Children who suffer the most

The rapidly spreading poxvirus disease (MPOX) has been declared a Public Health Emergency of International Concern by the World Health Organization, with much of the spotlight focused on the Democratic Republic of Congo, which has been responsible for nearly all of the recorded cases this year and more than 450 deaths.

A BBC visit to a treatment centre in the east of the country found that children are the ones most affected by the potentially fatal disease.

“At first, it looked like small inflamed spots. When the mother pressed on them, a watery discharge came out. Then other spots appeared and after a while it spread all over his body,” Alan Matavaro told the outlet, describing how his six-year-old son Amani was infected with MPOX.

He began to recover after four days of treatment at a clinic in Munigi, near Goma, eastern Congo's main city.

Dr Pierre-Olivier Ngadjoul, who works at the charity Medel, says about 75% of the patients he sees are under the age of 10.

Young people appear to be particularly affected by the MPOX epidemic because their immune systems are less developed.

Dr Ngadjole also blames overcrowding in nearby camps set up for people displaced by conflict in the region. MPOX spreads in part through very close contact, with children “playing together all the time. They don't really care about social distancing,” he told the BBC.

“Even within households, we see people spending the night in the same bed. Sometimes there are three, four, five children. Transmission is a daily occurrence.”

The Munigi clinic provides free treatment for skin infections, including antibiotics, paracetamol and safe drinking water, and has treated 310 MPOX cases since June, with five to 10 new admissions every day.

No one in the country has died from the disease, and Dr Ngadjole believes that's because people seek help early.

“I think it's really important to provide free health care, especially in a situation like this…” [It] This means people do not face financial barriers and come to health facilities earlier.”

At the hospital in Kavumu, 80 kilometers (50 miles) southwest of Munigi, on the other side of Lake Kivu, it's a different story.

Since June, 800 patients have been seen there and eight have died – all under the age of five.

Two-year-old Ansima Kanigo contracted MPOX from one of her four siblings, all of whom had the disease.

Her mother, Njigire Kanigo, 35, had no idea what it was at first.

“This is the first time I've seen this. When my child got sick, other parents told me it might be measles, but I started treating him for measles but it didn't work, so I decided to come here.”

“May God bless the doctor who brought the medicine…3 [children] Both of them are now at home. We are the only two people in the hospital together. Thank God.”

The hospital's medical director, Dr. Robert Musore, said authorities should not underestimate the outbreak.

“The situation is really serious and we are very overwhelmed because our capacity is small and the demand is so high.

“The first challenge we face in this response is getting patients in. The second challenge is getting the medicines, and we don't have them.”

Across eastern DRC there are several camps for millions of people who have fled their homes as various rebel groups operate in the region.

People are often crammed into makeshift buildings and live in poor conditions with little sanitation – the perfect environment for MPOX to spread.

Health workers are visiting places such as Muja camp near Mount Nyiragongo to educate people on what to do if they notice symptoms, including limiting contact with others.

“This disease has brought with it great fear that we will all get it,” said Josephine Silangunza, who lives in the camp with her five children.

She says the government needs to distribute basic equipment to prevent the spread of the disease.

“When we see someone getting sick, it makes us worry about how to protect ourselves.”

Bosco Sebke, 52, a father of 10 children, echoed the sentiment.

“We have become sensitive [about mpox]”We are full of fear because it is crowded in the shelters. We are sleeping in very poor conditions, sharing bedding, so prevention is difficult and that's why we are afraid,” he says.

The outbreak in eastern Democratic Republic of the Congo is due to a new type of MPOX, called lineage 1b, which is now spreading to neighbouring countries.

Last week, the Congolese government said it expected vaccines from the United States and Japan to start arriving soon. Until then, the country is without any vaccines despite being the epicenter of the virus.

Amani's father, Matabalo, who is currently recovering from MPOX, said he is hopeful at the news that a vaccine may be on the way.

But distribution is extremely limited and, as Dr Ngadjole says, vaccination is only one aspect of curbing the spread of the virus.

” [easiest] The measure that needs to be implemented is improving hygiene. If you improve hygiene at the household level, improve hygiene at the community level, it's very easy to reduce the risk of infection.”

“Please tell our leaders to send us medicines, soap and other preventive measures so that we don't get infected,” Silangunza said, echoing the doctor's thoughts.