At the forefront of the fight against the epidemic

Egide Irambona, 40, sat shirtless on a hospital bed near a window in a treatment room he shared with two other men.

His face, bathed in the soft sunlight of the setting sun over Bujumbura, Burundi’s main city, was covered in blisters. His chest and arms were also covered in blisters.

“I had swollen lymph nodes in my throat. The pain was so severe that I couldn’t sleep. Then the pain there subsided and moved to my legs,” he told the BBC.

Mr. Irambona suffers from mpox.

He is one of more than 170 cases confirmed since the last month in Burundi, one of the world’s poorest countries that borders the Democratic Republic of Congo, the epicenter of several recent smallpox outbreaks that have killed at least 450 people and caused 14,000 suspected cases so far this year.

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

However, the outbreak has been declared a global health emergency amid concerns that it could spread rapidly to previously unaffected countries and regions.

This is Mr Iramboona’s ninth day of treatment at King Khalid University Hospital. One way the virus spreads is through close contact with an infected person, and he appears to have passed it on to his wife.

She is also being cared for at the same facility.

“I had a friend who had blisters. I think I caught it from him. I didn’t know it was cowpox. Thankfully, none of our seven children showed any signs of infection,” Mr Irambona said, his voice trailing off.

The hospital in Bujumbura is one of three MPox treatment centres in the city.

Of the hospital’s 61 available beds, 59 are occupied by infected patients, a third of whom are under the age of 15, making children the worst-affected age group here, according to the World Health Organization.

Odette Nsawyimana, the hospital’s attending physician, said the number of patients was increasing.

“We are setting up tents outside now.” There are already three tents, one for triage, one for holding suspected cases, and one for receiving confirmed cases who will then be transferred to the ward.

“It’s hard, especially when babies are born. They can’t stay here alone, so I have to keep their mothers here too. Even if they don’t have any symptoms… it’s very hard,” said Dr. Nsawwimana, her voice muffled by a protective mask.

There is currently a surge in vaccinia cases in Burundi.

“I’m worried about the numbers. If the numbers continue to increase, we won’t be able to cope.”

The hospital put a lot of effort into isolating the infected from the rest of the hospital’s patients. There was red tape everywhere, and visitors had to wear protective gear and maintain physical distance from the infected.

Medical officials worry about limited resources. The country has only one laboratory that can test blood samples for the virus, insufficient testing kits and no vaccine.

Sanitation is also difficult to maintain in Bujumbura, as the city has limited supplies of basic resources such as water. Running water is in short supply, and people are often seen queuing at public taps.

Dr. Lillian Nkengulutsi, national director of the Public Health Emergency Operations Centre, said she was very concerned about the days ahead.

“It’s a real challenge. Diagnosis is only done in one place, which delays the detection of new cases.

“The health centre is calling the lab saying they have a suspected case but it takes time for the lab team to reach the suspected case location to collect samples.

“And it will take more time for the test results to be released. We need about $14m (£10.7m) to at least take our response to the next level,” she said.

While there are rumors that vaccines could arrive in the Democratic Republic of Congo as early as next week, there have been no reports of similar action in Burundi.

Public awareness of mpox is limited.

Bujumbura is just 20 minutes from the border with the Democratic Republic of Congo and is a hub for cross-border travel and trade, but people are not concerned about the risk of an outbreak.

The city was bustling with activity. People were still buying and selling goods as usual. Handshakes, hugs and very close contact were the norm. Long queues formed at bus stops as people scrambled to get on already packed buses.

“Many people don’t understand the magnitude of the problem. Even in places where cases have emerged, people are still just mixing together,” said Dr. Nkengurutesi.

The BBC spoke to several people in Bujumbura and found that most did not know what MPox was. And those who did know had no idea that the virus was spreading in their country.

One person said: “I’ve heard of this disease but I’ve never seen anyone with it. I’ve only seen it on social media.”

“I know it affects babies and young people. I’m scared, but that doesn’t mean I just stay home. I have to work. My family has to eat,” said another.

Health care workers know it may be difficult to convince a skeptical population facing numerous economic challenges to take better care of their health.

But they will continue to treat patients, ensure their recovery, and do their best to trace those they have come into contact with to curb the spread of the virus.