A 5-year-old boy lay on a bare mattress in the remote town of Mongbwalu in the Democratic Republic of the Congo. A tissue had been stuffed into his nose to stop the bleeding. His worried father stood over him.

A few beds away lay the body of Christiane Bahati, 21, who had died several hours earlier. The body, covered by a thin sheet, carried a highly contagious disease. But on that day in early May, hardly anyone in the ward wore protection. Relatives came and went, carrying food and water to ailing patients. A few had on rubber gloves or a scarf across their mouth. Most had nothing at all.

Seven hospital workers had already died from suspected Ebola, which had likely been spreading in the area for about a month. Ebola is one of the world’s most lethal viruses (see “Killer Bugs,” below), and there have been several outbreaks of the disease in Africa over the past 50 years. The virus spreads so quickly and easily that doctors must protect themselves with hazmat suits even when dealing with the dead. Yet few in the hospital in Mongbwalu had ever been trained to fight the disease, and basic equipment was in dangerously short supply: protective suits, goggles, masks, testing equipment, even drinking water.

A 5-year-old boy lay on a bare mattress in the remote town of Mongbwalu in the Democratic Republic of the Congo. A tissue had been stuffed into his nose to stop the bleeding. His worried father stood over him.

Christiane Bahati, 21, lay in a bed nearby. She had died several hours earlier. Her body was covered by a thin sheet. It carried a highly contagious disease. But on that day in early May, hardly anyone wore protection. Relatives came and went. They carried food and water to sick patients. Only a few had on rubber gloves or a scarf across their mouth. Most had nothing at all.

Seven hospital workers had already died from suspected Ebola. The disease had likely been spreading in the area for about a month. Ebola is one of the world’s most lethal viruses (see “Killer Bugs”). Over the past 50 years, there have been several outbreaks of the disease in Africa. The virus spreads quickly and easily. Doctors must protect themselves with hazmat suits even when dealing with the dead. Yet few in the hospital in Mongbwalu had ever been trained to fight the disease. Basic equipment was in dangerously short supply: protective suits, goggles, masks, testing equipment, even drinking water.

What made the disease even harder to fight was that it was an unusual strain of Ebola, called Bundibugyo. Doctors in the Democratic Republic of the Congo (D.R.C.) had seen it only twice since 2007, and their diagnostic tests were designed to recognize the more common strains of Ebola. By the time the Congolese Health Ministry declared this outbreak on May 15, it was too late. It had ballooned into the third-largest Ebola pandemic on record, spreading to other cities in the D.R.C. and into neighboring Uganda. As of late July, 2,556 cases and more than 1,000 deaths had been recorded, according to the countries’ health ministries. There’s no approved vaccine or treatment for this strain of the virus.

“If we don’t stop this outbreak now,” says Jean Kaseya, the director general of the Africa Centres for Disease Control and Prevention, “for sure, it will be the largest Ebola outbreak ever.”

Mongbwalu, in Ituri Province in northeastern D.R.C., provided an excellent place for Ebola to start spreading. The town is in the heart of gold mining country. People are constantly flowing in from other places: miners seeking work, traders, and smugglers. The town is also a refuge in a volatile region where ethnic conflict has raged for decades. Rebel soldiers fighting the Congolese government control the surrounding countryside. People fleeing the violence come to Mongbwalu looking for safety. Some of the infected later return home, spreading the virus further.

“It’s a perfect storm,” says Esther Sterk, a tropical medicines adviser with Doctors Without Borders in Mongbwalu.

What made the disease even harder to fight was that it was an unusual strain of Ebola, called Bundibugyo. Doctors in the Democratic Republic of the Congo (D.R.C.) had seen it only twice since 2007. Their diagnostic tests were designed to recognize the more common strains of Ebola. By the time the Congolese Health Ministry declared this outbreak on May 15,
it was too late. It had ballooned into the third-largest Ebola pandemic on record. The virus had spread to other cities in the D.R.C. and into neighboring Uganda. As of late July, 2,556 cases and more than 1,000 deaths had been recorded, according to the countries’ health ministries. There’s no approved vaccine or treatment for this strain of the virus.

