1691. Each new attack closes services permanently---the population and the staff leave.
Kostandova 24 — Natalya Kostandova, Jennifer OKeeffe, Bakary Baba Ali, et. al. August 27. Johns Hopkins Bloomberg School of Public Health. Institut Centrafricain des Statistiques et des Etudes Economiques et Sociales, Bangui. Geneva Centre of Humanitarian Studies, University of Geneva. Conflict and Health, “‘It’s normal to be afraid’: attacks on healthcare in Ouaka, Haute-Kotto, and Vakaga prefectures of the Central African Republic, 2016–2020,” vol. 18 Clopus
Participants reported that attacks on health faculties interrupted services for varying periods of time. In several cases, certain health services were closed permanently. Participants reported that the population was often left to look for alternate sources of care, either traveling great distances to reach neighboring facilities or turning to traditional sources of care. One participant stated that the entire village, including healthcare personnel and volunteers, had fled to Sudan.
Great efforts were made to reopen services soon after an attack, but staff and communities faced significant administrative and operational challenges. Health center staff struggled to repair the facility and rid it of debris. The direct effects of attacks were often exacerbated by general insecurity in the region, which made it difficult to transport construction materials and resupply the facilities. Some participants reported that they needed approval from senior health officials to reopen services. Reluctance to reopen in some cases was tied to the risks of subsequent attacks.
When facilities reopened despite damage from an attack, which could happen in a matter of weeks for the more accessible facilities or years for the more inaccessible ones, they faced enormous challenges. Damage to the structure could inhibit personnel from ensuring proper triage, patient flow, or even basic shelter from the elements for patients. Participants spoke of roofs so damaged that they were torn off completely.
In addition to structural damage, staff were also often unable to maintain quality of care because of lack of supplies, equipment, and inadequately trained staff. Sometimes, a re-opened facility would operate with temporarily reduced services or permanently discontinue certain services. Discontinued services included those intended for the most vulnerable groups: maternity and reproductive health, treatment of acute malnutrition, surgery, and HIV care. People being treated for TB and HIV often missed treatments, potentially increasing drug resistance. Following one attack, a facility suspended vaccination outreach, providing vaccines only on-site, which created an additional barrier to access. Some facilities never fully recovered, operating with more limited resources for months or years. In the worst cases, facilities closed permanently, leaving communities without care and overburdening neighboring facilities.
1702. And it's not a stock---new insecurity keeps uprooting people and forecloses return.
OCHA 4-29b — United Nations Office for the Coordination of Humanitarian Affairs. April 29. The UN body that coordinates humanitarian response across the Lake Chad Basin. OCHA, “Lake Chad Basin - Humanitarian Overview,” https://www.unocha.org/publications/report/nigeria/lake-chad-basin-humanitarian-overview-29-april-2026 Clopus
The humanitarian situation in the Lake Chad Basin remains extremely fragile and complex, marked by persistent insecurity, large-scale population displacement, and a significant contraction in resources dedicated to humanitarian action. Between January and March 2026, 239 security incidents and 345 associated fatalities were recorded, confirming the high volatility of the situation, particularly in north east Nigeria, the Lac region of Chad, the Far North of Cameroon, and the Diffa region of Niger. This chronic insecurity continues to uproot people from their lands and homes, with just over 3 million internally displaced persons and more than 325,000 refugees, severely limiting prospects for safe, voluntary, and sustainable returns. Humanitarian needs remain high with about 8.2 million people in need of aid, including 4 million targeted by the humanitarian response. To support these populations, the region’s financial requirements are estimated at US$ 548 million. However, the challenge of resource mobilization remains critical, with only 22 per cent of funding needs covered to date. Key sectors, including food security, nutrition, education, protection, and access to basic services, continue to be severely affected. The situation is particularly alarming, with 7.4 million people acute food insecure (IPC Phase 3 or more, or crisis and worse, according to the Integrated Food Security Phase Classification), severe acute malnutrition among children, and several non-functional schools, especially in areas most affected by conflict, depriving children of education. In this context, strengthening humanitarian coordination and access to affected areas is essential to effectively respond to the needs of the most vulnerable people. Substantial financial support remains critical to increase the level of funding for interventions to enable a humanitarian response commensurate with the persistent challenges in the Lake Chad Basin.
