There are growing concerns that the Ebola crisis in Democratic Republic of Congo, where more than 1,100 people have died since the outbreak was declared last August, will spill beyond its borders.

“I’m just back from Congo and it is clear that the Ebola outbreak is getting worse, not better, despite a proven vaccine and treatment,” said David Miliband, CEO of the International Rescue Committee (IRC). “We need to reset the response now before the outbreak spreads to other parts of the country.”

On Thursday, the International Federation of Red Cross and Red Crescent Societies (IFRC) appealed for help because it is running out of funds to conduct safe burials for Ebola victims. The practice is needed to contain the spread of infection: During the West African outbreak, 60 percent of all Ebola cases in Guinea were linked to traditional burials, and in parts of Sierra Leone that climbed to 80 percent.

The IFRC only has enough funding for safe, dignified burials for another two weeks, it said Thursday.

“We need more investment now,” said Emanuele Capobianco, the IFRC’s Director of Health and Care. “We cannot afford for Ebola to become entrenched in North Kivu and Ituri, nor can we allow it to spread to urban areas where it will be much more difficult to control. And we cannot allow it to cross international borders.”

Ron Klain, the former United States Ebola response coordinator, sees that possibility as ominous. “If the safe burial team runs out of funding, or meets greater resistance, that is a formula for this outbreak exploding,” he warned on Friday.

Regional insecurity and spread across borders

That looming fear of regional spread is rooted in part in the instability of North Kivu and Ituri provinces, where the Ebola outbreak is centered. Another 10 people died in Kilhewa on Friday in an attack attributed to Ugandan rebels, from among the armed groups that have moved back and forth across the border for years.

Protests broke out Friday in Kiwanja too, where Congolese security forces fired into the air to clear a main highway blockade – a highway that runs south to the border city of Goma, where international health officials carefully screen people coming in and out from Rwanda. Travelers coming north from Goma or headed south from Beni, a region hard-hit by the Ebola outbreak, were stranded at Kiwanja.

Those incidents were not directly linked to attacks on Ebola treatment facilities or health care workers, though far too much of the violence has been directed at them, but they illustrate the challenges of dealing with Ebola in the Congolese context. The situation has become so bad that health workers don’t want to be identified in public. “Our staff has to lie about being doctors in order to treat people,” said an IRC response director, in an account published by the Washington Post on Thursday.

Earlier this month, the Congolese Ministry of Health released data on the attacks on health workers. By May 3, there were 85 health workers injured or killed and 42 direct attacks on health facilities, in a total of 119 separate attacks linked to people or places engaged in the battle to control the Ebola outbreak. Another attempted attack happened Monday in Katwa, where a third of all Ebola fatalities are recorded.

The World Health Organization said Thursday the security situation “has subsided mildly into an unpredictable calm,” but it also said as recently as Tuesday that there was “no end in sight” to the security challenge coupled with the DR Congo’s political environment. They remain a stumbling block in executing the Ebola response and a threat to international spread. While the latter has not yet occurred, WHO staffers and the health ministries from DR Congo as well as Burundi, Rwanda, South Sudan and Uganda will meet in Kigali next week to review health surveillance and strengthen regional cooperation.

Ebola death toll increases

And there have been a few scares. Last week, a 37-year-old man under health monitoring as a known contact of an Ebola victim left Beni and traveled to Kampala by way of Kasindi for additional health care. Workers brought him back from Uganda and returned him to Beni. He remains well but is still watched.

In the meantime, the Ebola outbreak toll continues to soar within the North Kivu and Ituri provinces. More than 100 people have died just in the past 10 days – another 17 in Katwa, another 23 in Butembo, a spike of 26 in Mabalako and 12 more in Vuhovi. The Congolese health ministry says there are now more than 100 health care workers who have contracted the Ebola virus and 34 of them have died. All told, there are now 1,177 fatalities, despite the use of the promising rVSV-ZEBOV vaccine approved for experimental use in this Congolese Ebola outbreak and administered to more than 118,000 people.

Yet another community has recorded its first case, this time in Alimbongo, along that same main road blocked by Friday’s protesters in Kiwanja some 140 kilometers south. Only two of the 24 monitored health zones, Goma and Mambasa, have had zero confirmed cases but between them there are 19 people monitored as suspected cases. Almost all of them are in Goma.

The fears that the Ebola outbreak will spill beyond the borders of the two troubled Congolese provinces, into other parts of the country and beyond, remain heightened. They are real, and they are well-founded.