MUNIGI, DEMOCRATIC REPUBLIC OF CONGO – Esther Mwema thought her four-year-old son had chickenpox. He was lucky enough to undergo a medical examination in this displaced persons camp, where many families live in tents and even clean water is scarce.
But the diagnosis was something else: Mpox, a virus spreading in eastern Democratic Republic of Congo, Uganda and beyond. This is the second Mpox strain to hit the Democratic Republic of Congo hard. The first disease gained momentum in 2022 and was primarily transmitted through sexual contact. The new strain spreads quickly through close contact in everyday life, this time infecting adults but increasingly also children.
Data from various health and government sources is often contradictory, but one thing is clear: children are now bearing the brunt. Data from the United Nations Children’s Fund found that 84% of people who have died from Mpoxen in the Democratic Republic of Congo since January were children. This is based on a total number of approximately 15,600 cases of the virus.
Tam Berger of Medair, an aid organization that provides medical assistance in crisis countries, says 70% of the more than 300 people in Munigi, the camp where Mwema lives, are believed to be infected with Mpoxen, children under the age of 10.
From the Democratic Republic of Congo, the virus has spread across the border into Uganda, where authorities say the outbreak is well under control but local health workers consider the situation serious.
“You find someone who has blisters all over their body that are oozing pus,” said Jovia Biira, a midwife who the Ugandan government sent to the border with the Democratic Republic of Congo as part of an MPOX surveillance team. “Some have very high temperatures of 38 degrees Celsius and more.”
But Emmanuel Ainebyoona, spokesman for the Ministry of Health in Uganda, told the Global Press Journal to ignore the information provided by people at the border. There have only been four cases of confirmed Mpoxen, he says.
Another challenge is that MPox tests are scarce, health workers at the border told GPJ. They work based on MPox-like symptoms that people show.
More than 7 million people in the Democratic Republic of Congo, a country of about 105 million people, are displaced, with many living in camps like Munigi, where Mwema is one of thousands of residents. It was created for people escaping violence between armed groups and the Democratic Republic of Congo’s formal military, which has resulted in killings and destruction of property with near or complete impunity. Social distancing in the camp is difficult. Raw sewage flows through troughs along streets and sidewalks. Since water is scarce, handwashing is a challenge. It is an ideal place for the emergence and spread of Mpoxen and other dangerous viruses.
While 35 countries around the world have reported MPox cases last month, the Democratic Republic of Congo is the most affected, accounting for an estimated 90% of all cases in Africa this year, according to the European Center for Disease Prevention and Control. According to a report by Save the Children, an international non-governmental organization, some health centers in the city of Goma are overwhelmed and patient admissions are rising 4,000% above their capacity.
Mwema and her family moved to Munigi a year ago from Rutshuru, a town about 70 kilometers northeast. Violent clashes between the notorious armed group M23 and the Congolese army, known by its French initials FARDC, forced her to flee her hometown.
The family found a fragile peace in the camp, but there was another danger: a highly infectious, potentially deadly virus that can only be prevented by avoiding infected people.
This has happened before. This is where a steady stream of viruses, infections and diseases have emerged or spread rapidly once they arrive. This includes Ebola, which has broken out more than a dozen times in recent decades. Deforestation and the spread of pathogens resulting from close contact between humans and wildlife are a reason for outbreaks. Another reason is serious armed conflicts that push people into overcrowded camps. Another reason is the ongoing shortage and delays in the delivery of vaccines. The burden on the fragile health system, which is already battered by other health emergencies and serious staffing and supply shortages, is immense. Overall, people in the Democratic Republic of Congo face an overwhelming risk of virus outbreaks.
Mpox occurs in two main tribes or clades. Clade I, which is endemic to central and eastern Africa and spreads through close contact in daily life, causes more severe disease. In previous outbreaks, about 10% of those infected died. Endemic to West Africa, Group II can also spread through close human or animal contact, but typically through sexual contact. It is also milder, with 99.9% of people surviving.
The current outbreak of the more dangerous Clade I comes after a global outbreak of Clade II in 2022.
Although Mpoxen belongs to the same family of viruses as smallpox, they are not nearly as deadly. But it presents other challenges.
The eradication of smallpox in 1980 was possible in part because the virus only infected humans. Animals were never part of the spread, says Jessica Malaty Rivera, an epidemiologist and senior advisor for science communication at the de Beaumont Foundation, a U.S.-based public health organization. Mpox, on the other hand, has a wide range of animal reservoirs.
“If MPoxen becomes something catastrophic like smallpox, which I hope it never does, they could never be eradicated because they also affect animals,” she says.
Along the border between the Democratic Republic of Congo and Uganda, the transition from clade II to clade I is clear, health workers say. Hellen Kabugho, a nurse at a CARE PLUS drugstore in Bwera, a border town in Uganda, says she has been seeing people with MPox symptoms for several months, but the situation has changed. While only two cases have been confirmed in the hospital in Bwera, more and more people are suspected of being infected with the virus.
Both strains can spread easily, says Kabugho. “We use the same latrines in the market, so it’s easy to get them.”
Borderline activity makes it difficult to track symptomatic individuals.
“Physical contact is common because there is a lot of pressure at the border and a lot of people coming and going,” she says. “We mix a lot.”
Health officials in Kampala, Uganda’s capital, downplayed the outbreak, telling the Global Press Journal that it was well under control. Health Ministry spokesperson Ainebyoona said a major public education campaign was effective in educating people on how to protect themselves from Mpoxen.
The initial fears of people in border towns about the virus have faded.
“People are still meeting here as usual,” says Mariam Mbabu, a nurse at the Haki Medical Center in Uganda, just across the border, adding that many don’t know how easily I get infected.
Rosaria Masika, a Congolese woman who has been in Uganda for three months, says she went to a hospital in Bwera for prenatal care in July. She told a health worker there that she had lesions on her body. Staff tested her and then sent her home to isolate.
There are no MPOX vaccines in Uganda yet, says Dr. Amon Bwambale, the district health officer for Kasese district on the border with the Democratic Republic of Congo. Once available, priority will be given to pregnant women, children and people with immunodeficiencies, he adds.
In the Democratic Republic of Congo, vaccination efforts may be wishful thinking. On August 14, the World Health Organization declared the MPOX outbreak a “public health emergency of international concern,” a move intended to free up resources to stop its spread. The government of the Democratic Republic of Congo has approved the use of MPOX vaccines, but they have not yet arrived.
The country has had difficulty delivering vaccines to those who need them in the past. According to CARE, a humanitarian aid organization, the Democratic Republic of Congo received millions of COVID-19 vaccine doses but returned 1.3 million of them in April 2021 because they could not get them where they needed to go. According to CARE, only 60% of COVID-19 vaccination sites in the Democratic Republic of Congo were operational.
The country’s experience with COVID-19 does not bode well for the Mpox outbreak, and health experts worldwide are watching the spread with concern.
“Such a cascade of Mpox is something we were afraid of,” says Malaty Rivera, “but it’s not that shocking.”
Meanwhile, Mwema and her family have nowhere to go. There are no signs that decades of conflict will end. The armed groups and the FARDC are known for their lack of concern for the people in the areas where they fight. For Mwema, there are not just a few safe options; They are practically non-existent. It will remain in storage for the time being and possibly for many years to come.