1713. The state's own resettlement policy is collapsing---people are being pushed back out.
Campbell 25 — Philip Obaji Jr. November 5. Nigerian journalist reporting from Borno State. The New Humanitarian, “Boko Haram is back, and Nigeria’s IDP return policy is in trouble,” https://www.thenewhumanitarian.org/analysis/2025/11/05/boko-haram-back-nigeria-idp-return-policy-trouble Clopus
Darul Jamal had become the showcase home for 3,000 internally displaced persons (IDPs) who had been living for a decade in an overcrowded camp in the nearby town of Bama. It was part of the Borno State government’s ambitious “stabilisation” strategy that has seen the return of more than 170,000 IDPs to their home areas over the past few years.
Darul Jamal was targeted by the Aliyu Ngulde faction of JAS, based in the adjacent Gwoza Hills/Mandera mountains. The speculation is that it was punishment for the passing of information to the military by IDPs and vigilante groups on the movement of insurgents in the bush.
When Borno State Governor Babagana Zulum visited Darul Jamal the following day to offer his condolences, he urged the former IDPs to stay and rebuild – a refrain he has repeated on other occasions this year at scenes of similar atrocities.
But without adequate security – and systematic economic support to the newly returned IDPs – the “Reconstruct, Rehabilitate, and Resettle” pillar of Borno’s stabilisation strategy (one of nine pillars) looks decidedly shaky.
“[The policy] requires the government to answer more elaborately the question of what’s to be done around security,” explained Anietie Ewang of Human Rights Watch. “You can’t just return people and expect them to face whatever is out there.”
To understand the toll of these attacks on communities, earlier this year The New Humanitarian visited the towns of Damasak, Gamboru Ngala, and Monguno in northern Borno, Dikwa and Bama in the east, and Gwoza to the south.
We interviewed more than 60 former IDPs who had been resettled from camps in the state capital, Maiduguri. For a better insight into the insurgency, we also spoke with ex-JAS fighters who had recently surrendered to the army.
The IDPs all stressed their feeling of vulnerability. All of them knew someone who had been either kidnapped or killed by the insurgents – some of them family members. With only threadbare protection from a seemingly indifferent military, there was a profound sense that they were on their own. “We can rely only on God”, was a common refrain.
Nguro Soye lies just outside Bama, roughly 70 kilometres from Maiduguri. It was resettled in 2022 with IDPs from Maiduguri’s Dalori II camp. When The New Humanitarian visited a few months after their arrival , the residents spoke of the constant harassment they faced from JAS at night – despite the presence of a military detachment only a few kilometres away. That threat appears to have only increased.
“Most of us have regretted coming,” said Fatima Mohamed, who arrived in Nguro Soye with her husband and teenage sons. “In Maiduguri, we stayed peacefully, but here there is no security. Everybody is thinking of leaving – and many have – because Soye at night … You lie in bed listening, wondering what will happen.”
1721. ACCESS. OCHA's first-listed constraint in the northeast is military operations.
OCHA 4-29 — United Nations Office for the Coordination of Humanitarian Affairs. April 29. The UN body that coordinates humanitarian response, reporting with humanitarian partners in the field. OCHA, “North-East Nigeria: Borno, Adamawa, and Yobe states (BAY) First Quarter Humanitarian Access Snapshot,” https://www.unocha.org/publications/report/nigeria/north-east-nigeria-borno-adamawa-and-yobe-states-bay-first-quarter-humanitarian-access-snapshot-29-april-2026 Clopus
During Q1 2026, the humanitarian access in North-East Nigeria remained highly constrained due to military operations/ongoing hostilities, the presence of mines and unexploded ordnance, and illegal checkpoints along main supply routes (MSRs) and secondary roads, which regularly hindered response operations. Escalating insecurity across affected Local Government Areas (LGAs) continues to compromise civilian safety with attacks on towns regularly leading to large-scale civilian displacement from Gwoza, Pulka, Abadam, and Kukawa LGAs. The persistent insecurity in these areas poses significant risks to humanitarian personnel and assets, thereby limiting access and the ability to conduct timely assessments and interventions. Lastly, bureaucratic constraints in the form of halting cash distributions and registration of communication devices impeded partners' work until they were cleared up by advocacy efforts.
Humanitarian actors are increasingly exposed to risks such as ambushes, abductions, harassment, and threats from non-state armed groups (NSAGs), resulting in reduced field presence and constrained access. These constraints are compounded by the fact that some LGAs in the BAY States are not regularly serviced by UN Humanitarian Air Service (UNHAS), which makes road transport the only viable option for humanitarian actors. These challenges continue to delay or limit the delivery of life-saving assistance, further exacerbating unmet needs among vulnerable people.
