GENEVA — U.N. agencies warn that refugees and displaced communities in the Democratic Republic of Congo and other African countries infected with mpox are at particular risk of illness and death because of conditions under which they are forced to live.

The World Health Organization says at least 42 suspected cases of mpox have been identified among the refugee population in DR Congo’s South Kivu Province, one of the regions hardest hit by the disease. Confirmed and suspected cases of the new clade 1b strain also have been recorded among refugee populations in the Republic of the Congo and Rwanda.

“Suspected cases are being reported in conflict-impacted provinces that host the majority of the DRC’s 7.3 million internally displaced people,” Dr. Allen Maina, UNHCR public health chief, said Tuesday.

“In these areas, the virus threatens to exacerbate an already impossible situation for a population devastated by decades of conflict, forced displacement, appalling human rights abuses and a lack of international assistance,” the U.N. refugee official said.

He also warned that without additional, urgent international support, the recently declared mpox outbreak “could become devastating” for the DRC and other impacted African countries.

Nearly two weeks ago, the WHO declared mpox to be a public health emergency of international concern following an upsurge in the deadly disease in the DRC and 11 other countries in Africa.

Maina told journalists at a briefing in Geneva that refugees and displaced people are particularly vulnerable to mpox because people fleeing violence “are unable to implement many of the mpox prevention measures” that could keep them healthy and save their lives.

“Displaced families living in crowded schools, shelters and tents, and also in churches, and also in farmers’ fields have no space to isolate when they develop symptoms of the disease. UNHCR staff have found some affected individuals trying diligently to follow preventive measures and protect their communities by sleeping outside,” he said.

So far this year, the WHO reports more than 18,910 cases of mpox and 615 deaths, most in the DRC. “But most of these are suspected cases as they have not yet been laboratory confirmed,” said Dr. Margaret Harris, WHO spokesperson, adding that “We are seeing outbreaks of both clade 1a and clade 1b.”

Clade 1a is primarily transmitted through sexual contact, and there also have been outbreaks resulting from zoonotic spillover; while the new strain of the virus, clade 1b, is exclusively spread by contact between humans.

The WHO says a lot of outbreaks in north and south Kivu provinces are caused by clade 1b. The U.N. health agency has recorded 5,400 suspected cases as of August 23, noting that more than 220 cases of the new strain also have been found in neighboring countries.

Harris says scientists do not have the data to know whether clade 1b is more dangerous than clade 1a.

“Studies are underway to understand the properties of the new strain. The available epidemiological data does not suggest that the clade 1b variant causes more severe cases as yet.” She noted, however, that the disease spreads rapidly, putting refugees and displaced people at particular risk.

“You just heard the descriptions of the conditions under which people are living and have arrived already very stressed, hungry, terrified, displaced,” she said.

These difficult living conditions have led to weaker immune systems, she said, “which makes them more likely to become more ill with anything they get, including mpox.”

Mpox is a deadly infection that causes flu-like symptoms and pus-filled lesions. It is spread through close physical contact, which makes children particularly vulnerable “as the disease spreads easily through skin-to-skin contact,” Harris said, adding that children who have close physical contact with an infected adult relative “cannot fight off the virus because of a weakened immune system.”

WHO Director-General Tedros Adhanom Ghebreyesus launched a six-month global strategic preparedness and response plan Monday to stop human-to-human transmission of mpox through global, regional and national efforts.

“The mpox outbreaks in the Democratic Republic of the Congo and neighboring countries can be controlled, and can be stopped,” Tedros said in a statement.

The WHO followed Monday’s launch with an $87.4 million appeal Tuesday to implement critical activities over the next six months, emphasizing surveillance, research, equitable access to medical countermeasures and community empowerment.

The WHO is calling on donors to urgently fund the mpox response “to prevent further spread and protect those most at risk.”

The UNHCRs public health chief, Maina, has no doubt as to who is most at risk and what must be done.

“International solidarity is urgently needed to expand health services, isolation centers, humanitarian shelters, access to water and soap for those forced to flee,” he said. “In conflict zones, peace is also desperately needed, to ensure a sustainable response to stop the spread of the disease.”
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