“If we don’t stop this outbreak now,” says Jean Kaseya, the director general of the Africa Centres for Disease Control and Prevention, “for sure, it will be the largest Ebola outbreak ever.”

Mongbwalu, in Ituri Province in northeastern D.R.C., provided an excellent place for Ebola to start spreading. The town is in the heart of gold mining country. People are constantly flowing in from other places. These include miners seeking work, traders, and smugglers. The town is also a refuge in a dangerous area where ethnic fighting has raged for decades. Rebel soldiers fighting the Congolese government control the surrounding countryside. People fleeing the violence come to Mongbwalu looking for safety. Later some of the infected return home and spread the virus further.

“It’s a perfect storm,” says Esther Sterk, a tropical medicines adviser with Doctors Without Borders in Mongbwalu.

Like the more common strains of Ebola, Bundibugyo may have originated in fruit bats, which roost in the forests and pass the virus on to people through scratches or feces. People can also contract the virus through contact with the bodily fluids of an infected, sick, or dead person, or with contaminated objects like clothing, bedding, or medical equipment. Ebola symptoms, including sudden fever, muscle pain, and vomiting, eventually lead to uncontrolled bleeding and organ failure. According to the World Health Organization (W.H.O.), the fatality rate is 30-50 percent.

People’s distrust of authorities has made it hard to keep the disease from spreading. Some people don’t believe there’s an outbreak, calling it a moneymaking plot concocted by Congolese doctors and foreign aid workers. Others call it a curse. Often, doctors say, the early symptoms of Ebola resemble common ailments, like malaria or typhoid. Patients come to the hospital sick and die quickly. This only heightens suspicion.

Like the more common strains of Ebola, Bundibugyo may have originated in fruit bats. They roost in the forests and pass the virus on to people through scratches or feces. People can also contract the virus through contact with the bodily fluids of an infected, sick, or dead person. Objects like clothing, bedding, or medical equipment can also be contaminated. Ebola symptoms include sudden fever, muscle pain, and vomiting. These eventually lead to uncontrolled bleeding and organ failure. According to the World Health Organization (W.H.O), the fatality rate is 30 to 50 percent.

People’s distrust of authorities has made it hard to keep the disease from spreading. Some people don’t believe there’s an outbreak. They call it a moneymaking plot concocted by Congolese doctors and foreign aid workers. Others call it a curse. Early symptoms of Ebola resemble common ailments, like malaria or typhoid. Patients come to the hospital sick and die quickly. This only heightens suspicion.

One night in May, assailants in Mongbwalu burned down part of the hospital and a tent that served as an isolation ward, shortly after Doctors Without Borders put it up. In the chaos, 18 patients suspected of having Ebola fled their beds and vanished into the town, potentially spreading the virus even more.

“We’re here to save them,” says doctor Richard Lokudu of the angry crowds gathering outside the hospital. “They think we want to kill them.”

Family members come to claim the bodies of the dead so they can bury them. Traditional burial practices involve touching the body. But the doctors fear an unmanaged funeral could turn into a superspreader event and refuse to turn bodies over.

Two nights after the fire in Mongbwalu, more than 100 men, some armed with machetes and sticks, attacked the hospital in an effort to take the body of a well-liked preacher who had died of Ebola the day before. Police and soldiers fired warning shots to repel them. This went on for hours. The next morning, to appease the townspeople, a line of soldiers accompanied the preacher’s body as it wound through the town for a safe burial beside a church.

Not everyone dismisses the disease as a fraud or curse. Héritier Alezo, Christiane Bahati’s husband, was more focused on finding a way to tell their boys, aged 2 and 3, their mother was gone.

“In my opinion,” he says firmly, “Ebola exists.”

One night in May, assailants in Mongbwalu burned down part of the hospital and a tent that served as an isolation ward, shortly after Doctors Without Borders put it up. In the chaos, 18 patients suspected of having Ebola fled their beds. They vanished into the town, potentially spreading the virus even more.

“We’re here to save them,” says doctor Richard Lokudu of the angry crowds gathering outside the hospital. “They think we want to kill them.”

When someone dies, family members come to claim the body so they can bury it. Traditional burial practices involve touching the body. Doctors fear an unmanaged funeral could turn into a superspreader event. They often refuse to turn bodies over to family members.

