On the frontline of the fight to halt the spread

Egide Irambona, 40, sits bare-chested on his hospital bed, next to the window, in a treatment room that he shares with two other men.

The rays of the evening sun shining above Burundi’s main city, Bujumbura, filter in. His face, bathed in a soft light, is covered in blisters. His chest too, and his arms.

“I had swollen lymph nodes in my throat. It was so painful I couldn’t sleep. Then the pain subsided there and it moved to my legs,” he tells the BBC.

Mr Irambona has mpox.

He is one of the more than 170 confirmed cases recorded since last month in Burundi. One of the poorest countries in the world, it borders the Democratic Republic of Congo, the epicentre of several recent mpox outbreaks, which have led to at least 450 deaths and 14,000 suspected cases so far this year.

In Burundi, there have been no recorded deaths and it is not yet clear how deadly the current outbreak – of a new strain called Clade 1b – is because there is not enough capacity to carry out testing in the affected areas.

However, it has been declared a global health emergency because of fears it could spread quickly to previously unaffected countries and regions.

This is Mr Irambona’s ninth day of treatment at the King Khaled University Hospital. One way that the virus is spread is through close contact with someone infected and it seems that he passed it on to his wife.

She is also being looked after at the same facility.

“I had a friend who had blisters. I think I got it from him. I did not know it was mpox. Thankfully our seven children have not shown any signs of having it,” Mr Irambona says, his voice trailing off.

This hospital in Bujumbura is home to one of three mpox treatment centres in the city.

Fifty-nine of the 61 available beds are occupied by infected patients – a third are under the age of 15 and, according to the World health Organization, children are the worst-affected age group here.

Odette Nsavyimana is the doctor in charge at the hospital and says the number of patients is increasing.

“We are now setting up tents outside.” There are three so far – one for triage, one to hold suspected cases and one to take confirmed cases before they can be transferred to the wards.

“It is tough, especially when the babies come. They cannot stay alone, so I have to keep their mothers here as well. Even if they have no symptoms… It is such a tough situation,” Dr Nsavyimana says, her voice muffled by her protective face mask.

Burundi is now seeing a surge in mpox cases.

“I am worried about the numbers. If they keep increasing, there is no capacity for us to handle that.”

A lot of effort is made to isolate those infected from the rest of the hospital’s population. There is red tape everywhere, and visitors, who are required to wear protective equipment, are physically distanced from those infected.

Medical officials are worried about limited resources. There is only one laboratory in the country where blood samples can be tested for the virus, there are insufficient testing kits and no vaccines.

Maintaining hygienic conditions across Bujumbura is also hard as access to basic resources like water is limited in the city. There is a shortage of running water and people can be seen queuing up at public taps.

Dr Liliane Nkengurutse, national director for the Centre for Public Health Emergency Operations, says she is really concerned about the coming days.

“This is a real challenge. The fact that diagnosis is only done in one place delays detecting new cases.

“Health centres are calling the laboratory saying they have suspected cases, but it takes time for teams from the lab to deploy to where the suspected cases are to take samples.

“And it takes much more time to release the test results. We need about $14m (£10.7m) to be able to at least take our response to the next level,” she says.

Despite talk of vaccines reaching DR Congo as early as next week, there are no reports of a similar move for Burundi.

Public awareness about mpox is limited.

Bujumbura is just 20 minutes from the border with DR Congo and is a hub for cross-border travel and trade. But there is no sense of the possible risks of an outbreak.

The city is abuzz with activity. People are still buying and selling goods as usual. Handshakes, hugs and very close contact are the norm. There are long queues at the bus stations, with people scrambling to get onto already crammed public service vehicles.

“Many people do not understand the gravity of this issue. Even where there have been cases, people still just mingle,” Dr Nkengurutse says.

The BBC spoke to several people in Bujumbura and the majority did not know what mpox was. And those that did were not aware that it was spreading in their country.

“I have heard about this disease, but I have never seen someone who suffers from it. I have only seen it on social media,” one person said.

“I know it affects babies and young people. I am scared of it, but that does not mean I will just stay at home. I have to work. My family has to eat,” said another.

Health workers know that persuading people to take more care may be hard among a sceptical population that is facing a host of economic challenges.

But they will continue to treat patients, make sure they get better and try and trace those that they have been in contact with in efforts to contain the spread of the virus.