Confirmed cases in Congo’s Ebola outbreak have surpassed 9,000 as efforts to contain transmission falter, according to health ministry data released Tuesday.

The ministry reported 9,066 confirmed cases and 4,381 deaths — a death toll equivalent to nearly half the 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 said “community transmission remains a concern,” with 88 new confirmed cases recorded.