The Ebola Virus outbreak in the Democratic Republic of the Congo (DRC) is now the second biggest such outbreak in history. The Washington Post reports that the World Health Organization (WHO) made the announcement late last week and that the current epidemic is second only to the massive outbreak of the hemorrhagic fever in 2014, which took place in West Africa. Dr. Peter Salama, the chief of emergencies for the WHO, referred to the increasing number of patients as the “sad toll.”

Currently, the DRC’s health ministry states that there have been 426 Ebola cases and 198 confirmed deaths. An additional 47 deaths are suspected of being Ebola-related, but health workers have not verified these. According to the WHO, roughly half of all Ebola patients eventually die from the disease, but this number depends on the individual strain and the health of the patient; and the mortality rate can fluctuate between 25 percent and 90 percent depending on these and other factors.

As the virus continues to spread throughout the DRC, so does the violence in the most heavily affected regions. The current outbreak’s epicenter is the city of Beni, in North Kivu province. Violent militia groups such as the Allied Democratic Forces (ADF) are still attacking healthcare workers and government personnel around Beni, as well as UN peacekeepers in the area, with regularity. Although the ADF is the most well-known of these groups, one report from Len Rubenstein, Chairperson of the Safeguarding Health in Conflict Coalition, claims that there are around 20 different groups active in the region. Many experts fear that a coordinated attack on the Ebola workers would result in the halt of operations.

“There is no easy solution, but without concerted leadership and action to ensure the safety of health workers and the people they serve in the DRC and elsewhere, violence against health care, as we are seeing in Yemen, could once again lead to catastrophe,” wrote Rubenstein in a letter posted on Relief Web.

While the United States has deployed medical personnel from both the Centers for Disease Control and Prevention (CDC) and the US Agency for International Development (USAID) to the region, a new threat against the US embassy in Kinshasa may derail the current international effort. According to the Washington Post, the US issued a security alert that there was “credible and specific information of a possible terrorist threat against U.S. government facilities” in the city. Many believe that the ADF, which is loosely allied with the Islamic extremist group al-Shabaab, is responsible for the threat.