1732. WORKERS. Insecurity makes them leave---and the workforce is the health system.
Onvlee 23 — Olivier Onvlee, Maryse Kok, James Buchan, et. al. August 5. KIT Royal Tropical Institute, Amsterdam. WHO Collaborating Centre on Health Workforce Development, University of Technology Sydney. World Bank, Washington, DC. International Journal of Health Policy and Management, “Human Resources for Health in Conflict Affected Settings: A Scoping Review of Primary Peer Reviewed Publications,” vol. 12 Clopus
Conflict has devastating effects on health systems. It results in destruction of health infrastructure, loss of healthcare workers (HCWs), and weakening of health governance at all levels. At the same time, demand for health services increases. 2 , 3 This poses a serious threat to achieving universal health coverage.
The health workforce is the engine of any health system, as all activities and programmes have to be adopted or adapted through them. 4 Insecurity and direct attacks lead HCWs to leave or avoid working in CAS. Consequently, small numbers of health workers are left in CAS, working in difficult conditions with often very little support. 5 , 6 The COVID-19 pandemic further aggravated this situation for many HCW.
1743. COVERAGE. An attacked facility loses vaccination---more susceptibles, earlier outbreak.
Kostandova 25 — Natalya Kostandova, Jennifer OKeeffe, Alexandre Mahieu, et. al. August 5. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. International Medical Corps, Washington, DC. Geneva Centre of Humanitarian Studies, University of Geneva. Conflict and Health, “Healthcare under fire: quantifying the impact of violence on medical services in facilities supported by International Medical Corps in three prefectures of Central African Republic,” vol. 19 Clopus
When the health system is disrupted by attacks on healthcare, the risk of vaccine-preventable and epidemic-prone diseases increases, potentially contributing to avertible mortality. Between February 2019 and January 2020, CAR reported 3,653 measles cases, with an outbreak declared in 2019 in five districts [ 33 ]. The measles outbreak provided an opportunity to analyze the time from attack to the first facility-reported measles case. We analyzed data at health facility level, defining exposure as any attack on healthcare in 2018 (the year prior to the outbreak). There were no measles cases reported at an IMC facility in 2020, likely due to gaps in facility surveillance or reporting data, since measles cases in Vakaga were reported elsewhere [ 34 ]. Thus, analysis was restricted to facilities with at least six months of reporting or at least one measles case in 2019. We excluded facilities not supported by IMC for pediatric health services during the study period. Vakaga prefecture was the only area with data to support survival analysis.
To distinguish true zeros from missing data, we used weekly outpatient consultations—reported on the same forms—as a proxy for facility reporting, treating weeks with zero consultations as non-reporting and excluding facilities with more than half of weeks missing. Missing or non-reporting was relatively limited in the remaining facilities, as shown in Figure S1 ; given that gaps were often reported retroactively and that measles is a notifiable disease, we considered it unlikely that suspected or confirmed cases would go unreported. Thus we treated the first reported case as the true first case, supported by consistency with internal monthly reports.
We conducted survival analysis comparing time to first reported measles case between exposed and unexposed facilities. We hypothesized that facilities with an attack had lower MCV coverage, leading to an increased number of susceptible children and earlier measles introduction. Statistical testing and survival curve plots were generated using survival [ 35 ] and ggsurvfit [ 36 ] R packages, respectively.
1754. OUTCOME. Conflict events roughly double reported Ebola risk---and it lasts weeks.
Charnley 24 — Gina E. C. Charnley, Nathan Green, Ilan Kelman, et. al. March 20. Bloomberg School of Public Health, Johns Hopkins University. School of Public Health, Imperial College London. Institute for Global Health, University College London. BMC Public Health, “Evaluating the risk of conflict on recent Ebola outbreaks in Guinea and the Democratic Republic of the Congo,” vol. 24 Clopus
Reducing Ebola virus transmission relies on the ability to identify cases and limit contact with infected bodily fluids through biosecurity, safe sex practices, safe burial and vaccination. Armed conflicts can complicate outbreak detection and interventions due to widespread disruption to governments and populations. Guinea and the Democratic Republic of the Congo (DRC) have historically reported the largest and the most recent Ebola virus outbreaks. Understanding if conflict played a role in these outbreaks may help in identifying key risks factors to improve disease control.
