An outbreak of Ebola in remote Democratic Republic of Congo (DRC) has spread to a city, health watchdogs said Thursday, sharpening fears that the deadly virus now posed a regional threat.
The fresh outbreak, publicly declared on May 8 with 23 deaths so far, had previously been reported in a rural part of Equateur Province in the vast country's northwest.
But the DRC's health ministry and the World Health Organization (WHO) on Thursday said a case had been confirmed in Equateur's capital Mbandaka, located about 150 kilometres (90 miles) from the Bikoro area where the outbreak originated.
Amid anecdotal evidence of alarm among local people, a doctor at the city's General Hospital, who requested anonymity, told AFP that more than 300 people in Mbandaka had had either direct or indirect contact with Ebola.
Doctors Without Borders (MSF), quoting local officials, said 514 people were believed to have been in contact with Ebola patients and were now being monitored.
Peter Salama, in charge of emergency response at the WHO, said the spread to a city complicated the fight against Ebola, which depends on identifying and isolating suspected cases.
Mbandaka's population has been variously estimated at between 700,000 and 1.2 million.
"In the past, in most of the Ebola outbreaks in DRC, it's been rural and fairly self-limited, but now we know that populations of more than a million are at risk," Salama said in Geneva.
"Another major issue here is that this centre of Mbandaka is on the banks of Congo River, and that river connects to the internal hinterland of DRC but also to surrounding countries such as Congo-Brazzaville and Central African Republic, so this outbreak now has a real risk of national and regional amplification."
The WHO announced it was sending 30 experts to Mbandaka, while MSF said it was sending several tonnes of medical supplies there.
The International Federation of Red Cross and Red Crescent Societies called for an alert to be sent out across Equateur "and even beyond."
"If we don't, then the virus may spread too far and too quickly," Ben Adinoyi, the Red Cross's regional healthcare chief, said in a statement.
- Urban risk -
Ebola is lethal and highly contagious, which makes it difficult to contain -- especially in urban environments where people are mobile and come into more contact with others.
Lacking an arsenal of drugs to treat the virus, doctors isolate patients and trace people who have been in contact with them.
Adding to the headache is the fact that the virus has broken out anew in one of the world's most volatile countries.
A country four times the size of France, the DRC has been chronically unstable and episodically racked by violence since it gained independence from Belgium in 1960.
Despite vast mineral wealth, the country remains mired in poverty and corruption. Basic infrastructure -- hospitals, roads, electricity -- is a major obstacle in remote areas.
The current outbreak involves the same strain of the virus that hit three West African countries in 2013-15 and sparked an international panic.
It went on to kill more than 11,300 people, in the deadliest ever Ebola epidemic.
- Worried population -
In Mbandaka on Thursday, the mood among many people changed from insouciance to worry as news of Ebola's spread was announced on the radio.
Bars, restaurants and public offices set up basins of water and soap dispensers for people to wash their hands, while at the city's airport, health ministry workers were taking travellers' temperatures with laser thermometers, an AFP reporter saw.
"I am looking for a boat to leave," said Constantine Boketshu, who is married to a member of the armed forces.
"The authorities have let the disease come here. We run the risk of being wiped out in the (military) camp -- the hygiene is bad."
Market hawker Adolphine Dikela said: "Even at normal times, the hospitals are short of medicines. How are we going to survive if the disease spreads here?"
Fisherman Jean-Pierre Kelokelo said: "I'm going to stop coming to Mbandaka to stop selling my fish -- I don't want to be infected by this disease and go back and spread it in my village."
- $25 million 'investment' -
The WHO was fiercely criticised over its handling of the 2013 outbreak and has pledged to improve emergency response.
There is no licensed drug to treat or prevent Ebola, although an experimental vaccine arrived in the DRC on Wednesday and has been cleared for use by the Kinshasa government.
Salama said combatting the DRC outbreak would cost "around $25 million dollars" for the first three months of operations.
"But it is a cost that is worth investing now, because we know from Ebola West Africa experience that that cost the international community between $3-4 billion" in addition to the death toll, he said.
Health workers don protective equipment at Bikoro Hospital in northwest DR Congo -- the epicentre of the latest Ebola outbreak
Map of DR Congo, locating the Ebola outbreak in Bikoro and Mbandaka
Guinea was among three West African countries that bore the brunt of an Ebola epidemic in 2013-15. Containing the outbreak entailed sending specialised workers to remove bodies from houses, following by rigorous disinfection procedures