Congo's humanitarian crisis helped mpox spiral again into a global health emergency

GOMA, Congo (AP) — Sarah Bagheni had a headache, fever, and itchy and unusual skin lesions for days, but she had no inkling that her symptoms might have been caused by mpox and that she might be another case in a growing global health emergency.

She also has no idea where to go to get medical help.

She and her husband live in the Bulengo displacement camp in eastern Congo, a region that is effectively ground zero for a series of mpox outbreaks in Africa.

This year's alarming rise in cases, including a new form of the virus identified by scientists in eastern Congo, led the World Health Organization to declare it a global health emergency on Wednesday. It said the new variant could spread beyond the five African countries where it had already been detected — a timely warning that came a day before Sweden reported its first case of the new strain.

In the vast central African nation of Congo, which has had more than 96% of the world's roughly 17,000 recorded cases of mpox this year — and some 500 deaths from the disease — many of the most vulnerable seem unaware of its existence or the threat that it poses.

“We know nothing about this,” Bagheni’s husband, Habumuremyiza Hire, said Thursday about mpox. “I watch her condition helplessly because I don’t know what to do. We continue to share the same room.”

Millions are thought to be out of reach of medical help or advice in the conflict-torn east, where dozens of rebel groups have been fighting Congolese army forces for years over mineral-rich areas, causing a huge displacement crisis. Hundreds of thousands of people like Bagheni and her husband have been forced into overcrowded refugee camps around Goma, while more have taken refuge in the city.

Conditions in the camps are dire and medical facilities are almost nonexistent.

Mahoro Faustin, who runs the Bulengo camp, said that about three months ago, administrators first started noticing people in the camp exhibiting fever, body aches and chills — symptoms that could signal malaria, measles or mpox.

There is no way of knowing how many mpox cases there might be in Bulengo because of a lack of testing, he said. There haven't been any recent health campaigns to educate the tens of thousands of people in the camp about mpox, and Faustin said he's worried about how many people might be undiagnosed.

“Just look at the overcrowding here,” he said, pointing to a sea of ramshackle tents. “If nothing is done, we will all be infected here, or maybe we are already all infected.”

Around 70% of the new mpox cases in the Goma area in the last two months that were registered at a treatment center run by Medair were from displacement camps, said Dr. Pierre Olivier Ngadjole, the international aid group's health advisor in Congo. The youngest of those cases was a month-old baby and the oldest a 90-year-old, he said.

In severe cases of mpox, people can develop lesions on the face, hands, arms, chest and genitals. While the disease originated in animals, the virus has in recent years been spreading between people via close physical contact, including sex.

Bagheni's best hope of getting a diagnosis for her lesions is a government hospital that's a two-hour drive away. That's likely out of the question, given that she already struggles with mobility having previously had both her legs amputated.

Seven million people are internally displaced in Congo, with more than 5.5 million of them in the country's east, according the U.N. refugee agency. Congo has the largest displacement camp population in Africa, and one of the largest in the world.

The humanitarian crisis in eastern Congo has almost every possible complication when it comes to stopping an mpox outbreak, said Dr. Chris Beyrer, director of Duke University’s Global Health Institute.

That includes war, illicit mining industries that attract sex workers, transient populations near border regions, and entrenched poverty. He also said the global community missed multiple warning signs.

“We’re paying attention to it now, but mpox has been spreading since 2017 in Congo and Nigeria,” Beyrer said, adding that experts have long been calling for vaccines to be shared with Africa, but to little effect. He said the WHO’s emergency declaration was “late in coming,” with more than a dozen countries already affected.

Beyrer said that unlike COVID-19 or HIV, there’s a good vaccine and good treatments and diagnostics for mpox, but “the access issues are worse than ever” in places like eastern Congo.

In 2022, there were outbreaks in more than 70 countries around the world, including the United States, which led the WHO to also declare an emergency that lasted until mid-2023. It was largely shut down in wealthy countries within months through the use of vaccines and treatments, but few doses have been made available in Africa.

The new and possibly more infectious strain of mpox was first detected this year in a mining town in eastern Congo, about 450 kilometers (280 miles) south of Goma. It's unclear how much the new strain is to blame, but Congo is now enduring its worst outbreak yet and at least 13 African countries have recorded cases, four of them for the first time.