We used data from a range of publicly available data sources for both Ebola virus cases and conflict events from 2018 to 2021 in Guinea and the DRC. We fitted these data to conditional logistic regression models using the Self-Controlled Case Series methodology to evaluate the magnitude in which conflict increased the risk of reported Ebola virus cases in terms of incidence rate ratio. We re-ran the analysis sub-nationally, by conflict sub-event type and tested any lagged effects.
Conflict was significantly associated with an increased risk of reported Ebola virus cases in both the DRC and Guinea in recent outbreaks. The effect was of a similar magnitude at 1.88- and 1.98-times increased risk for the DRC and Guinea, respectively. The greatest effects (often higher than the national values) were found in many conflict prone areas and during protest/riot-related conflict events. Conflict was influential in terms of Ebola virus risk from 1 week following the event and remained important by 10 weeks.
Extra vigilance is needed following protests and riot-related conflict events in terms of Ebola virus transmission. These events are highly disruptive, in terms of access to transportation and healthcare and are often in urban areas with high population densities. Additional public health messaging around these types of conflict events, relating to the risks and clinical symptoms may be helpful in reducing transmission. Future work should aim to further understand and quantify conflict severity and intensity, to evaluate dose–response relationships in terms of disease risk.
The online version contains supplementary material available at 10.1186/s12889-024-18300-8.
**Keywords:**Ebola virus, Conflict, Outbreaks, Guinea, Democratic Republic of the Congo
Ebola is a virus belonging to the _Filoviridae_ family and was first identified in 1976 in what are now the Democratic Republic of the Congo (DRC) and South Sudan [1, 2]. Ebola virus disease (EVD) causes acute haemorrhagic fever, leading to mortality rates of ~ 50%, in the absence of any specific treatment. The virus is spread through human-to-human transmission via contact with infected body fluids and fomites, with an average incubation period of 8 to 10 days [3, 4].
Since its discovery, there have been several EVD outbreaks (with sporadic cases in Europe and North America) [5]. The worst recorded outbreaks, in terms of total cases and deaths, were the 2013–2016 West Africa outbreak, particularly in Sierra Leone, Liberia and Guinea and the 2018–2020 outbreak in the DRC. The most recent EVD outbreaks have been reported in Uganda (_Sudan Orthoebolavirus)_, Guinea (_Zaire Orthoebolavirus)_ and the DRC (_Zaire Orthoebolavirus)_, all of which occurred in 2021 and 2022 [6].
EVD control is achieved through identifying cases and interventions which reduce the risk of contact with infected people, via biosecurity in EVD treatment centres, safe burial practices, reducing sexual transmission [7], timely detection (via strategically positioned decentralized laboratories) [8], contact tracing and post-mortem testing to identify EVD-related deaths, genomic sequencing (to infer spatiotemporal transmission dynamics) [9, 10], and more recently with the rVSVΔG-ZEBOV-GP Ebola virus envelope glycoprotein vaccine and monoclonal antibody therapeutics [11, 12]. Conflict can impact these control measures, reducing the capacity to identify and respond to outbreaks [13]. Furthermore, conflict can cause disruption to a range of basic services including transport, healthcare and water, sanitation and hygiene (WASH) [14].
Targeted attacks on healthcare centres and workers are not limited to specific diseases or geographic regions [15] and there have been several reported attacks on Ebola treatment centres, creating fear and avoidance in accessing them [16]. To protect staff and patients, security forces and military personnel are often required to carry out healthcare activities [10, 15, 17]. Additionally, fear and mistrust can lead to further attacks, sabotage and disruption of healthcare facilities and services. Distrust and dissatisfaction in the government, the military and international involvement via non-governmental organisations (NGOs) has also reduced the willingness to follow public health guidance and has increased vaccine hesitancy and misinformation [7, 18].
1765. And this army does it on purpose---cutting off outside resources includes aid.
Baret 19 — Guillaume Baret. December 19. Head of Médecins Sans Frontières programmes in Nigeria and Niger. Médecins Sans Frontières, “Medical care needed outside northeast Nigeria’s garrison towns,” https://www.msf.org/medical-care-needed-outside-northeast-nigerias-garrison-towns Clopus
Other problems are the authorities’ restrictions on travel on certain roads or to so-called "inaccessible" areas. The Nigerian army prohibits or restricts access in Yobe, Borno and Adamawa states, depending on how it gauges its ability to ensure security.
Similar restrictions are imposed during military and counter-insurgency operations aimed at isolating areas controlled by armed groups to cut off their access to outside resources – which includes humanitarian aid – without considering that civilians may be present.
