Health workers said public mistrust is now the biggest obstacle to stopping the epidemic, with many refusing vaccines, resisting treatment and concealing symptoms, as the world’s second-biggest Ebola outbreak spreads.

This mistrust resulted in people being 15 times less likely to seek medical treatment at an Ebola health centre, according to the study published in the Lancet Infectious Diseases journal.

The study, released on Wednesday, was based on interviews conducted last September, about a month after the outbreak began. It comes as the number of probable and confirmed cases exceeds 1,000.

At least 639 people have died from Ebola in eastern DRC since August in what is now the second-deadliest outbreak in history, according to the World Health Organization.

In recent weeks, there have been, on average, eight new cases a day, said the country’s health ministry.

The response to the outbreak has been hampered by a series of deadly attacks on Ebola health centres since the study was completed. As a result, Doctors Without Borders has stopped staffing two health centres at the outbreak’s epicentre after violent attacks.

Researchers found that trust in public authorities had already fallen in the cities of Beni and Butembo before Ebola hit, due to decades of conflict and poor governance.

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