GOMA, Republic of Congo — For days, Sarah Bageni had been suffering from headaches, fever, itchiness and unusual skin lesions, but she had no idea that her symptoms could be caused by MPOX, or that she could be another case in a growing global health crisis.
She also doesn’t know where to go to get medical help.
She and her husband live in the Burengo displacement camp in eastern Congo, the de facto epicenter of Africa’s string of MPOX outbreaks.
An alarming rise in infections this year, including one identified by scientists in eastern Congo, prompted the World Health Organization to declare it a global health emergency on Wednesday. The organization said the virus could spread beyond the five African countries where it has already been detected, a timely warning that came a day before Sweden reported its first case of the virus.
Congo, a vast central African country, has seen more than 96% of the roughly 17,000 MPOX cases recorded worldwide this year and has killed around 500 people from the disease, yet many of its most vulnerable people appear unaware of its existence or the threat it poses.
“We don’t know anything about this,” Bageni’s husband, Habumuremiza Hire, said of MPOX on Thursday. “We are helplessly watching her condition as we don’t know what to do. We continue to stay in the same room.”
Millions of people are thought to be without access to medical aid or advice in the war-torn east, where dozens of rebel groups have been battling the Congolese army for years over mineral-rich territory, sparking a massive displacement crisis. Hundreds of thousands of people like Bageni and her husband have been forced into overcrowded refugee camps around Goma, with many more seeking refuge in the city.
Conditions in the camps are dire and medical facilities are almost non-existent.
Mahoro Fastin, who runs the Burengo refugee camp, said about three months ago, managers first began noticing that people in the camp were exhibiting symptoms that could indicate malaria, measles or measles-rubella, such as fever, body aches and chills.
Because of a lack of testing, there is no way of knowing how many cases of MPOX there are in Burengo, he said. There have been no recent health campaigns to educate the tens of thousands of people in the camp about MPOX, and Fastin said he worries about how many go undiagnosed.
“Look at how crowded it is here,” he said, pointing to the sea of dilapidated tents. “If we don’t do something, we’ll all be infected here. Or maybe we’re all infected already.”
Dr. Pierre-Olivier Ngadjoul, health adviser in Congo for the international aid group Medea, said that about 70 percent of new MPOX cases registered in the past two months at a treatment center run by Medea in the Goma region were from displacement camps. The youngest of those cases was a one-month-old baby, and the oldest was a 90-year-old man.
In severe cases of MPOX, lesions may appear on the face, hands, arms, chest, and genitals. The disease originates from animals, but in recent years the virus has spread from person to person through close physical contact, including sexual contact.
Bageni’s best hope of having the lesion diagnosed is to travel to a public hospital, a two-hour drive away, but given that she has had both legs amputeed and already struggles to get around, this is probably not possible.
According to the United Nations High Commissioner for Refugees, 7 million people are internally displaced in Congo, including more than 5.5 million in the eastern part of the country. Congo is home to the largest number of displaced persons camps in Africa and some of the largest in the world.
Dr. Chris Beyer, director of the Duke University Global Health Institute, said the humanitarian crisis in eastern Congo poses nearly every challenge to containing the MPOX epidemic.
These include war, illegal mining that attracts sex workers, a floating population near the border and persistent poverty, and he said the international community was ignoring several warning signs.
“We’re now seeing MPOX, which has been circulating in Congo and Nigeria since 2017,” Beyer said, adding that experts have long called for African countries to get vaccines to the country, but to little effect. He said the WHO’s emergency declaration was “too late,” and that more than a dozen countries were already affected.
Beyer said that unlike COVID-19 and HIV, MPOX has good vaccines, good treatments and diagnostics, but in areas such as eastern Congo, “the access problem is bigger than it’s ever been.”
In 2022, the disease spread to more than 70 countries around the world, including the United States, and the WHO declared it a global emergency that will last until mid-2023. Within months, the disease was largely eradicated in wealthy countries through the use of vaccines and treatments, but vaccines are scarce in Africa.
The new, potentially more contagious, type of MPOX was first detected this year in a mining town in eastern Congo, about 450 kilometers (280 miles) south of Goma. It’s unclear to what extent the new type of virus is to blame, but Congo is now experiencing its worst outbreak yet, with cases reported in at least 13 African countries, including the first cases in four of them.
Outbreaks in four countries – Burundi, Kenya, Rwanda and Uganda – have been linked to an outbreak in Congo, and Doctors Without Borders said on Friday that the surge in cases there was a “threat of a large-scale spread of the disease to other countries.”
Salim Abdul Karim, an infectious disease expert who chairs the emergency committee for the Africa Centers for Disease Control and Prevention, said the Congo outbreak is a particularly worrying change because it is disproportionately affecting young people: Children under 15 account for 70% of infections and 85% of deaths in the Congo, according to a report by the Africa CDC.
While the 2022 global pandemic primarily affected gay and bisexual men, MPOX now appears to be spreading among heterosexual populations.
All of Congo’s 26 provinces have recorded cases of MPOX, according to the state news agency, but Health Minister Samuel Roger Kamba said Thursday that the country still did not have a single dose of the vaccine and urged “everyone in Congo to be vigilant in all directions.”
Dr. Rachel Maguru, head of the multimorbidity center at North Kivu provincial hospital in Goma, said there are no drugs or established treatments for MPOX, so they are relying on other specialists, such as dermatologists, to help where they can. A major outbreak around the city and in the many displacement camps already overburdened by the influx would be “frightening,” she said.
She also noted a crucial issue: the poor and displaced have other priorities, like earning enough money to eat and survive. Aid agencies and overstretched local governments are already struggling to provide food, shelter and basic health care to millions of displaced people, while also dealing with outbreaks of other diseases, such as cholera.
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Asadu reported from Abuja, Nigeria.
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