The outbreaks in those four countries — Burundi, Kenya, Rwanda and Uganda — have been linked to Congo's, and Doctors Without Borders said Friday that Congo's surge “threatens a major spread of the disease” to other countries.

Salim Abdool Karim, an infectious disease expert who chairs the Africa Centers for Disease Control and Prevention's emergency committee, said the Congo outbreak has a particularly concerning change, in that it's disproportionately affecting young people. Children under 15 account for 70% of cases and 85% of all deaths in the country, the Africa CDC reported.

Unlike the 2022 global outbreak, which predominantly affected gay and bisexual men, mpox now appears to be spreading in heterosexual populations.

All of Congo’s 26 provinces have recorded mpox cases, according to the state-run news agency. But Health Minister Samuel-Roger Kamba said Thursday that the country doesn't have a single vaccine dose yet and he pleaded for "vigilance in all directions from all Congolese.”

Dr. Rachel Maguru, who heads the multi-epidemic center at Goma's North Kivu provincial hospital, said they also don't have drugs or any established treatments for mpox and are relying on other experts such as dermatologists to help where they can. A larger outbreak around the city and its numerous displacement camps already overburdened with an influx of people would be “terrible,” she said.

She also noted a pivotal problem: poor and displaced people have other priorities, like earning enough money to eat and survive. Aid agencies and stretched local authorities are already wrestling with providing food, shelter and basic health care to the millions displaced, while also dealing with outbreaks of other diseases like cholera.

Asadu reported from Abuja, Nigeria. AP Medical Writer Maria Cheng in London contributed to this report.

The Associated Press receives financial support for global health and development coverage in Africa from the Bill & Melinda Gates Foundation Trust. The AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

Doctor Rachel Maguru does rounds at the general hospital in Goma, Democratic Republic of Congo, Wednesday, Aug. 14, 2024 after the World Health Organization declared the mpox outbreaks in Congo and elsewhere in Africa a global emergency. (AP Photo/Moses Sawasawa)

FILE - Family nurse practitioner Carol Ramsubhag-Carela prepares a syringe with the Mpox vaccine before inoculating a patient at a vaccinations site on, Aug. 30, 2022, in the Brooklyn borough of New York. (AP Photo/Jeenah Moon, File)

FILE - This undated image provided by the National Institute of Allergy and Infectious Diseases shows a colorized transmission electron micrograph of monkeypox particles (red) found within an infected cell (blue), cultured in the laboratory that was captured and color-enhanced at the NIAID Integrated Research Facility in Fort Detrick, Md. (NIAID via AP, File)

This photo supplied by MSF (Doctors Without Borders) dated May 31, 2023, shows health workers educating children on the symptoms of the mpox disease in Goma, Congo. (Augustin Mudiayi/Doctors Without Borders/Médecins Sans Frontières via AP)

Medical staff talk to each other at the general hospital in Goma, Democratic Republic Of Congo, Wednesday, Aug. 14, 2024 after the World Health Organization declared the mpox outbreaks in Congo and elsewhere in Africa a global emergency. (AP Photo/Moses Sawasawa)

A poster bringing attention to the mpox outbreak hangs at the Goma General Hospital, Democratic Republic of the Congo, Tuesday, July 16, 2024. (AP Photo/Moses Sawasawa)

A health worker attends to Lucie Habimana, 13, a mpox patient, at a treatment centre in Munigi, eastern Congo, Friday, Aug. 16, 2024. (AP Photo/Moses Sawasawa)

Sarah Bagheni, in the Bulengo refugee camp in Goma, Congo, suspects she may be infected with Mpox after the World Health Organization had declared Thursday, Aug, 15, 2024, the increasing spread of mpox in Africa a global health emergency, warning the virus might ultimately spill across international borders. (AP Photo/Moses Sawasawa)

Sarah Bagheni, center back, in the Bulengo refugee camp in Goma, Congo, suspects she may be infected with Mpox after the World Health Organization had declared Thursday, Aug, 15, 2024, the increasing spread of mpox in Africa a global health emergency warning the virus might ultimately spill across international border. (AP Photo/Moses Sawasawa)

