Ebola may have killed more than 200 people so far in the Democratic Republic of Congo and African officials warned the outbreak is turning into a regional security threat as it spills over to neighboring countries.

“When an outbreak threatens cross-border spread, it becomes a regional concern,” Khaled Abdel Ghaffar, Egypt’s health minister, said Monday at a virtual briefing of state officials. “When it tests preparedness across member states, it becomes a continental responsibility.”

The Ebola response is taking place in one of the world’s most unstable regions, where armed groups control territory, health systems are fragile and attacks on treatment centers have disrupted containment efforts. Health workers were able to follow up with only about 20% of identified contacts in a single day, according to ministry data.

“The delay in detecting the outbreak means that we are now playing catch up with a very fast-moving epidemic,” World Health Organization Director-General Tedros Adhanom Ghebreyesus said at the briefing. “We have stopped every previous Ebola outbreak and we will stop this one too. The question is just how quickly we can do it and how many more lives will be lost before we do.”

More than 900 suspected cases have been reported across 11 health zones spanning three eastern Congo provinces, according to health ministry data released late Sunday. Regional figures indicate cumulative suspected deaths reached 210 as of May 23. Neighbor Uganda reported two new cases on Monday, both of them health workers.

South Africa on Monday agreed to provide an initial $5 million contribution to the Africa Centres for Disease Control and Prevention, doubling the initial amount. President Cyril Ramaphosa at the briefing called on other governments, financial institutions and private-sector leaders to contribute to the Ebola response. Egypt pledged to provide personal protective equipment and medical assistance, including supplies of the antiviral remdesivir, while a partnership with India is scheduled to deliver about 20 tons of medical supplies by Monday.

The local situation of violence and mistrust is making containment more difficult and increasing the urgency of a coordinated response, Ramaphosa and others said.

Angry residents stormed a hospital in the town of Mongbwalu late Sunday after authorities refused to release bodies for burial because of infection risks, the Associated Press reported.

Earlier unrest in Ituri — the province along the Ugandan border where the outbreak was first detected and most cases are concentrated — led to Ebola treatment tents being set on fire and patients fleeing a treatment center, according to reports from the area.

As many as one in three people in Ituri believe the virus isn’t real, according to ActionAid, a charity group that started conducting information sessions to address these perceptions.

Fighting myths

“We are not just fighting a deadly virus, we are fighting myths, fear and deep-seated suspicion,” Saani Yakubu, the director of ActionAid DRC, said in a statement.

Regional health ministers meeting in the Ugandan capital Kampala on Saturday warned that porous borders, active mining corridors and large population movements were also increasing the risk of cross-border Ebola transmission.

Ten African countries are now considered at risk from the outbreak because of regional mobility and gaps in surveillance and diagnostic capacity, according to Jean Kaseya, the Africa CDC’s director-general.

“When we talk about borders, look at the borders between DRC and Uganda, between DRC and South Sudan,” Kaseya said at the briefing. “People are living across the border — morning they’re in one country, evening they’re in another.”

The crisis is being driven by the rare Bundibugyo strain of Ebola, for which there are no approved vaccines or antibody treatments. The WHO declared the epidemic a public health emergency of international concern on May 17.

An American infected while caring for Ebola patients in Congo had been evacuated to Germany for treatment, while high-risk contacts were moved to Germany and the Czech Republic, the U.S. Centers for Disease Control and Prevention said.

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