Sarah Bagheni had been suffering from headaches, fever, itching and unusual skin lesions for several days, but had no idea that her symptoms could be caused by ampox and that she could be another case in a growing global health emergency.
He doesn’t even know where to go to get medical help.
She and her husband live in the Bulengo displacement camp in eastern Congo, an area that is effectively the focal point for a series of ampox outbreaks in Africa.
An alarming surge in cases this year, including a new variant of the virus identified by scientists in eastern Congo, prompted the World Health Organization to declare it a global health emergency on Wednesday. It said the new variant could spread beyond the five African countries where it has already been identified – a timely warning that came a day before the first case of the new strain was reported in Sweden.
In the vast central African country of Congo, where more than 96% of the world’s nearly 17,000 recorded cases of ampox have occurred this year – and nearly 500 people have died from the disease – most of the most vulnerable people there appear to be unaware of its existence or the threat it poses.
“We don’t know anything about it,” Bagheni’s husband, Habumuremiza Hire, said of the Mpox on Thursday. “I watch her condition helplessly because I don’t know what to do. We live in the same room.”
Millions are believed to be out of reach of medical aid or advice in the conflict-torn eastern region, where dozens of rebel groups have been fighting Congolese army forces for years over mineral-rich areas, triggering a huge displacement crisis. Millions of people like Bagheni and her husband have been forced to live in overcrowded refugee camps around Goma, while more have taken refuge in the city.
Conditions in the camps are poor and medical facilities are almost nonexistent.
Mahoro Faustin, who runs the Bulengo camp, said that about three months ago, administrators noticed people at the camp experiencing fever, body aches and chills — symptoms that could be signs of malaria, measles or ampox.
He said there was no way to know how many Mpox cases there might be in Bulengo because of a lack of testing. There have been no recent health campaigns to educate the thousands of people in the camp about Mpox, and Faustin said he was concerned about how many people may have gone undiagnosed.
“Look at the crowding here,” he said, pointing to a pile of ramshackle tents. “If nothing is done, we will all get infected here, or maybe we all already are.”
About 70% of the new Mpox cases registered at a Medair-run treatment center in the Goma region over the past two months were from displacement camps, said Dr. Pierre Olivier Ngadjole, a health adviser for the international aid group in Congo. He said the youngest case was a one-month-old baby and the oldest was 90 years old.
In severe cases of ampox, people may develop lesions on their face, hands, arms, chest, and genitals. Although the disease originated in animals, in recent years the virus has been spreading between people through close physical contact, including sexual contact.
Bagheni’s best hope of getting her wounds treated is at a government hospital, a two-hour drive away. That’s probably impossible, as she already has difficulty walking since both her legs have already been amputated.
According to the UN refugee agency, 7 million people are internally displaced in Congo, more than 5.5 million of them in the eastern part of the country. Congo has the largest number of displaced people camps in Africa and one of the largest in the world.
The humanitarian crisis in eastern Congo presents nearly every conceivable possibility for preventing an ampox outbreak, said Dr. Chris Beyrer, director of Duke University’s Global Health Institute.
This includes war, illegal mining industries that attract sex workers, floating populations near border areas, and deep poverty. He also said the global community has ignored many warning signs.
“We are paying attention to it now, but ampox has been spreading in Congo and Nigeria since 2017,” Beyrer said. He said experts have long called for vaccine sharing with Africa, but this has not had much effect. He said the WHO emergency declaration was “late coming” because more than a dozen countries have already been affected.
Unlike COVID-19 or HIV, there is a good vaccine and good treatments and diagnostics available for ampox, but in places like eastern Congo “access problems are worse than ever,” Beyrer said.
In 2022, outbreaks occurred in more than 70 countries around the world, including the United States, leading the WHO to also declare an emergency lasting until mid-2023. It was largely contained in rich countries in a matter of months through the use of vaccines and treatments, but few doses have been made available in Africa.
The new and possibly more contagious strain of ampox was first detected this year in a mining town in eastern Congo, about 450 kilometers (280 miles) south of Goma. It is unclear how much of the new strain is to blame, but Congo is suffering its worst outbreak so far and cases have been reported in at least 13 African countries, including four for the first time.
Outbreaks in four countries – Burundi, Kenya, Rwanda and Uganda – have been linked to Congo, and Doctors Without Borders said on Friday that a surge in cases in Congo “puts other countries at risk of a massive outbreak of the disease.”
Infectious disease expert Salim Abdool Karim, who chairs the Africa Centres for Disease Control and Prevention’s emergency committee, said the dynamics of the pandemic in Congo are particularly worrying because it is disproportionately affecting young people. The Africa CDC reported that children under the age of 15 in the country account for 70% of cases and 85% of deaths.
Unlike the 2022 global outbreak, which mainly affected gay and bisexual men, ampox now appears to be spreading to heterosexual populations.
Cases of ampox have been reported in all of Congo’s 26 provinces, according to the state news agency. But Health Minister Samuel-Roger Kamba said on Thursday that the country did not yet have a single dose of the vaccine and urged “all Congolese to remain vigilant in all directions.”
Dr. Rachel Maguru, who heads the multi-epidemic centre at the North Kivu provincial hospital in Goma, said they also have no medicines or any established treatment for ampox and rely on other specialists, such as dermatologists, to help where they can. A major outbreak around the city and its many displacement camps, already burdened by an influx of people, would be “catastrophic,” she said.
They also noted a critical problem: poor and displaced people have other priorities, such as earning enough money to eat and survive. Aid agencies and stretched local authorities are already struggling to provide food, shelter and basic healthcare to millions of displaced people, as well as to combat outbreaks of other diseases such as cholera.