But given that the current outbreak in North Kivu is perhaps the first time the virus has spread into an area already home to a large-scale humanitarian crisis, containing the spread of Ebola this time around is proving to be a lot more difficult.

It is already the largest outbreak in the DRC and is on course to become the second largest Ebola outbreak ever.

“The difference is that we are now operating in a war zone,” Axelle Ronsse, the emergency coordinator for MSF’s Ebola response, told Al Jazeera, referring to the militia violence that has long plagued parts of the country’s east.

How has the security crisis impacted efforts to contain the virus?
North Kivu is home to a number of armed groups, including the Allied Defence Forces (ADF), a Ugandan rebel group, that has operated with impunity since 1995.

The endless upheavals in the region have meant regular dispossession and the incessant movement of refugees to neighbouring countries or within the province itself. As it stands, there are more than a million internally displaced people in North Kivu.

“The violence impacts our work on a daily basis,” Ronsse says. “We are not targeted but it is a matter of being in the wrong place at the wrong time.”

Likewise, Gutcher, from the WHO, says that some attacks have resulted in medical activities being severely impeded or temporarily shut down.

“Community violence has also at times impeded the work of safe burial teams’ ability to conduct safe and dignified burials.”

How West Africa’s Ebola outbreak shapes response in DRC
In October, rebels killed 13 civilians and kidnapped a dozen children in an assault on Beni.

In November, seven Malawian and one Tanzanian peacekeeper were killed in another attack on the town.

The instability has also made it difficult for health professionals to locate others who might have been in contact with suspected victims, in what is known as “contact tracing”, considered a basic pillar of any effort to contain Ebola.

Last month, The New England Journal of Medicine (NEJM) wrote that “carrying out the effective contact tracing and community engagement can permit rapid identification of people who are ill and facilitate the provision of early clinical care, which has been shown to improve the likelihood of survival.”

Jessica Ilunga, communications officer for the DRC’s Ministry of Public Health, told Al Jazeera that every security-related incident affected field activities. She added that the underlying security context had also created a climate in which health workers faced an unprecedented level of community resistance.

“The predominance of traditional healers, who are more trusted by the population than modern medicine, has also led to an important number of nosocomial transmissions of the virus,” Ilunga said.

Citing the instability in the eastern DRC, the WHO elevated the national crisis to “very high” in late September. The crisis is still not considered a public health emergency of international concern and the world health body does not recommend imposing any trade or travel restrictions with the DRC.

How have the DRC and the international community responded to this crisis?
Since the introduction of the vaccination programme by the DRC’s government and the WHO, a key intervention has involved vaccinating suspected patients and then administering a second “ring” to those who might have come into contact with these suspected cases.

The vaccine is Canadian-developed but licensed and produced by the American pharmaceutical company Merck.

According to the WHO, around 300 medical specialists have been deployed to the country to support the response plan. Around 32,500 people-at-risk have been vaccinated, including 10,600 health workers and 8,600 children.

On November 24, the government and the WHO said they would be conducting clinical trials to assess the safety and effectiveness of drugs used on Ebola patients to find the most effective treatment for the virus.

Authorities have already started using the drugs on a case-by-case basis on around 151 people. Those who used the drugs had a 63 percent chance of survival, while those who did not receive medication had a fatality rate close to 80 percent.

“Now that protocols for trials are in place, patients will be offered treatments under that framework in the facilities where the trial has started,” the WHO said.

With a month to key elections, ‘difficult times ahead’ for DRC
Over and above vaccinations and drugs, efforts have been made to spread information through door-to-door advocacy, with more than 2,500 homes visited, including almost 1,400 homes in Beni alone.

“Faced with rumours and misinformation, some families have chosen to care for sick relatives at home; some patients leave healthcare centres to find alternatives or actively avoid follow up,” Gutcher says.

Authorities have also trained around 1,700 volunteers to assist with community-based efforts. Across the border in Uganda, 758 health workers in 19 health facilities have been vaccinated.

In mid-November, the WHO said that the outbreak would end in mid-2019.

But Ilunga, from the DRC’s Ministry of Public Health, says her government is hopeful that the efforts to contain the outbreak would succeed sooner than the WHO’s target, but concedes that “the success of this response also depends on a number of factors that we do not control, such as security”.

Why do outbreaks continue to occur in the DRC?
Microbiologists argue that viruses such as Ebola often occur among animal populations faced with restricted movement.

However, health professionals are concerned that should the Ebola become endemic to the troubled areas in the northeastern DRC, it would mean “a sustained and unpredictable spread of the deadly virus, with major implications for travel and trade”.

“This will mean that we’ve lost the ability to trace contacts, stop transmission chains and contain the outbreak,” Tom Inglesby, director of the Johns Hopkins Center for Health Security, said in a briefing earlier in November.

For her part, Ilunga says the country needs to accept the fact that the disease “will resurface regularly” and “make preventive and curative treatments more available and improve the population’s knowledge about the virus”.