First, liquid-filled blisters developed on three-year-old Marceline Désiré’s back. Then about two weeks later, they appeared on her younger brother Jordan’s body, starting from his neck and then spreading to his back. The two children spent weeks in hospital until they recovered.
As Marceline sat on the ground inside their tarpaulin shelter at the Mudja displacement camp in the Democratic Republic of the Congo on Tuesday, Jordan in the arms of their mother, Bambire Rwanika, next to her, lesions and scars caused by mpox were still visible, especially on Marceline.
“Everyone was afraid to approach the sick children – except me, because as a mother, I couldn’t abandon them,” said Rwanika.
More than 17,000 cases of mpox, a viral disease that causes painful rashes and flu-like symptoms, have been reported in 13 African countries this year.
The DRC has been the most affected, with the vast central African country accounting for 96% of all cases and 97% of all deaths this year.
Cases of the disease on the continent have increased by 160% year on year. The fast rise in cases and spread of the disease across borders – several countries have reported cases for the first time – led the Africa Centres for Disease Control and Prevention (Africa CDC) and the World Health Organization to declare the mpox outbreak a public health emergency this month.
First recorded in a human in 1970 in what is now the DRC, mpox spreads from person to person and from animals to people through direct contact. The virus that causes it comes from the same family as that of smallpox. In 2022, mpox was declared a global emergency when it spread to more than 70 countries.
In May, scientists reported a new strain of the virus, clade 1b, in the DRC that they said was more virulent and is associated with a higher mortality rate. Scientists believe the new form is contributing to the current spread. Clade 1b causes death in about 3.6% of cases, with children more at risk, according to the WHO.
Most people recover from mpox without medical treatment. Western countries have managed to control the spread of the disease through vaccines but there is an acute shortage of vaccines in Africa. The DRC hopes to receive its first doses this week via pledges by Japan and the US, according to the Congolese health minister, Samuel Roger Kamba Mulamba.
The outbreak in the DRC is happening against the backdrop of a severe humanitarian crisis in the eastern part of the country, where long-term fighting between the Congolese army and M23 rebels has pushed hundreds of thousands of people from their homes.
Overcrowding in camps for the displaced people – such as Mudja where Rwanika and her children live – are overcrowded and experts say this has probably fuelled the spread of the disease, and made the response to the outbreak difficult.
“You can imagine a really cramped displaced camp where already the sanitary conditions are not good and then you add an mpox outbreak. It just makes it harder,” said Heather Kerr, the country director for the DRC at the International Rescue Committee (IRC).
Goma, the capital of North Kivu province in eastern DRC, is home to hundreds of thousands of displaced people and many displacement camps.
On top of concerns that conditions in the camps may help spread the disease, awareness about mpox – how it’s transmitted, how to prevent it and how to respond to it – among local people is low.
That information gap has led to uncertainty about treatment, fear, and even stigma.
At the Mudja camp on Tuesday, Furaha Mwaluhubira’s four grandchildren had skin rashes and other mpox-like symptoms. She said she pounded leaves from the Muravumba shrub, which are often used in the DRC to treat tonsillitis, coughs, scabies and chickenpox, then applied the paste to the children’s bodies after a bath, before rubbing them with palm oil.
Mwaluhubira thought her grandchildren had chickenpox, but she was now considering taking them to a specialised mpox treatment centre about 9 miles away.
“I might take them to the centre tomorrow,” she said.
Many of the mpox cases reported across the continent have been attributed to cross-border movement. They include Kenya’s only two confirmed cases, involving long-distance truck drivers who operate across east and central Africa.
Goma borders Rwanda. On Tuesday at the border, one of the busiest on the continent for commercial traffic, there was no sign of screening or testing centres.
“I just came from Uganda. No one told me to protect myself. I crossed as usual,” said Aman Lukondo, a Ugandan truck driver.
While mpox has existed for decades and has been known to spread through direct contact, it wasn’t documented to spread through sex until as recently as 2022. Last year, the WHO confirmed sexual transmission of mpox in the DRC for the first time.
Infected sex workers in the DRC have faced stigma, and experts say this could worsen the crisis as it may prevent them from seeking medical care.
“[You can get mpox through] any contact with someone who is infected,” said Dr Jean Kaseya, the director general of the Africa CDC, at a press briefing on Tuesday. “This is a message that is critical now. Otherwise, we are creating fear. We are creating stigma.”
Aggrey Aluso, the Africa director at Pandemic Action Network, said there was a need to mobilise, support and engage community health workers to support the mpox response by helping to disseminate information and build trust.
“Our best bet, particularly in resource-constrained contexts like most African states, is to work with the community,” he said. “The community are key allies in promoting global health security and must be recognised and supported.”
Kerr said that learning from previous outbreaks, such as Ebola, the government and other people working in health response should work with communities to develop messages that will be accepted and will help people understand what to do if they have signs of mpox.
Back at Mudja, the fear of mpox is omnipresent. As Widuaye Jacqueline trimmed tree branches she had cut from nearby bushes on Tuesday to sell as firewood to fellow camp residents, she reflected. “It’s a bad disease. Many people have already contracted it at the camp,” she said.
“I’m afraid of catching it myself. If I get sick, I won’t be able to come to fetch wood to feed myself.”
