By Michela Mansoldo - Human Rights Team

Introduction

On August 14, 2024, the World Health Organization (WHO) declared the Mpox crisis a public health emergency of international concern. This declaration comes as the outbreak spreads broadly across the overall Western and Central African region, with two-thirds of the cases recorded in the Democratic Republic of Congo (DRC). This situation exacerbates the already existing challenges within the country’s internal political system and deteriorates the ongoing human rights crisis. The Congolese population faces enormous aggravations due to ongoing armed conflict, high food insecurity, and continuous human rights abuses, particularly in the mining sector. This article will examine how the Mpox outbreak in the DRC highlights broader social challenges in the country, including the impact of the mining industry on the already burdened healthcare system.

What is Mpox?

Mpox is an infectious disease that spreads through close and/or sexual contact, and it poses a significant risk to individuals with weakened immune systems, especially pregnant women and children, whose contractions can be fatal. While the initial outbreak was identified in 2022, Mpox has been reported in the DRC for over a decade. The situation worsened in 2024 with the emergence of a new strain, resulting in over 26,000 cases and 833 deaths to date.

In response to the outbreak, vaccination campaigns commenced in September 2024, but the rollout faced delays, making it challenging to keep up with the rapidly increasing case numbers. This situation raises critical questions on equitable access to healthcare in the country, where over 7 million people are internally displaced and around 25 million face food insecurity. Among the most vulnerable populations are children, especially those who are undernourished and live in refugee camps, where sanitation and access to clean water are limited.

According to the Global Director of Health and Nutrition at Save the Children, the DRC records some of the highest levels of child insecurity globally and in 2023, violence, displacement, and killings reached alarming peaks, as reported by UNICEF. Furthermore, issues such as lack of sanitation, sexual abuse and child labour, significantly affect the contraction rate of Mpox amongst another vulnerable group in the DRC: miners.

Cobalt Mines and Human Rights Issues

Owning approximately 70% of the world's cobalt resources, eastern DRC has become a hotspot for conflict and exploitation. The mining industry has caused significant human rights violations in the country, triggering numerous interventions and peacekeeping efforts. The exploitation of Congolese labour dates back to the Belgian colonial period, and both internal and international actors have profited from it ever since.

The demand for cobalt has intensified with advancements in technology and the production of batteries, yet this surge has not been accompanied by a secure and sustainable approach to extraction. In fact, cobalt is highly toxic to inhale and leads to a number of healthcare complications for artisanal workers. Although mining may appear to be one of the better-paid jobs for locals, it comes with significant social and medical obstacles.

In mining areas, the risk of injuries is high due to the constant collapse of pits, often burying workers alive, including children. Reports indicate that tens of thousands of children are involved in the cobalt industry, which often leads them to abandon their education. Moreover, their prolonged exposure to toxic substances can severely damage internal organs, further aggravating immune responses to infections, which are very common in mining communities. Besides the rare access to sanitation facilities in mines, another issue is related to sexual abuses, which often results in the contraction of sexually transmitted and debilitating diseases. 

This situation underscores the vulnerability of individuals with already compromised health, further exacerbating the spread of mpox in Eastern DRC, where most mines are located.

Challenges for Healthcare

Despite ongoing efforts to deliver vaccines, the WHO remains optimistic about eradicating Mpox. However, the situation in mining areas poses significant challenges to this vision. Key obstacles include the remote locations of some communities and a lack of awareness about Mpox among local populations. Many individuals lack basic knowledge about the diseases they may contract and the preventive measures necessary to limit their spread. In fact, with the fourth-largest population in Africa and a substantial number of displaced people, the DRC faces an even more complex health burden. Many diseases affect the population - including malaria, HIV, and tuberculosis - and only a portion of these are transmittable. Apart from Mpox, vaccination efforts against other infectious diseases remain insufficient, with geographical coverage remaining low. According to the WHO, the lack of childhood immunisation in the DRC has reached alarming levels, with nearly 2 million children classified as zero-dose or under-immunised.

In times of emergencies, it is important to not only highlight the challenges in ensuring timely responses but also to examine the underlying causes of these issues. In the DRC, limited access to healthcare is influenced not only by geographical barriers or population density but also by the ongoing conflict. Insecurity, high population mobility, and resource exploitation are contributing factors to the spread of Mpox in the country, and they point to gaps in both governmental efforts and regional cooperation.

Root Causes and Systemic Failures

The underlying causes of conflict in the DRC contribute to various challenges affecting healthcare stability. For instance, displacement, food insecurity, and economic uncertainty can lead to behaviors such as transactional sex, which may increase the spread of diseases. Additionally, difficulties in establishing accountability among political actors can hinder efforts to strengthen community resilience. The country's high level of militarization has also contributed to local distrust of both internal and external actors, which may extend to healthcare and humanitarian personnel.

Effectively addressing the Mpox crisis requires a multifaceted approach. Beyond implementing measures to control the spread of the disease, integrating conflict resolution strategies into healthcare efforts is essential. To restore a system facing significant challenges and improve human rights protections in the DRC, a comprehensive reevaluation of societal issues is needed.

Although finding definitive solutions is highly complicated, there is a large space for improvement. For instance, involving the local population in the management and participation of health programs is essential. As proposed by Bashwira, Mihigo and Duclos from the Social Science in Humanitarian Action Platform (SSHAP), initiatives such as mapping conflicts and assessing organisational patterns could prove beneficial for larger-scale responsiveness.

Conclusions

Access to healthcare is a fundamental human right, and global accountability plays an important role in advocating for those with limited means to voice their needs. Promoting equitable healthcare access, while also addressing the socioeconomic factors that contribute to health disparities, is essential. Implementing community-led programs can help create sustainable solutions to the challenges faced by vulnerable populations. Collaborative efforts between local actors and international NGOs can support the delivery of essential services and resources.

In conclusion, the Mpox emergency is not solely a medical issue but is closely connected to broader societal challenges. Addressing it from a wider perspective can provide not only immediate health interventions but also contribute to reducing the underlying factors that increase population vulnerability. Through comprehensive efforts, there is potential to improve health outcomes for the Congolese people and uphold their fundamental rights.