On the frontline of the fight to halt the spread

Egide Iranbona, 40, sits shirtless in a hospital bed next to the window in the treatment room he shares with two other men.

The light of the setting sun shining brightly over Bujumbura, Burundi’s main city, bathes his face in soft light and blisters cover his chest and arms.

“I had swollen lymph nodes in my throat. It was so painful I couldn’t sleep. Then the pain went away and the pain went into my legs,” he told the BBC.

Illambona has MPOX.

He is one of more than 170 confirmed cases in Burundi since last month. One of the world’s poorest countries, Burundi shares a border with the Democratic Republic of Congo, which has recently become the epicenter of multiple MPOX outbreaks that have killed at least 450 people and caused another 14,000 suspected cases so far this year.

No deaths have been recorded in Burundi and it is not yet clear how deadly the current outbreak – a new lineage called clade 1b – is because there are insufficient capacity to carry out testing in affected areas.

However, due to the risk of it spreading rapidly to previously unaffected countries and regions, it has been declared a global health emergency.

Iranbona is in his ninth day of treatment at King Khalid University Hospital. One of the ways the virus spreads is through close contact with an infected person, and it appears that Iranbona transmitted the virus to his wife.

She is also receiving care at the same facility.

“I had a friend who had blisters and I think I caught it from him. I didn’t know it was measles. Thankfully, our seven children have not shown any symptoms of measles,” Ilanbona said, lowering her voice.

The hospital in Bujumbura is one of three MPOX treatment centres in the city.

Of the 61 available beds, 59 are occupied by infected patients, a third of whom are under 15 years old – children are the hardest-affected age group here, according to the World Health Organization.

Odette Nsaviyimana, the hospital’s chief physician, said the number of cases was increasing.

“Right now we have tents set up outside,” he said. There are currently three tents: one for triage, one to hold suspected cases and one to hold confirmed cases before they are transferred to the ward.

“It is especially difficult when babies come. We cannot leave the baby alone so we have to keep the mother here too. Even if there are no symptoms… it is a very difficult situation,” said Dr Nsaviyimana, his voice muffled by a protective mask.

Burundi is currently experiencing a surge in MPOX cases.

“The numbers are worrying. If they continue to increase, we don’t have the capacity to cope.”

Great efforts are being made to isolate infected people from other patients in the hospital: there is bureaucracy everywhere, and visitors, who must wear protective gear, are physically distanced from infected people.

Medical workers are worried about limited resources: the country has just one lab that can take blood samples and test for the virus, there is a shortage of test kits and no vaccine.

Limited access to basic resources like water makes hygiene difficult in Bujumbura, where running water is in short supply and people can be seen queuing at public taps.

National director of the Public Health Emergency Operations Centre, Dr Lilian Nkenguletse, said she was extremely worried about the days ahead.

“This is a real challenge because diagnosis is only done in one place, which means new cases are being detected late.

“The health centres are informing the laboratories that there are suspected cases, but it takes time for the laboratory teams to travel to the suspected cases and take samples.”

“It will take longer to publish test results and we need around $14 million (£10.7 million) to at least take our response to the next level,” she said.

Despite talk of vaccines arriving in the Democratic Republic of Congo as early as next week, there are no reports of a similar move for Burundi.

Public awareness of mpox is limited.

Bujumbura is just 20 minutes from the border with the Democratic Republic of Congo, making it a cross-border travel and trade hub, yet it has not felt at risk of infection.

The streets are bustling with activity. People are still buying and selling. Handshakes, hugs and very close contact are the norm. Long lines form at bus stops and people fight to get onto already packed public transport.

“A lot of people don’t understand the magnitude of the problem. Even in places where there are cases, people are just interacting,” Dr Nkengulze said.

The BBC spoke to several people in Bujumbura but most didn’t know what MPOX was, and those who did were unaware it was widespread in their country.

“I’ve heard about the disease but I’ve never actually seen anyone suffering from it, only on social media,” one person said.

“I know it affects babies and young people. I’m scared, but that doesn’t mean I can stay locked up at home. I have to work and my family has to eat,” said another woman.

Healthcare workers acknowledge it may be tough to convince a skeptical public to pay more attention, especially in the face of many economic challenges.

But they will continue to treat patients, ensure they recover and work to trace those who have come into contact with them to stop the spread of the virus.