In Goma, DRC, many people I talked to seem to sense that something new, uncertain, and frightening is coming. But no one can predict what it will mean for them yet, or how deeply it will impact their lives.
Mpox is not new in DRC; it is endemic in several parts of the country, and has been on the rise for the past decade. However, in North and South Kivu, the virus has mutated into a form that seems to be more transmissible between humans, which is a significant concern, as cases have been reported in very densely populated areas like Goma—a city of 2 million people—and in sites where hundreds of thousands have sought refuge due to the ongoing armed crisis in North Kivu.
Although the lethality of this new strain remains limited, there is still reason to worry, because conditions necessary to prevent it from spreading in and around Goma are simply not in place, and the capacity to provide care for patients at risk of complications, like young children and people with advanced HIV, remains limited.
Two years into the M23 crisis, displaced people lack basic essentials
How can we expect families living in tiny shelters—without adequate water, sanitation facilities, or even soap—to implement preventive measures? How can malnourished children have the strength to ward off complications? And how can we expect this variant—which is notably transmitted through sexual contact—to not spread in displacement camps given dramatic levels of sexual violence and exploitation affecting girls and women living there?
MSF has repeatedly denounced the inhumane living conditions that people face in the camps, and the glaring gaps in the humanitarian response. More than two years after the escalation of the M23 crisis [a conflict between the armed group March 23 Movement, or M23, and the Congolese army and its allies] and the mass displacement it triggered, families living in the overcrowded camps still lack the essentials: food, water, safety, basic hygiene items, as well as access to sanitation and health care.
During a counseling session that I attended with survivors of rape, a woman told me she lives with her seven children under a plastic sheet. Her partner abandoned her after she was raped. For women like her, the tried-and-tested solutions to prevent the spread of the mpox epidemic are unimaginably difficult to implement. If she develops a rash due to mpox, she will be told to change her linens, wash everything thoroughly, disinfect her belongings, and isolate herself until she heals. But how can she wash without soap and with only a few liters of water available each day? How can she isolate herself and protect her children while living together under their minuscule plastic sheeting shelter? If she isolates, who will get food for the kids, collect firewood, or comfort the newborn?
Improving living conditions is a critical factor to fight outbreaks
For the survivor I met—and all those who have sought refuge in displacement camps—the mpox epidemic feels like just another challenge amid a torrent of problems—and frankly , not the most urgent one given the daily struggles they face, including outbreaks of other life-threatening diseases such as measles and cholera.
Mpox is there and needs to be tackled. To address this new, additional challenge, we need to make survival easier for people through a response that is tailored to their specific needs and real-life challenges. This starts by listening to people and providing them with basic supplies for infection control: water, soap, disinfectant, and sanitary installations. These are simple but essential. We cannot rely solely on the arrival of vaccines to fix the problem. Improving people’s living conditions is a critical factor in fighting such outbreaks.
Together with health authorities, our teams do their best to provide care and raise awareness for those living in the campss, as we do in other parts of the country affected by the outbreak. We hope that the long-awaited vaccines will arrive in the country as soon as possible. Yet, they will not be a magic bullet: governmental and non-governmental actors must also urgently address the foundations of the mpox response, which must be adapted to the needs and realities of the people.
