Confirmed cases in Congo’s Ebola outbreak have surpassed 9,000, with more than 4,300 deaths, as health authorities struggle to contain an outbreak spreading across seven provinces, according to government figures released Tuesday.

The Health Ministry reported 9,066 confirmed cases and 4,381 deaths, with the death toll approaching half the number of confirmed cases.

The rising death toll has alarmed health workers and authorities, with a large share of recorded deaths occurring outside treatment centers. The latest report recorded 88 new cases and warned that “community transmission remains a concern.”

The outbreak has created new hot spots as it spreads to more communities, with 65 health zones across seven provinces now affected.

Officials say the confirmed cases account for only a third of all cases, with many going undetected. The outbreak involves the rare Bundibugyo virus, for which there is no approved vaccine or treatment.

Efforts to contain the virus have been impaired by several factors, including fighting between government forces and rebel groups, which has created one of the world’s direst humanitarian crises, widespread disregard for health precautions, intense population movements and shortages of medical supplies and treatment centers.

The outbreak has surpassed Congo’s 16 previous outbreaks in scale and is on track to top the 2014-2016 West Africa regional outbreak that killed 11,000 people.

“I feel that the government is overwhelmed by events. But there is nothing else to say. The government needs to fully shoulder its responsibilities to ensure the effectiveness of the response against Ebola,” said Samuel Buju, a resident of Bunia, the provincial capital of Ituri, one of the outbreak’s hot spots.

Last week, Kenya became the second country after Uganda to report an Ebola case imported from Congo, deepening concerns about the virus spreading across borders.