These are the factors explaining why aid is concentrated in ‘garrison’ towns. Elsewhere, the situation appears very challenging for aid organisations, and even more so since October when the authorities decided to temporarily suspend ACF’s and Mercy Corps’ activities on the grounds they were supporting terrorist groups.
1776. It already happened---an airstrike killed a health worker and the NAF arrests them.
SHCC 26 — Safeguarding Health in Conflict Coalition and Insecurity Insight. April. A coalition of more than forty organizations documenting violence against health care in armed conflict, reporting incident data compiled by Insecurity Insight. Safeguarding Health in Conflict Coalition, “Care in the Crosshairs: Violence Against Health Care in Conflict,” https://www.insecurityinsight.org/wp-content/uploads/2026/04/2025-SHCC-Annual-Report.pdf Clopus
Nigeria Most incidents were attributed to unidentified men armed with guns. Katsina militia were implicated in two attacks on health centers during which health workers were killed and injured.60 Zamfara militia carried out a road ambush, kidnapping a health worker and other civilians. 61 Fulani militants armed with AK-47s and machetes raided a hospital, abducting and raping an unspecified number of women.62 ISWAP was linked to five incidents across the BAY states, mostly involving health facilities being raided, set on fire, and looted of medicine and food supplies. 63 Boko Haram ambushed an ambulance in Borno state, injuring the driver, stealing medical supplies and seizing the vehicle.64 The NAF and police reportedly arrested health workers on accusations of links to opposition groups in Katsina, Niger, and Sokoto states. 65 An NAF air strike reportedly targeting a camp belonging to an armed group killed a health worker treating a wounded fighter.66 At least four incidents in the BAY states involved health centers being deliberately set on fire, often during wider attacks in the area where other civilian infrastructure was also damaged. On one occasion, an improvised explosive device (IED) planted by an unidentified armed group damaged staff residences at a hospital in Kebbi state.67 Kidnapping incidents increased by over 70% in 2025 compared to 2024, while the number of health workers who were kidnapped remained similar to those reported in 2024. Most kidnapped health workers were abducted outside Nigeria’s northeast in areas where kidnappings for profit are common. Maternal care services in Nigeria were affected by conflict-related violence in 2025 when unidentified attackers raided a nursing and maternity center in Kaduna state and abducted a health worker, a security guard, and five patients, including a nine-month pregnant woman and a nursing mother with her baby.68 Source: Insecurity Insight for the SHCC. 48 CARE IN THE CROSSHAIRS: VIOLENCE AGAINST HEALTH CARE IN CONFLICT | 2025
1781. THEIR OWN INSTITUTION---WHO Africa says its own surveillance falls short.
Olu 26 — Olushayo Oluseun Olu, Robert Lubajo, Misaki Wayengera, et. al. January 29. World Health Organization Regional Office for Africa, Brazzaville, Congo. Makerere University, Kampala. University of St Andrews. One Health Outlook, “Beyond counting the numbers - focused outbreaks response strategies are needed to control the mpox outbreak in Africa,” vol. 8 Clopus
First, we believe that the current surveillance and laboratory efforts fall short of what is required to effectively and timely identify, diagnose, isolate and treat all cases of mpox. This has not only resulted in an underestimation of the outbreak but, more importantly, allowed potentially infectious individuals to remain in the community, a risk that likely contributes significantly to ongoing community transmission [ 9 ]. For instance, only 12.6% of 60,697 suspected mpox cases were tested in DRC from 2010 to 2023 due to logistic and resources constraints [ 10 ]. Moreover, surveillance efforts remain largely parallel, with limited integration across human and animal health sectors, despite mpox’s zoonotic nature, reflecting ongoing disconnects in the implementation of cross-sectoral surveillance and information sharing systems [ 11 ].
1792. And they name the cause---insecurity directly constrains what the response can do.
Olu 26 — Olushayo Oluseun Olu, Robert Lubajo, Misaki Wayengera, et. al. January 29. World Health Organization Regional Office for Africa, Brazzaville, Congo. Makerere University, Kampala. University of St Andrews. One Health Outlook, “Beyond counting the numbers - focused outbreaks response strategies are needed to control the mpox outbreak in Africa,” vol. 8 Clopus
Finally, chronic conflict across many parts of the continent remains among the principal drivers of the ongoing mpox outbreak. The disproportionate burden observed in DRC, a conflict-affected country experiencing long-standing underdevelopment underscores this association [ 5 ]. Protracted insecurity directly constrains the implementation of outbreak preparedness and response interventions, while conflict-induced population displacement frequently results in settlement in overcrowded settings with limited access to essential social services, including health care, safe water, and sanitation. These conditions create an enabling environment for sustained transmission and substantially undermine efforts to prevent, detect, and control outbreaks [ 5 ].