A child plays in the Bulengo refugee camp in Goma, Congo, after the World Health Organization had declared Thursday, Aug, 15, 2024, the increasing spread of mpox in Africa a global health emergency, warning the virus might ultimately spill across international borders. (AP Photo/Moses Sawasawa)

Faustin Mahoro, head of the Bulengo refugee camp in Goma, Congo, speaks with Sarah Bagheni after the World Health Organization had declared Thursday, Aug, 15, 2024, the increasing spread of mpox in Africa a global health emergency, warning the virus might ultimately spill across international border. (AP Photo/Moses Sawasawa)

Women walk in the Bulengo refugee camp in Goma, Congo, after the World Health Organization had declared Thursday, Aug, 15, 2024, the increasing spread of mpox in Africa a global health emergency, warning the virus might ultimately spill across international borders. (AP Photo/Moses Sawasawa)

FILE - An unidentified man infected with mpox at the Goma General Hospital, Democratic Republic of the Congo, on July 16, 2024 where he continues treatment. The World Health Organization declared the mpox outbreaks in Congo and elsewhere in Africa a global emergency on Wednesday, aug. 14, 2024, with cases confirmed among children and adults in more than a dozen countries and a new form of the virus spreading. Few vaccine doses are available on the continent. (AP Photo/Moses Sawasawa)

Health workers attend to Lucie Habimana, 13, a mpox patient, at a treatment centre in Munigi, eastern Congo, Friday, Aug. 16, 2024. (AP Photo/Moses Sawasawa)

A health worker takes a saliva sample from Lucie Habimana, 13, a mpox patient, at a treatment centre in Munigi, eastern Congo, Friday, Aug. 16, 2024. (AP Photo/Moses Sawasawa)

Sarah Bagheni, in the Bulengo refugee camp in Goma, Congo, suspects she may be infected with Mpox after the World Health Organization had declared Thursday, Aug, 15, 2024, the increasing spread of mpox in Africa a global health emergency, warning the virus might ultimately spill across international borders. (AP Photo/Moses Sawasawa)

Congo's humanitarian crisis helped mpox spiral again into a global health emergency

Sarah Bagheni, in the Bulengo refugee camp in Goma, Congo, suspects she may be infected with Mpox after the World Health Organization had declared Thursday, Aug, 15, 2024, the increasing spread of mpox in Africa a global health emergency, warning the virus might ultimately spill across international borders. (AP Photo/Moses Sawasawa)

Congo's humanitarian crisis helped mpox spiral again into a global health emergency

KYIV, Ukraine (AP) — U.S. Secretary of State Antony Blinken announced more than $700 million in aid for Ukraine Wednesday during a visit to Kyiv, aiming to bolster the energy grid that Russia has repeatedly pounded ahead of an expected difficult winter.

At a news conference with Ukrainian Foreign Minister Andrii Sybiha and British Foreign Secretary David Lammy, Blinken said the assistance also would provide humanitarian support and pay for demining operations.

The $325 million in energy support in the package will help repair and restore Ukraine’s power generation facilities, provide emergency backup power and strengthen the physical security of energy infrastructure.

Some $290 million will fund food, water, shelter, health care and education programs for Ukrainians in need in the country and refugees outside the country. The remaining $102 million will be used for mine-removal activities.

Late last week, the U.S. announced it was sending $250 million more in weapons to Ukraine, including air defense missiles and artillery.

THIS IS A BREAKING NEWS UPDATE. AP’s earlier story follows below.

KYIV, Ukraine (AP) — The top U.S. and British diplomats traveled together to the Ukrainian capital Wednesday to underscore their commitment to the country in its war with Russia, and Ukrainian officials pressured the visitors to let them use Western-provided long-range missiles against targets inside Russia.

The rare joint visit by U.S. Secretary of State Antony Blinken and British Foreign Secretary David Lammy unfolded as Russia’s bigger and better-equipped army bears down on Ukraine’s eastern Donetsk region and pounds the country with missiles, glide bombs and drones that claim many civilian casualties.

Lammy said the 2 1/2-year conflict is at a “critical” juncture following Ukraine's daring incursion last month into Russia’s Kursk region, even as it tries to defend against its neighbor’s aerial attacks on cities across the country.

"We convey the deepest condolences for the shocking attacks that we have seen, over the loss of civilian life, particularly women and children — horrific, barbaric, unbelievable,” Lammy said.

