On the front lines of the fight to stop the spread

Egide Irambona, 40, sits shirtless on his hospital bed near the window in a treatment room he shares with two other men.

The rays of the setting sun, shining over Bujumbura, the capital of Burundi, filter inside. Her face, bathed in a soft light, is covered in blisters. Her chest too, her arms too.

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

Mr. Irambona has mpox.

He is one of 170 confirmed cases recorded since last month in Burundi. One of the poorest countries in the world, it borders the Democratic Republic of Congo, the epicentre of several recent outbreaks of mpox, which have caused at least 450 deaths and 14,000 suspected cases since the start of the year.

In Burundi, no deaths have been recorded and it is not yet known how deadly the current outbreak – of a new strain called Clade 1b – is, because there is insufficient capacity to test in affected areas.

However, the disease has been declared a global health emergency due to fears that it could spread rapidly to previously unaffected countries and regions.

This is Mr Irambona’s ninth day of treatment at King Khaled University Hospital. The virus is spread through close contact with an infected person, and he appears to have passed it on to his wife.

She is also supported in the same establishment.

“I had a friend who had blisters. I think he gave me the disease. I didn’t know it was MPOX. Fortunately, our seven children showed no signs of the disease,” Mr. Irambona says, his voice trailing off.

This Bujumbura hospital houses one of the city’s three MPOX treatment centers.

Fifty-nine of the 61 available beds are occupied by infected patients – a third are under 15 and, according to the World Health Organization, children are the age group most affected.

Odette Nsavyimana is the doctor in charge of the hospital and says the number of patients is increasing.

“We are now setting up tents outside.” There are three of them at the moment: one for triage, one to hold suspected cases and one to collect confirmed cases before they can be transferred to the wards.

“It’s hard, especially when babies come. They can’t stay alone, so I have to keep their mothers here too. Even if they don’t have any symptoms… It’s a very difficult situation,” says Dr. Nsavyimana, his voice muffled by his protective mask.

Burundi is currently experiencing an increase in MPOX cases.

“I am concerned about the numbers. If they continue to rise, we will not have the means to manage them.”

Extensive efforts are being made to isolate infected people from the rest of the hospital population. Administrative measures are in place everywhere and visitors, who must wear protective equipment, are physically distanced from infected people.

Medical officials are concerned about the lack of resources. There is only one laboratory in the country where blood samples can be tested for the virus, there are insufficient testing kits and there are no vaccines.

Maintaining hygiene conditions in Bujumbura is also challenging, as access to basic resources such as water is limited in the city. Running water is scarce and people are seen queuing at public taps.

Dr Liliane Nkengurutse, national director of the Public Health Emergency Operations Centre, says she is very concerned about the days ahead.

“It’s a real challenge. The fact that diagnosis is only carried out in one place delays the detection of new cases.

“Health centres call the laboratory saying they have suspected cases, but it takes time for the laboratory teams to deploy to where the suspected cases are to take samples.

“And it takes a lot longer to get the test results out. We need about $14m (£10.7m) to be able to at least take our response to the next level,” she said.

Despite rumors that vaccines would arrive in the DRC as early as next week, there are no reports of similar action in Burundi.

Public awareness of MPOX is limited.

Bujumbura is just 20 minutes from the border with the DRC and is a hub for cross-border travel and trade. But the risks of a possible outbreak are unknown.

The city is bustling with activity. People continue to buy and sell goods as usual. Handshakes, hugs and close contact are the norm. Long queues stretch at bus stations, and people jostle to board already crowded public transport vehicles.

“Many people don’t understand the seriousness of the problem. Even where there have been cases, people continue to mix,” says Dr Nkengurutse.

The BBC spoke to several people in Bujumbura and the majority of them did not know what MPOX was. And those who did were not aware that the disease was spreading in their country.

“I have heard of this disease but I have never seen anyone suffering from it. I have only seen it on social media,” one person said.

“I know it affects babies and young people. I’m scared, but that doesn’t mean I’m going to stay home. I have to work. My family has to eat,” said another.

Health professionals know that it can be difficult to persuade people to pay more attention to their health in a skeptical population facing many economic challenges.

But they will continue to treat patients, monitor their recovery and try to trace people they have been in contact with in order to contain the spread of the virus.