JOHANNESBURG — Congo’s deadly Ebola outbreak is now the second largest in history, behind the devastating West Africa outbreak that killed thousands a few years ago, the World Health Organization said Thursday.

WHO’s emergencies chief, Dr. Peter Salama, called it a “sad toll” as Congo’s health ministry announced the number of cases has reached 426. That includes 379 confirmed cases and 47 probable ones. So far this outbreak, declared on Aug. 1, has 198 confirmed deaths, with another 47 probable ones, Congo’s health ministry said.

Attacks by rebel groups and open hostility by some wary locals have posed serious challenges to health workers that Ebola experts say they’ve never been seen before. Many venture out on critical virus containment missions only accompanied by U.N. peacekeepers in areas where gunfire echoes daily.

Salama this month predicted that the outbreak in northeastern Congo will last at least another six months before it can be contained. West Africa’s Ebola outbreak killed more than 11,000 people from 2014 to 2016.

Day by day, reports by health organizations note one new difficulty after another in this latest outbreak, even as their work sets milestones that have given new hope in the fight against one of the world’s most notorious diseases.

More than 37,000 people have received Ebola vaccinations, and Congo has begun the first-ever trial to test the effectiveness and safety of four experimental Ebola drugs. And yet the risk of Ebola spreading in so-called “red zones” — areas that are virtually inaccessible because of the threat of rebel groups — is a major concern in containing this outbreak.

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