There is no good place to have an outbreak of ebola, but given the choice, almost anywhere would be better than North Kivu.

A province in the east of the Democratic Republic of Congo, it is the most volatile region of a country where volatility has long been the norm.

The most recent of DRC’s many wars started here and it is where the conflict continues to ravage lives and livelihoods most intensely while much of the rest of the country enjoys a patchy peace.

One in five of the population is internally displaced, there are frequent fresh movements of people fleeing the latest flashpoint, poverty is rife, education rare, healthcare and sanitation abysmal and infrastructure basic at best but largely notable by its absence.

And then came ebola.

The first case was reported in August last year near Beni in the north of the province and since then the dreaded virus is known to have infected 840 people and killed 537, including 22 health workers.

Irish aid worker Mark Johnson had come to the provincial capital, Goma, located in the south of the province, in May 2017 to work as emergency programme officer for Concern and there were already quite enough crises to keep him busy.

Now the 33-year-old Dubliner had to head up an effort to help contain the outbreak and, crucially, stop it from reaching Goma.

“The big worry is that if it reaches Goma, we’ll lose control of it. We’re on the border with Rwanda here so there are people crossing over and back,” he explained in a phone call from Concern’s base in the city.

“We’re beside Lake Kivu which is shared with Rwanda and there are fishermen moving around it all the time.

“We have flights going to other cities in Congo from here [including the country’s capital, Kinshasa, a city of more than 11m people] and international flights to Ethiopia and Uganda. If it comes here, it’ll be very hard to stop it spreading much further.”

Mark and his team have been organising the training of more than 350 health workers in how to control the outbreak — boosted by a €100,000 emergency donation from Irish Aid — and they are also equipping local health centres with infection prevention and control kits containing vital equipment such as masks, gloves, disinfectant and infrared thermometers that can screen for fever without contact.

Water and sanitation programmes have also been a key part of Concern’s work in the region for some time and that is continuing apace.

But the challenges are immense. “The instability makes access very difficult. Fighting can break out at any time and it might be government forces against rebels, one rebel group against another or factions within one rebel group so it’s unpredictable,” Mark said.

“There are massacres and kidnappings and sudden movements of people and when that happens, we have to react and put in place emergency supplies for them (shelter, water, food, sanitation) and then start thinking about ebola too.”

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Another problem is the lack of proper roads which hampers the distribution of supplies. The next of the year’s two rainy seasons will turn the dirt tracks to mud from March to May so that a trip of 80km can take a full day.

A big part of the response to the crisis is education for the wider public. DRC had the world’s first ever recorded case of ebola in 1976 and there have been numerous outbreaks since so the authorities have experience of the disease.

Many people with access to education and communications will also be aware of the deadly West African outbreak in Sierra Leone, Liberia and Guinea from 2014-2016 that killed more than 11,300 people.

“People can be of the view too that some disease or other is going to get me so what does it matter if it’s ebola?

“It’s also hard to convince people to come to an ebola clinic because they see it as the place you don’t come home from. Unfortunately that’s true in many cases because the death rate is high but people are still infectious after they die and only the clinics are equipped to properly deal with the corpses.”

Not everyone dies. Treatments have improved since the West African outbreak and a vaccine has also been developed although its effectiveness is not yet proven and the side effects are reputedly severe.

Long-term, a safe and reliable vaccine may relegate the horror of ebola to history but Mark said that shouldn’t detract from the effort to improve the lives of the populations at risk.

“Ebola is carried by wild animals and as long as people are displaced by conflict and can’t farm their land, as long as they are hungry and need to hunt animals for food, the risk of outbreaks will persist. This is not just an ebola situation. It really is one component of a much, much wider humanitarian crisis. The situation in Congo has been rolling on so long it loses coverage.

“It’s fighting for attention with places like South Sudan and Yemen and of course, the needs are massive there as well, but Congo has all the resources any country could need and yet it is one of the poorest and most difficult to live in. Ebola just makes up a new strand of the challenge.”