He noted that Britain is setting aside 3 billion pounds ($3.9 billion) a year to help Ukraine.

But relations between Ukraine and its Western partners have been increasingly strained by Kyiv’s repeated appeals for the West’s authorization to use long-range weapons from the United States and other allies to strike targets deeper inside Russia.

That issue has become more urgent given Russia’s latest reported acquisition of ballistic missiles from Iran, but Western leaders have balked at the request, fearing that, if granted, it could escalate the war.

U.S. President Joe Biden has allowed Ukraine to fire U.S.-provided missiles across the border into Russia in self-defense, but has largely limited the distance they can be fired.

Ukrainian President Volodymyr Zelenskyy said he hoped for changes to those limitations.

“Let’s count on some strong decisions, at least,” he said. “For us, it’s very important.”

He said he hoped to speak to Biden later this month, noting that U.S. military and financial support is crucial.

“We rely heavily on it, and frankly, we can’t prevail without it,” Zelenskyy said.

However, U.S. Defense Secretary Lloyd Austin last week pushed back on the idea that long-range strikes would be a game-changer.

“I don’t believe one capability is going to be decisive, and I stand by that comment,” Austin said at a meeting of allied military leaders in Germany. The Ukrainians have other means to strike long-range targets, he added.

Ukrainian Prime Minister Denys Shmyhal told Lammy he hoped an agreement on using long-range assets “for strikes on the territory of our enemy” could be reached. “We hope for your help and support in this issue.”

Shmyhal described the meeting with Lammy in Kyiv as “intense” but gave no other details in his post on his Telegram channel.

A hard winter likely lies ahead for Ukraine. Its power grid is under severe strain after Russian missiles and drones knocked out around 70% of the country’s generation capacity.

Kyiv officials will also have to navigate the outcome of the U.S. election in November, which could produce important policy shifts in Washington. Former President Donald Trump said in a presidential debate Tuesday that he wants the war to end but did not clearly say he wants Ukraine to win.

The top U.S. and British diplomats reached the Ukrainian capital by train from Poland.

Blinken traveled from London, where he accused Iran of providing Russia with Fath-360 short-range ballistic missiles, calling the move a “dramatic escalation” of the war.

Referring to those missiles, Shmyhal added: “Russia’s use of weapons from its terrorist allies to strike at Ukraine continues their genocidal war and terrorism on our territory. We must be able to respond to such terrorism in kind by destroying military targets on their territory to ensure greater safety for our citizens.”

Wednesday’s visit came ahead of British Prime Minister Keir Starmer’s planned trip to Washington, where he will meet Biden at the White House on Friday. Ukraine's request for permission to strike Russian targets is due to feature in the discussion.

The visit was, unusually, announced in advance — a public signal of American and British support for Ukraine.

As Blinken and Lammy arrived in Kyiv, the U.K. announced it would ban 10 commercial ships it accuses of illicitly transporting Russian oil in violation of international sanctions. The U.K. government said the vessels would be barred from British ports and could be detained if they enter.

Associated Press writers Jill Lawless in London and Derek Gatopoulos in Kyiv contributed to this report.

Follow AP’s coverage of the war in Ukraine at https://apnews.com/hub/russia-ukraine

On the podium from left, Deputy Chairman of the Mejlis of the Crimean Tatar Nariman Dzhelyal, British Foreign Secretary David Lammy, Foreign Minister of Ukraine Andrii Sybiha, Head of the Office of the President of Ukraine Andriy Yermak, President of Lithuania Gitanas Nauseda, President of Ukraine Volodymyr Zelenskyy, Prime Minister of Croatia Andrej Plenkovic, and the Chairman of the Verkhovna Rada of Ukraine, Ruslan Stefanchuk attend the Fourth Crimea Platform Leaders Summit in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (Leon Neal/Pool via AP)

Front from left, US Secretary of State, Antony Blinken, Deputy Chairman of the Mejlis of the Crimean Tatar Nariman Dzhelyal and British Foreign Secretary David Lammy attend the Fourth Crimea Platform Leaders Summit in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (Leon Neal/Pool via AP)

U.S. Secretary of State Antony Blinken and British Foreign Secretary David Lammy arrive at the train station in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (AP Photo/Mark Schiefelbein, Pool)

