Mpox preys on people already sapped by war in DR Congo, MSF says

• Displaced Congolese unable to isolate, change clothes
• Migrants often excluded from national health policies
• Mpox could put spotlight on other DRC human rights issues

In packed camps in the Democratic Republic of Congo, people displaced by war have little to eat, nowhere to wash and little privacy, leaving them critically exposed to mpox, according to a Médecins Sans Frontières (Doctors without Borders) official.

The eastern DRC, where conflict has upended lives for decades, offers a clear case study of how mpox preys upon the most vulnerable, according to the relief agency.

"This displaced population comes from small rural villages - suddenly combatants arrive and they take what they can, and they flee," said Natalia Torrent, MSF head of mission for the eastern North Kivu province.

"They are extremely vulnerable because they have been fleeing for months," she told Context from her office in Goma, the capital of North Kivu.

"Fleeing means they have lost all economic capacity to generate an income ... everyone is in emergency mode."

Migrants, refugees and internally displaced people are more prone to mpox infection because of barriers to prevention and treatment, such as precarious living conditions, according to the U.N.'s International Organization for Migration (IOM).

This is evident in Goma, where there are around 750,000 displaced people, who fled their homes because of fighting between the Congolese army and the M23 rebel group.

Women in the camps are particularly vulnerable in a country that has become notorious for the use of sexual violence as a means of warfare, Torrent said.

"Women have to leave the camps to fetch food, exposing themselves to be attacked and sexually abused," she said.

The variant seen in this new mpox outbreak, known as clade Ib, appears to spread more easily through close contact, including sexual contact.

"There is a lot of what we call transactional sex happening because women are forced to have sex to get food and survive, and this is also worrying us," Torrent said.

Nowhere to isolate

Mpox, a viral infection that can spread through close contact is usually mild but can lead to death in some cases. It causes flu-like symptoms and pus-filled lesions on the body.

In August, the World Health Organization declared mpox a global public health emergency for the second time in two years, following an outbreak of the viral infection in DRC that has since spread around the world.

Africa has seen nearly 30,000 suspected mpox cases so far this year and more than 800 people have died, the World Health Organization said in late September.

In August, the IOM said the spread of mpox across the east, south and Horn of Africa was a particular concern for "the vulnerable migrant, highly mobile populations and displaced communities often overlooked in such crises". The region hosts 12.2 million international migrants – nearly half of all migrants in Africa, according to the IOM.

The first 100,000 vaccines arrived in DRC in early September as part of a European Union donation programme, but millions more are needed even as further donations roll in.

Torrent said the situation in the camps of eastern DRC highlighted the urgency of getting vaccines rapidly to these populations, who may be unable to take precautionary measures.

When treated quickly, mpox is not necessarily fatal. Patients are typically advised to isolate and change and clean their clothes while taking the necessary medication.

All of these instructions are hard to fulfill in the camps in Goma.

"So you see that you are giving some recommendations to your patients, but they cannot follow them because there is nowhere to isolate, they do not have a change of clothes and they cannot even shower," said Torrent.

Even when people are tested, they often have to wait for days for their results as laboratories have been overwhelmed by the number of people requiring tests.

This increases the risk that they will spread the infection in their crowded shelters, Torrent said.

Alongside free medical treatment, MSF provides water, new clothing and spaces to isolate for patients.

Torrent said that, in many ways, the mpox crisis reminded her of the COVID-19 pandemic in the way that it has spotlighted vaccine inequality, exposed challenges with isolating, revealed stigma around the virus and resulted in the poorest being left behind.

She still hopes this new outbreak will bring international attention to the ongoing conflict and suffering in the DRC.

"(The Congolese) deserve to have the chance to live the life that they want to live, and so far this is not the case."

(Reporting by Kim Harrisberg; Editing by Clár Ní Chonghaile and Ana Nicolaci da Costa.)