Confirmed cases in the Democratic Republic of Congo's Ebola outbreak have surpassed 9,000, with more than 4,300 deaths, as health authorities struggle to contain a virus now spreading across seven provinces in the north and east of the country. The Health Ministry reported 9,066 confirmed cases and 4,381 deaths in figures released on Tuesday, meaning the death toll is approaching half the number of confirmed cases.

The latest report recorded 88 new cases and warned that "community transmission remains a concern." A large share of recorded deaths are occurring outside treatment centers, which has alarmed health workers. The outbreak has produced new hot spots as it reaches more communities, with 65 health zones now affected. Officials say confirmed cases represent only about a third of all cases, with many going undetected.

The outbreak was declared in mid-May, though experts believe the virus emerged weeks or even months earlier. It began in Ituri, a province in northeastern Congo, and is the country's 17th Ebola outbreak. It has already surpassed the scale of all 16 previous ones and is on track to exceed the 2014–2016 West Africa epidemic, which killed 11,000 people.

The outbreak is caused by the Bundibugyo strain, a rare form of the virus for which there is no approved vaccine or treatment. The World Health Organization said on Tuesday that a clinical trial for a vaccine is scheduled to begin in Congo this month. For now, frontline volunteers have received doses of Ervebo, a vaccine that is effective against the Zaire strain of Ebola but not designed for this one.

Several factors have undermined the response. Fighting between government forces and rebel groups has created one of the world's most severe humanitarian crises and limited access to affected areas. Medical and humanitarian staff also face distrust from local communities, and officials cite widespread disregard for health precautions, intense population movements, and shortages of medical supplies and treatment centers.

Frustration is visible among residents. "I feel that the government is overwhelmed by events," said Samuel Buju, a resident of Bunia, the capital of Ituri province. "The government needs to fully shoulder its responsibilities to ensure the effectiveness of the response against Ebola."

The risk of regional spread is also growing. Last week Kenya became the second country after Uganda to report an Ebola case imported from Congo, deepening concerns about cross-border transmission. With no licensed vaccine, a high share of undetected cases and ongoing conflict, the outbreak poses a major test for Congolese authorities and international health agencies.