U. S. Secretary of State Antony Blinken speaks with chef Yevhen Klopotenko as he visits a restaurant in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (AP Photo/Mark Schiefelbein, Pool)

US Secretary of State Antony Blinken, left, listens as UK Foreign Secretary David Lammy, right, speaks during the Fourth Crimea Platform Leaders Summit in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (Leon Neal/Pool via AP)

U.S. Secretary of State Antony Blinken and British Foreign Secretary David Lammy arrive at the train station in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (AP Photo/Mark Schiefelbein, Pool)

U.S. Secretary of State Antony Blinken, left, and Britain's Foreign Secretary David Lammy meet with Ukraine's Foreign Minister Andriiy Sybiha at the Ministry of Foreign Affairs in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (AP Photo/Mark Schiefelbein, Pool)

U.S. Secretary of State Antony Blinken, left, and Britain's Foreign Secretary David Lammy meet with Ukraine's Foreign Minister Andriiy Sybiha at the Ministry of Foreign Affairs in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (AP Photo/Mark Schiefelbein, Pool)

U.S. Secretary of State Antony Blinken, left, and Britain's Foreign Secretary David Lammy meet with Ukraine's Foreign Minister Andriiy Sybiha at the Ministry of Foreign Affairs in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (AP Photo/Mark Schiefelbein, Pool)

UK Foreign Secretary David Lammy attends a bilateral meeting with Ukrainian Prime Minister Denys Shmyhal (not pictured) and other officials Wednesday, Sept. 11, 2024 in Kyiv, Ukraine. The British Foreign Secretary joined his American counterpart on a visit to Ukraine to discuss the country's military needs in its fight against Russia. (Leon Neal/Pool via AP)

UK Foreign Secretary David Lammy attends a bilateral meeting with Ukrainian Prime Minister Denys Shmyhal (not pictured) and other officials Wednesday, Sept. 11, 2024 in Kyiv, Ukraine. The British Foreign Secretary joined his American counterpart on a visit to Ukraine to discuss the country's military needs in its fight against Russia. (Leon Neal/Pool via AP)

UK Foreign Secretary David Lammy attends a bilateral meeting with Ukrainian Prime Minister Denys Shmyhal Wednesday, Sept. 11, 2024 in Kyiv, Ukraine. The British Foreign Secretary joined his American counterpart on a visit to Ukraine to discuss the country's military needs in its fight against Russia. (Leon Neal/Pool via AP)

U.S. Secretary of State Antony Blinken is greeted as he arrives at the train station in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (AP Photo/Mark Schiefelbein, Pool)

British Foreign Secretary David Lammy, right. and US Secretary of State, Anthony Blinken arrive at Kyiv train station Wednesday, Sept. 11, 2024 in Kyiv, Ukraine. The British Foreign Secretary joined his American counterpart on a visit to Ukraine to discuss the country's military needs in its fight against Russia. (Leon Neal/Pool via AP)

U.S. Secretary of State Antony Blinken and British Foreign Secretary David Lammy arrive at the train station in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (AP Photo/Mark Schiefelbein, Pool)

U.S. Secretary of State Antony Blinken and British Foreign Secretary David Lammy are greeted as they arrive at the train station in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (AP Photo/Mark Schiefelbein, Pool)

U.S. Secretary of State Antony Blinken and British Foreign Secretary David Lammy arrive at the train station in Kyiv, Ukraine, Wednesday, Sept. 11, 2024. (AP Photo/Mark Schiefelbein, Pool)

British Foreign Secretary David Lammy, left, and U.S. Secretary of State Antony Blinken board a train at Przemysl train station in Poland Wednesday, Sept. 11, 2024 as they prepare to travel to Ukraine. (Leon Neal/Pool Photo via AP)

British Foreign Secretary David Lammy, front left, and U.S. Secretary of State Antony Blinken board a train at Przemysl train station in Poland Wednesday, Sept. 11, 2024 as they prepare to travel to Ukraine. (Leon Neal/Pool Photo via AP)

British Foreign Secretary David Lammy, front left, and U.S. Secretary of State Antony Blinken board a train at Przemysl train station in Poland Wednesday, Sept. 11, 2024 as they prepare to travel to Ukraine. (Leon Neal/Pool Photo via AP)