The Ebola outbreak in the Democratic Republic of the Congo is spreading further, with more regions affected and case numbers rising, a World Health Organization (WHO) official said on Friday.

An overall 676 cases had been confirmed by Thursday, including 136 deaths, said Olivier le Polain, who is in Beni in North Kivu province to support local authorities on behalf of the WHO.

“Almost every day, cases are being identified in new health zones,” he said, although most were still in Ituri province.

While most cases in North and South Kivu involved people who had come from Ituri, local transmission had now also been recorded there, he noted.

Challenges include ongoing conflict, large numbers of displaced people and a weak healthcare system, le Polain said, warning of “blind spots” in some high-risk areas.

“The full scale of the outbreak is not yet clear,” the healthcare official added.

The United Nations Children’s Fund (UNICEF) has warned that families are avoiding routine check-ups at hospitals or are not seeking medical help for sick children, out of fear of infection. The danger is that more children will die as a result, it said.

More than half of children aged under five in Ituri province are malnourished, putting them in a precarious situation, UNICEF said.

Read More: WHO: Ebola spreading to new regions in Congo