Two nights after the fire in Mongbwalu, more than 100 men attacked the hospital. Some were armed with sticks and machetes. They were trying to take the body of a well-liked preacher who had died of Ebola the day before. Police and soldiers fired warning shots to keep them away. This went on for hours. The next morning, to appease the townspeople, a line of soldiers accompanied the preacher’s body through the town for a safe burial beside a church.

Not everyone dismisses the disease as a fraud or curse. Héritier Alezo, Christiane Bahati’s husband, was more focused on finding a way to tell their boys, aged 2 and 3, their mother was gone.

“In my opinion,” he says firmly, “Ebola exists.”

Scientists are scrambling to find a vaccine, which could take months. Even if they identify a possible one, it would have to undergo the slow process of clinical testing involving large groups of people.

“It’s going to take a long, committed response to bring this outbreak under control,” says Richard Hatchett, the chief executive of the nonprofit Coalition for Epidemic Preparedness Innovations.

The W.H.O., the United Nations, the European Union, and South Africa’s government are sending aid to the D.R.C., and the country’s government has set aside $20 million for the outbreak, health officials say.

The United States has committed more than $200 million to provide things like clean water and medical supplies and to build clinics, the State Department said in May. Previously, the U.S. had funded disease surveillance networks in the region to prevent outbreaks from spreading to other nations. That ended last year, when the Trump administration shut down the U.S. Agency for International Development (U.S.A.I.D.).

Scientists are trying to find a vaccine. It could take months. Even if they identify a possible vaccine, it would have to undergo the slow process of clinical testing involving large groups of people.

“It’s going to take a long, committed response to bring this outbreak under control,” says Richard Hatchett, the chief executive of the nonprofit Coalition for Epidemic Preparedness Innovations.

The W.H.O, the United Nations, the European Union, and South Africa’s government are sending aid to the D.R.C. The country’s government has set aside $20 million for the outbreak, health officials say.

The United States has committed more than $200 million. The money will provide things like clean water and medical supplies, as well as build clinics, the State Department said in May. Previously, the U.S. had funded disease surveillance networks in the region to prevent outbreaks from spreading to other nations. The program ended last year, when the Trump administration shut down the U.S. Agency for International Development (U.S.A.I.D.).

The absence of U.S.A.I.D. will be felt most sharply, experts say, in the supply chain for moving medical supplies and a vaccine or treatment if and when it’s available.

For now, the outbreak remains concentrated in Ituri Province, but experts say there’s a high risk it will reach other countries bordering the D.R.C. besides Uganda. Global spread of Ebola, they say, is unlikely.

Health officials are working in local communities to dispel misinformation about the virus and boost efforts to contain it. Thousands of people who’ve had contact with an infected person have been tracked down, and those with the disease have been urged to isolate.

Elizabeth Kombi, a pharmacist in Bunia, says she’s keeping her six children at home to protect them. She hopes international agencies will deliver a treatment soon.

“People are afraid because this time around, it’s killing a lot of people,” she says. “And there’s no cure yet.”

The absence of U.S.A.I.D. will be felt most sharply, experts say, in the supply chain for moving medical supplies and a vaccine or treatment if and when it’s available.

For now, the outbreak remains concentrated in Ituri Province. There’s a high risk it will reach other countries bordering the D.R.C. besides Uganda, experts say. But global spread of Ebola is unlikely.

Health officials are working in local communities to stop the spread of misinformation about the virus and boost efforts to contain it. Thousands of people who’ve had contact with an infected person have been tracked down. Those with the disease have been urged to isolate.

Elizabeth Kombi, a pharmacist in Bunia, says she’s keeping her six children at home to protect them. She hopes international agencies will deliver a treatment soon.

“People are afraid because this time around, it’s killing a lot of people,” she says. “And there’s no cure yet.”

^{With reporting by Apoorva Mandavilli, Stephanie Nolen, Declan Walsh, and Carl Zimmer of The New York Times.}

^{With reporting by Apoorva Mandavilli, Stephanie Nolen, Declan Walsh, and Carl Zimmer of The New York Times.}