BANGUI, Central African Republic — African health officials said mpox cases have spiked by 160% so far this year, warning the risk of further spread is high given the lack of effective treatments or vaccines on the continent.

The Africa Centers for Disease Control and Prevention said in a report released Wednesday that mpox, also known as monkeypox, has now been detected in 10 African countries this year including Congo, which has more than 96% of all cases and deaths.

Officials said nearly 70% of cases in Congo are in children younger than 15, who also accounted for 85% of deaths.

There have been an estimated 14,250 cases so far this year, nearly as many as all of last year. Compared to the first seven months of 2023, the Africa CDC said cases are up 160% and deaths are up 19%, to 456.

Burundi and Rwanda both reported the virus for the first time this week.

New outbreaks were also declared this week in Kenya and Central African Republic, with cases extending to its densely populated capital, Bangui.

“We are very concerned about the cases of monkeypox, which is ravaging (the capital region),” the Central African Republic’s public health minister, Pierre Somsé, said Monday.

On Wednesday, Kenya’s Health Ministry said it found mpox in a passenger traveling from Uganda to Rwanda at a border crossing in southern Kenya. In a statement, the ministry said that a single mpox case was enough to warrant an outbreak declaration.

The Africa CDC said the mpox death rate this year, at about 3%, “has been much higher on the African continent compared to the rest of the world.” During the global mpox emergency in 2022, fewer than 1% of people infected with the virus died.

Earlier this year, scientists reported the emergence of a new form of the deadlier version of mpox, which can kill up 10% of people, in a Congolese mining town that they feared might spread more easily among people. Mpox spreads via close contact with infected people, including via sex.

An analysis of patients hospitalized from October to January in eastern Congo suggested that recent genetic mutations in the virus were the result of the ongoing spread in people.

Unlike in previous mpox outbreaks, where lesions were mostly seen on the chest, hands and feet, the new form of mpox causes milder symptoms and lesions mostly on the genitals, making it harder to spot.

The medical charity Doctors Without Borders called the expanding mpox outbreak “worrying,” noting the disease had also been seen in camps for displaced people in Congo’s North Kivu region, which shares a border with Rwanda.

“There is a real risk of explosion, given the huge population movements in and out,” said Dr. Louis Massing, the group’s medical director for Congo.

Mpox outbreaks in the West have mostly been shut down with the help of vaccines and treatments, but barely any have been available in African countries including Congo.

“We can only plead … for vaccines to arrive in the country and as quickly as possible so that we can protect the populations in the areas most affected,” Massing said in a statement.

In May, WHO said that despite the ongoing outbreak in Africa and the potential for the disease to spread internationally, not a single donor dollar had been invested in containing mpox.

Earlier this week, the Coalition for Epidemic Preparedness Innovations announced it was starting a study in Congo and other African countries next month to see if giving people an mpox shot after they had been exposed to the disease could help prevent severe illness and death.
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PHOENIX, ARIZONA — Mexican farm worker Avelino Vazquez Navarro didn’t have air conditioning in the motor home where he died last month in Washington state as temperatures surged into the triple digits.

For the last dozen years, the 61-year-old spent much of the year working near Pasco, Washington, sending money to his wife and daughters in the Pacific coast state of Nayarit, Mexico, and traveling back every Christmas.

Now, the family is raising money to bring his remains home.

“If this motor home would have had AC and it was running, then it most likely would have helped,” said Franklin County Coroner Curtis McGary, who determined Vazquez Navarro’s death was heat-related, with alcohol intoxication as a contributing cause.

Most heat-related deaths involve homeless people living outdoors. But those who die inside without sufficient cooling also are vulnerable. They are typically older than 60, living alone and with a limited income.

Underscoring the inequities around energy and access to air conditioning as summers grow hotter, many victims are Black, Indigenous or Latino, such as Vazquez Navarro.

“Air conditioning is not a luxury, it’s a necessity,” said Mark Wolfe, executive director of the National Energy Assistance Directors’ Association, which represents state energy assistance programs. “It’s a public health issue, and it’s an affordability issue.”

The most vulnerable

People living in mobile homes or in aging trailers and RVs are especially likely to lack proper cooling. Nearly a quarter of the indoor heat deaths in Arizona’s Maricopa County last year were in those kinds of dwellings, which are transformed into a broiling tin can by the blazing desert sun.

“Mobile homes can really heat up because they don’t always have the best insulation and are often made of metal,” said Dana Kennedy, AARP director in Arizona, where many heat-related deaths occur.

