to enter trials by the end of May or in June.

In the meantime, he said, the government was implementing public health preventive measures including protecting healthcare workers and treating cases based on symptoms. “This is how we brought the Bundibugyo strain outbreak under control in 2012 in Isiro, not far from Ituri,” he said.

This is the 17th Ebola outbreak in the DRC. From August 2018 to June 2020, the country recorded the second largest outbreak of the disease in history globally, and the country’s deadliest, centred in North Kivu and Ituri provinces. It caused more than 2,000 deaths.

In Ituri, authorities have to address enduring stigma and misconceptions and rumours associated with Ebola in fighting the disease, just as with past outbreaks. Kasuna, the Irumu resident, said: “Our people tend to believe in false myths rather than rely on scientific evidence. We need to raise awareness to save people’s lives.”