Ebola has killed 201 people in the Democratic Republic of Congo since an outbreak started two months ago in the country’s war-torn east.

“No other epidemic in the world has been as complex as the one we are currently experiencing,” Health Minister Dr Oly Ilunga Kalenga said.

This is Congo’s 10th outbreak since 1976, when the haemorrhagic fever was first identified in Yambuku, in the Equateur province, the ministry said. Health Minister Dr Oly Ilunga Kalenga said the figures now exceed that outbreak.

There have been 291 confirmed cases of the virus, half of which were in North Kivu region’s Beni, a city of some 800,000 people, the health ministry said. Less than one in three of those who contract the disease survive.

Over 28,000 people in the central African nation have received a vaccine. But civil war is hampering efforts to protect more.

This is the first time an ebola outbreak has occurred in Congo’s far northeast. It is a region where numerous militia groups are fighting over Congo’s rich natural resources.

“Since their arrival in the region, the response teams have faced threats, physical assaults, repeated destruction of their equipment, and kidnapping,” Kalenga said. “Two of our colleagues in the Rapid Response Medical Unit even lost their lives in an attack.”

Besides militia attacks that have hindered health workers, the region’s high population density and movements across the borders to Uganda and Rwanda pose additional risks the highly lethal disease could spread in the region.

“This epidemic remains dangerous and unpredictable, and we must not let our guard down. We must continue to pursue a very dynamic response that requires permanent readjustments and real ownership at the community level,” he said.

The outbreak began shortly after the Congo’s government declared an end to another outbreak in the west of the country in June and lauded those involved for managing to swiftly contain the spread of the disease.

Earlier this month, the health ministry said it will install health checkpoints at the entrances to all polling stations in Congo’s ebola-affected region during the December presidential election, when millions of Congolese are expected to come out to vote.

Ebola is spread via the body fluids of infected people, including the dead