The outbreak of a new and dangerous strain of mpox in the eastern Democratic Republic of Congo has now spread to Goma, eastern DRC’s largest city with 25 cases reported, mostly in the city’s displaced persons camps, WHO officials confirmed on Thursday. 

And with person-to-person transmission occurring, particularly within communities on the move after fleeing attacks by Congo’s M23 rebel forces, there is a rising risk of cross border spread of the new strain, WHO officials warned at a press conference Thursday. 

The wide-ranging WHO press briefing also touched upon half a dozen other health emergencies and threats, including the soaring worldwide rate of dengue virus cases and evidence of an ever-widening outbreak of H5N1 avian flu amongst dairy cattle in the United States. 

WHO Director General Dr Tedros Adhanom Ghebreyesus also touched upon the continuing toll of war in Sudan; Gaza and Ukraine, including the recent Russian bombing of a children’s hospital in Kiev and Israel’s recent order to Gaza City Palestinian residents to move southward again in a grinding war against Hamas that just entered its ninth month. 

Goma cases could fuel more cross-border infections

In the case of DRC’s mpox outbreak, the risk of cross border infection is growing, insofar as Goma sits astride a busy transport hub, right alongside the border with Rwanda. 

“There is a risk of cross border infection as the virus continues to move because the  borders are very porous with neighboring countries – Rwanda, Burundi, even perhaps Uganda. There’s clearly a lot of population movements across those borders,” said WHO mpox specialist Dr Rosamund Lewis. 

“Large scale population movements, internally displaced population movements, insecure settings – these all bring associated risks, but also the facts that not all cases are reported, not necessarily detected.   

“The strain that is transmitting, so far, is exclusively person-to-person,” she added, ruling out any connection between the new outbreak and animal hosts that historically harboured the disease in the wild. “It is largely through sexual contact, initially, including amongst sex workers, and increasingly in the community.”

WHO working to expand access to diagnostics and, eventually, immunization

She said that comparatively high rates of laboratory testing of cases confirms that the dominant mpox strain being transmitted is part of the more severe Clade 1 family of mpox virus – which has up to a 10% fatality rate. 

However, in the case of the new strain, many people still experience only mild symptoms, which then pass under the wire of detection.

“The proportion of cases that are laboratory confirmed is very high, and the proportion of those that are tested that turned out to be Clade 1 mpox is also very high. So we’re confident in the data that we’re seeing and need to continue to support the Ministry of Health for a robust response in that region.” 

Current efforts are focused mostly on expanding diagnosis and treatment, she said.  Although the DRC recently approved the emergency use of mpox vaccines, rollout has yet to begun – and Lewis provided no strategy or timeline for how and when the vaccines might eventually be deployed. 

Largest ever mpox outbreak in DRC

Congo has seen 20,000 cases and more than 1,000 deaths from mpox since the start of 2023, according to WHO and national Congolese authorities – the largest ever mpox outbreak to be recorded. 

“More than 11,000 cases have been reported this year and 445 deaths, with children the most affected,” said WHO’s Director General Dr Tedros, speaking at the briefing. 

He noted that South Africa, as well, has recently reported 20 cases of mpox to WHO, including three deaths – the first cases seen in the country since 2022. 

“The cases were all men and most self-identified as men who have sex with men. None had reported any history of international travel, which suggests that the confirmed cases are a small proportion of all cases, and that community transmission is ongoing,” Dr Tedros said. 

As with DRC, WHO is supporting South Africa to respond to the outbreak, to engage the affected communities and to develop immunization strategies, he said.

Regional conflicts fueling more hunger, disease and despair 

In terms of conflict related emergencies, WHO officials said it was providing medical supplies to Ukrainian hospitals that are receiving children evacuated from a Children’s hospital in Kiev on Monday, just minutes before a large part of the complex took a direct hit – apparently from a Russian missile, according to the UN.  

WHO was also assessing damage to medical equipment at the Okhmatdyt hospital, where the intensive care, oncology and surgery wards were most heavily damaged.  

More than 600 children were in the hospital just before the missile struck. A rapid evacuation meant that only two people, including one child, were killed – despite massive infrastructure damage to what is the largest children’s hospital in the country. 

In Sudan, meanwhile, the number of displaced people has now grown to 12.7 million including 10.5 million internally displaced and 2.2 million who have sought refuge in neighboring countries. 

At the same time, “access to health services continues to be severely constrained due to insecurity and shortages of medicines, medical supplies and health workers.  Almost 15 million people need urgent health assistance,” said Tedros adding that “the risk of famine is growing with more than half of Sudan’s populations facing crisis levels of food security or worse.”

Chad, in particular, has been overwhelmed with refugees.  

“Most communities in Chad have been very hospitable, offering food, water and shelter for refugees. But the needs are overwhelming,” he said, noting that a recent WHO joint mission to the refugee areas assessed the potential fo scale up cross border operations to meet needs of those refugees and build health system capacity – “Despite the increasing needs in both Chad and Sudan, WHO has only 18% of the funds we need to meet those needs,” Tedros warned, saying that “the international community must do better than that. 

Gaza – hunger, displacement … and trash

In terms of Gaza, more than 10,000 seriously ill Palestinian patients remained trapped in the enclave awaiting evacuation since the closure of the Gaza-Egypt Rafah crossing following Israel’s military occupation of the area in early May, Dr Tedros said. 

Almost the entire population of Gaza still faces acute food insecurity, with one in four facing starvation, Tedros added, saying:  “At the same time, very few supplies are getting into Gaza with only five WHO trucks allowed into Gaza last week, and more than 34 trucks still waiting at Egypt’s Al Arish crossing into Gaza.”  A further 40 trucks are waiting at other crossings, he noted. 

And the already desperate situation may only get worse following Israel’s recent order to Gaza City residents to evacuate south – for the second time since Israel’s invasion of Gaza nine months ago. Israel attacked following the 7 October attack by Hamas on nearby Israeli communities that left 1200 Israelis dead and some 240 taken hostage. Since then, some 38,000 Gazan Palestinians have since been killed, according to Palestinian health authorities, while Hamas continues to hold 120 Israeli and foreign nationals hostages – of which less than half may still be alive.

On a trip to Gaza last week, Hanan al Balkhy, WHO’s Regional Director for the Eastern Mediterranean Region said she saw “first hand the scale of devastation, lives and homes in ruins, hospitals overwhelmed and a fully destroyed city. 

“The lack of fuel is compromising all health and humanitarian operations. Running sewage and garbage litter demolished streets with the smell of fermenting waste permeating the area. 

“This situation is providing the perfect breeding ground for diseases to spread, leading to an increase in cases of acute watery diarrhoea and acute respiratory infections among many others. 

“Ongoing violence and the breakdown of law and order are devastating in an already crippled city, creating an extremely high risk environment, not just for aid workers, but for everyone. The breakdown of law and order also makes it nearly impossible to manage gender-based violence exposing displaced Palestinians to additional life threatening risks.

“As a result of increasing hostilities and soaring needs, WHO has expanded its medical supply chain. However much of this aid remains stuck on the wrong side of the borders. With only a fraction reaching, Gaza. And even when supplies do, the breakdown, again, I repeat of law and order makes it challenging for our teams to deliver them to hospitals that urgently need them.” 

Image Credits: © UNHCR/Blaise Sanyila, National Foundation for Infectious Diseases , WFP/Jacques David, UNRWA .