1803. The bottleneck is national---diagnostic networks, labs and people. A continental body owns none of it.
Jean Louis 25 — Frantz Jean Louis, Lisa Nichols, Cecilia de la Torre, et. al. August 14. Infectious Disease Detection and Surveillance project, ICF, Rockville, Maryland. Public Health Reviews, “Strengthening Outbreak Detection in Africa to Achieve the 7-1-7 Global Framework: Challenges and Opportunities,” vol. 46 Clopus
Timely detection of infectious disease outbreaks is essential to limit health, social, and economic impacts, yet diagnostic and surveillance gaps persist across Africa. This review applies the 7-1-7 global target framework—detect within 7 days, notify within 1, and respond within 7—to assess strategies for strengthening early detection capacities across African countries.
Methods:
We conducted a review of peer-reviewed literature, institutional reports, and field evidence published without time span limitations. Key themes were organized around five strategic pillars: diagnostic preparedness, surveillance, workforce development, community engagement, and governance.
Results:
Identified bottlenecks include limited diagnostic networks capacity, fragmented surveillance systems, workforce shortages, and underinvestment in digital infrastructure. Promising solutions include diagnostic network optimization, deployment of point-of-care molecular tools, integration of event- and indicator-based surveillance through interoperable platforms, and AI-enabled early warning systems. Field examples from Uganda, Senegal, and Nigeria demonstrate improved timeliness where coordinated investments and multisectoral collaboration have been implemented.
1811. There is no Lassa vaccine---and the reason is structural.
Bardach 25 — Ariel Bardach, Mabel Berrueta, Agustín Ciapponi, et. al. December 17. Institute for Clinical Effectiveness and Health Policy, Buenos Aires. National Scientific and Technical Research Council, Argentina. PLOS ONE, “Efficacy, safety, and immunogenicity of Lassa fever vaccines: A living systematic review and landscape analysis,” vol. 20 Clopus
The Josiah strain serves as the prototypical representative of lineage IV and has been extensively characterized in laboratory studies [ 16 ]. The majority of vaccine candidates under preclinical and clinical investigation have predominantly utilized the glycoprotein (GP) from the Josiah strain of lineage IV as the primary immunogen, with homologous lineage IV strains employed in challenge studies [ 1 , 16 ].
No vaccine against LF is currently licensed for human use [ 16 ]. The virus’s genetic heterogeneity, the lack of established immune correlates of protection, and logistical challenges for conducting large efficacy trials in resource-limited settings with sporadic outbreaks have hampered vaccine development [ 1 , 17 ]. However, renewed focus, driven by recurrent large outbreaks, recognition by the World Health Organization (WHO) of LF virus as a priority pathogen with epidemic potential, and initiatives like the Coalition for Epidemic Preparedness Innovations (CEPI) seeking to support preventive strategies, have spurred the development of numerous vaccine candidates [ 16 – 18 ].
1822. Where a vaccine exists, insecurity is what stops the needle---vaccinators get shot at.
Onyeaghala 25 — Chizaram Onyeaghala and Michael Iroezindu. December 9. Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria. Department of Medicine, University of Nigeria Teaching Hospital, Ituku, Enugu. BMJ Global Health, “The 2024-2025 upsurge of mpox in Africa: another opportunity to accelerate global solidarity for a neglected disease,” vol. 10 Clopus
Since mid-2024, over 2.9 million doses of mpox vaccine have been distributed across Africa, with the DRC receiving the majority—approximately 2.5 million doses. Of these, about 600 000 doses have been administered across six African countries. 13 However, in conflict zones such as Eastern DRC, several factors impede effective deployment. These include persistent insecurity that exposes vaccinators to potential harm, limited cold chain capacity in remote and unstable regions and restricted community outreach in displaced populations.
Community mistrust, sometimes fuelled by misinformation campaigns, further diminishes vaccine acceptance. 19 In such environments, equitable access requires more than vaccine supply; it demands adaptive strategies such as mobile vaccination teams, negotiated humanitarian corridors and the integration of mpox prevention into broader humanitarian and peacekeeping operations.