By Nellie Peyton
DAKAR, Aug 17 (Thomson Reuters Foundation) - A deadly Ebola outbreak in a conflict-hit area of the Democratic Republic of Congo poses an "unprecedented" challenge to health workers trying to access victims and contain the disease, medical charities said on Friday.
At least 44 people have died in Congo's tenth Ebola outbreak since the deadly virus was discovered in the 1970s, according to the World Health Organization.
It started just a week after the country declared an end to an outbreak and marks the first time responders have had to work in an active conflict zone, where armed groups regularly kill and kidnap civilians.
"With Ebola, this situation is unprecedented. It will make the response longer and more expensive," said Michelle Gayer, director of emergency health for the International Rescue Committee (IRC), which is working to contain the outbreak.
Longstanding conflict in the region has made people more susceptible to disease because of poor sanitation and high levels of malnutrition and displacement, Gayer said, with many people now living in camps.
Treatment centres have been set up in towns that are violence free, but surveillance teams cannot access surrounding areas to check for cases, said Papys Lame of the Alliance for International Medical Action (ALIMA).
"Measures are in place to be able to manage it as best as possible despite the insecurity," he told the Thomson Reuters Foundation.
The virus, which spreads via bodily fluids and causes vomiting, bleeding and diarrhoea, has already spread from its epicentre in North Kivu province to neighbouring Ituri province since the first cases were detected on August 1.
The WHO is having to rely on local health workers in the "red zones" deemed too unsafe for its staff to enter, and has been unable to send in experts, regional emergencies director Ibrahima Soce Fall told the Thomson Reuters Foundation.
Authorities are trying to negotiate access with the militia, the WHO director-general said earlier this week.
It has been difficult to raise support and awareness because the outbreak so closely followed another one, Fall said.
"We mobilised very quickly the money needed to respond to the first outbreak, but now we are going back to the same donors and there can be this kind of fatigue," he said.
"It is really important for the international community to know that this outbreak is more complex."
Millions died in civil wars in eastern Congo from 1996 to 2003, but Ituri province had experienced relative peace until violence erupted again this year.
Ethnic rivalries and militia fighting throughout the country have been fanned by a breakdown of state authority since President Joseph Kabila refused to step down at the end of his mandate in 2016.
(Reporting by Nellie Peyton, Editing by Claire Cozens. Please credit Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights, and climate change. Visit www.trust.org)
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