Businesswoman Mary Malisi crosses the border regularly for work. The Kenyan hotel owner buys grain from markets in Uganda for use in her establishment back home in the border town of Malaba.
On both sides of the Kenya-Uganda border, Malaba – which shares one name – is bustling and vibrant, filled with people of different cultures and nationalities constantly passing through.
Malaba is a one-stop border post which clears more than 2,000 trucks every day, making it the busiest transit route among East African countries.
On the Ugandan side, there is also the Malaba river which marks another busy crossing point between the neighbours.
On August 14, when a new strain of the mpox virus known as Clade 1b was declared a global health emergency by the World Health Organization (WHO), Malisi and others who travel frequently became worried.
Just recently, a first case was recorded on this border.
A truck driver had travelled from the Democratic Republic of the Congo – where the outbreak emerged – through to Uganda, on to the Kenyan coastal city of Mombasa. He then travelled back using the same route and fell sick on arrival in Uganda. He has since recovered.
Health officials in Kenya and Uganda say they have increased surveillance along their borders. Malisi has noticed the changes.
“We are directed to hand washing points on arrival in both countries. When I come back to Kenya, I have to be tested. Some people are taken for further examinations by health officials when they present some symptoms,” she told Al Jazeera.
Such screenings are not new to this region and were also enforced during the COVID-19 pandemic.
So Malisi knows the drill: temperate checks for fever and rapid tests – and she is glad for it.
The Clade 1b variant of mpox has infected more than 19,000 people so far, mostly in the DRC but also in neighbouring Burundi, Rwanda, Uganda and Kenya. These countries had never reported cases of mpox before now.
More than 500 people in DRC have died from mpox since last year, health authorities there said.
‘A lot of crises’
The DRC faced an outbreak in 2023. Doctors treating patients say Clade 1b, the new mutation, is spreading rapidly and is far more dangerous.
The first case of this new strain was traced back to a gold mining area of Kamituga in South Kivu province.
It’s a town filled with artisanal miners from across the region, including Uganda, Rwanda and Burundi. They often use informal crossings to get to their destinations.
Mpox is transmitted through close contact, including sex and skin-to-skin touch, as well as talking or breathing close to another person or touching contaminated objects. The disease has been endemic in DRC for decades. It causes flu-like symptoms and pus-filled lesions and can be lethal.
Dr Pierre Olivier works for Medair, a medical aid agency that runs a treatment centre in North Kivu’s capital, Goma.
He has dealt with an Ebola outbreak that killed more than 2,000 people in 2022 (it was not the first Ebola outbreak in the country); COVID-19; measles and cholera, which health workers are still struggling to contain.
“It’s a lot of crises for a country that has few resources,” he told Al Jazeera.
“We are not only trying to manage the spread of the [mpox] disease but the stigma that is now being associated with it because of a link to sexual contact, especially in South Kivu. Some people are reluctant to come to hospital, they’d rather look for traditional herbs and other local remedies. By the time they seek help, it’s more difficult to treat them.”
Medical teams in South and North Kivu provinces say the situation there is complicated by security challenges.
An armed group called M23, which began fighting the Congolese army in 2012, saw a resurgence two years ago and has since been fighting to gain territory in eastern DRC. M23, which is among 100 armed groups in the mineral-rich nation, has taken large swaths of territory in Masisi and Rutchuru territories since 2022.
Security analysts say the group’s threat to the DRC’s sovereignty is compounded by its alleged ties with Rwanda – a claim Kigali denies.
The Congolese army, a multinational force from the Southern African Development Community (SADC) and a United Nations peacekeeping mission have, meanwhile, struggled to bring peace.
Authorities say some seven million Congolese are displaced across the country; the latest round of fighting has displaced about two million in the east. Most are now sheltering in overcrowded tents with little food, water or proper medical care and sanitation.
Ayona Munyakazia, his wife and six children are among those displaced by conflict. They fled from their home in 2023 and are living in the Muja displacement camp in Goma.
“We are afraid of the disease. We normally go to the forest to look for food for the children. But now we are told by health officials we should avoid going to the forest or we might bring the disease. They tell us to avoid touching each other, but how can we when so many of us are sharing tent space?” he said.
Olivier and his team share similar frustrations to those they are trying to help.
“The situation in the camps festers the disease. People cannot keep personal distance, they struggle to find adequate water which is crucial. The camp where I am is north of Lake Kivu, so the displaced can’t access the lake. Water has to be tracked and rationed so hand washing becomes a luxury for many.”
Vaccine delays
More than 10 African countries have recorded cases of the disease, with infections traced in all 26 provinces in DRC.
The scale of transmission outside DRC is limited for now, but health experts are concerned that the situation could become a crisis for the entire continent if health measures in individual countries are not taken seriously.
Burundi has recorded the second highest number of infections with cases detected in 26 of 49 districts.
Dr Liliane Nkengurutse is the director of Burundi’s public health emergency department.
“It’s a new disease, so even the health staff don’t have enough knowledge about it. There needs to be a lot of awareness. We are in the process of training community health workers who play an important role in detection and tracing the disease. We want our citizens to go to any health facility when they get the symptoms. The treatment is free,” she said.
The WHO is expected to deploy the first batch of vaccines but it’s not clear when. The process has been slow and bureaucratic. Meanwhile Nigeria – which has recorded 40 mpox cases but could have several hundred – received 10,000 doses donated by the United States, making the first African country to get the jab.
Dr Samoel Ashimosi Khamadi is the director of virus research at the Kenya Medical Research Institute (KEMRI).
“We feel this outbreak is not receiving the attention it deserves,” he told Al Jazeera.
“From our experience with COVID-19, we learnt that vaccines are very important in preventing the spread of the virus. Since the epicentre of the virus is in Central and West Africa, especially DRC, we would expect more focus there and a quick rollout of the doses.”
Half a dozen scientists in Africa, Europe and the United States told Reuters agency that the virus is changing more quickly than expected and often in areas where experts lack the funding and equipment to properly track it.
At the same time, there are many unknowns about the virus itself, its potency, its transmission – all of these complicating the response.
“We can and must tackle mpox together across regions and continents by putting systems in place to control and eliminate mpox globally or we will enter another cycle of panic and neglect,” said Hans Kluge, the WHO regional director for Europe.
“How we respond now, and in the years to come will prove a critical test for Europe and the world.”
Back at the Kenya-Uganda border, Malisi has made another trip to the market in Uganda. She says the prices there are cheaper, so it is worth the trip.
The border region is still bustling, with life continuing as normal despite fears about the disease. But it is on people’s minds, with more discussions turning to mpox these days – as many wonder how to protect themselves and their families, waiting for the tide of another outbreak to turn.
