Nearly 100 children have died in an Ebola outbreak ravaging the Democratic Republic of Congo as health workers warn it could be far from over. According to a press release from Save the Children, 65 of the 97 children who have died since August were under age 5. Additionally, more than 180 have been orphaned by the disease.

“We are at a crossroads,” Heather Kerr, Save the Children’s Country Director in DRC, said in a press release. “If we don’t take urgent steps to contain this, the outbreak might last another six months, if not the whole year.”

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The outbreak is the second-largest in history, with the charity reporting at least 731 confirmed cases of Ebola within the last six months, and 484 deaths. The country suffered its worst outbreak between 2014 and 2016, which claimed over 11,000 lives and prompted calls for more preventative efforts and the development of an experimental vaccine. However, lack of Ebola knowledge continues to plague relief efforts.

“People don’t yet know what the disease is,” Dr. Brian D’Cruz, of Doctors Without Borders, told the Associated Press.

More than 70,000 people have received an experimental Ebola vaccine, but it remains to be seen how effective it is. According to the Associated Press, some patients who have received doses have contracted the virus, which is spread through contact with an infected person’s bodily fluids. Merck, the drug company behind the vaccine, said it is prepared to ship another 120,000 doses to the Congo by the end of the month.

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But scarce availability of the vaccination is not the only roadblock health workers are facing in trying to contain the outbreak. Kerr said aid workers are being threatened by rebels and locals who either don’t believe the virus is real, or who believe it is being spread by the aid workers themselves.

“People have disrupted funerals because they didn’t believe the deceased had succumbed to the virus,” she said in the press release. “Aid workers were threatened because it was believed they spread Ebola. We have to scale up our efforts to reach out to the vocal youth and community leaders to build trust and to help us turn this tide. Treating the people who are sick is essential, but stopping Ebola from spreading further is just as important.”

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The Associated Press reports the outbreak, which is mostly afflicting the eastern region, is nearing Goma, a major border city with a population of over 1 million. The United Nations said earlier this month that a coordinated relief effort was already being sent to the region, which included vaccinating nearly 2,000 front-line workers.