Health workers in the Democratic Republic of Congo are struggling to contain a rapidly growing Ebola outbreak in the country’s North Kivu and Ituri provinces.

The World Health Organization (WHO) announced Thursday that the outbreak, which was first reported in early August, had so far killed approximately 159 people (124 of those deaths were confirmed Ebola Virus Disease, or EVD cases, 35 considered “probable”). In total, 247 EVD cases have been reported so far, with 212 confirmed and dozens of others probable.

It is the second wide-scale Ebola outbreak the country has seen in less than a year. The first major outbreak was initially reported in May, and killed 33 people by the time it was contained in late July.

The grim outlook in this recent outbreak has been made worse by ongoing civil conflict in the region, as well as a high refugee population which is particularly vulnerable to the disease.

“Security incidents over the past week, ranging from clashes between rebel and government forces resulting in civilian deaths to response vehicles being pelted with stones, continued to cause community distress and severely impede response activities […],” WHO officials said Thursday. “These incidents are occurring amidst intense EVD transmission in communities in the city of Beni.”

More troubling is the fact that at least 17 of the 27 new EVD cases identified over the past week had no established contact with any other infected individuals. Dr. Mike Ryan, assistant director-general of the WHO’s emergency preparedness and response program, told STAT News the unmapped chains of transmission pose a particular threat to the containment process.

“There is underground community transmission in Beni. It may not be at a very intense level. But it is enough to continue and drive transmission in this town. And we need to stop it,” he said. “We need to pull the roots of this thing out of this city.”

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Image credit: MONUSCO