Research shows mobile home dwellers are particularly at risk in blistering hot Phoenix, where 45-degree Celsius (113 Fahrenheit) weather is forecast for this weekend.

“People are exposed to the elements more than in other housing,” said Patricia Solís, executive director of the Knowledge Exchange for Resilience at Arizona State University, who worked on mapping hot weather impacts on mobile home parks for a state preparedness plan.

Worse, some parks bar residents from making modifications that could cool their homes, citing esthetic concerns. A new Arizona law required parks for the first time this summer to let residents install cooling methods such as window units, shade awnings and shutters.

In Arizona’s Maricopa County, home to Phoenix, 156 of 645 heat-related deaths last year occurred indoors in uncooled environments. In most cases, a unit was present but was not working, was without electricity or turned off, public health officials said.

One victim was Shirley Marie Kouplen, who died after being overcome by high temperatures inside her Phoenix mobile home amid a heat wave when the extension cord providing her electricity was unplugged.

Emergency responders recorded the 70-year-old widow’s body temperature at 41.7 C (107.1 F). Kouplen, who was diabetic and had high blood pressure, was rushed to a hospital, where she died.

Kouplen apparently was struggling financially, if the shabby condition of her mobile home was any indication. It still sits on Lot 60, surrounded by a chain-link fence with a locked gate and a dirt driveway overgrown with weeds.

It’s unclear how the cord got unplugged, if Kouplen had an electricity account or how she got her power.

“Losing your air conditioning is now a life-threatening event,” said Texas A&M University climate scientist Andrew Dessler, who grew up in hot, humid Houston in the 1970s. “You didn’t want to lose your air conditioning, but it wasn’t going to kill you. And now it is.”

Arizona’s regulated utilities have been banned since 2022 from cutting off power during the summer, following the 2018 death of a 72-year-old woman after Arizona Public Service disconnected her electricity over a $51 debt.

Ann Porter, spokesperson for Arizona Public Service, which provides electricity to homes in the park where Kouplen lived, said “due to privacy concerns” the company could not say if she had an account at the time of her death or in the past. Porter said the utility does not cut power from June 1 to Oct. 15.

Cutoffs can occur after those dates if mounting debts are not paid.

Arizona is among 19 states with shut-off protections, leaving about half of the U.S. population without safeguards against losing electricity during the summer, the National Energy Assistance Directors Association said in a new study.

Almost 20% of very-low-income families have no air conditioning at all, especially in places such as Washington state, where they weren’t commonly installed before climate-fueled heat waves grew increasingly stronger, more frequent and longer lasting.

Not only in the Southwest

In the Pacific Northwest, several hundred people died during a 2021 heat wave, prompting Portland, Oregon, to launch a program to provide portable cooling units to vulnerable, low-income people.

Chicago, better known for its cold winters, saw a heat wave kill 739 mostly older people over five days in 1995. Amid high humidity and temperatures over 37.7 C (100 F), most victims had no air conditioning or couldn’t afford to turn on their units.

In 2022, Chicago adopted a cooling ordinance after three women died in their apartments in a building for older adults on an unusually warm spring day. Certain residential buildings must now have at least one air-conditioned common area for cooling when the heat index exceeds 26.6 C (80 F) and cooling is unavailable in individual units.

Nonprofits in historically hotter areas such as Arizona also are trying to better address the inequities low-income people face during the sweltering summers. The Phoenix-based community agency Wildfire recently raised money to buy over $2 million worth of air conditioning equipment to help 150 households statewide over three years, Executive Director Kelly McGowan said.

Laws protect renters in some places. Phoenix landlords must ensure that air conditioning units cool to 28 C (82 F) or below and that evaporative coolers lower the temperature to 30C (86 F).

Palm Springs, California, and Las Vegas, Nevada, both desert cities, have ordinances requiring landlords to offer air conditioning in rental dwellings. Dallas, where temperatures can pass 43.3 C (110 F) in the summer, has a similar law.

But most renters pay their own electricity costs, leaving them to agonize whether they can afford to even turn on the cooling or how high to set the thermostat.

A new report estimates the average cost for U.S. families to keep cool from June to September will grow nationwide by 7.9% this year, from $661 in 2023 to $719 this summer.

Wolf noted the federal Low Income Home Energy Assistance Program, which grants money to states to help families pay for heating and cooling, is underfunded, with 80% going to heat homes in winter.
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MEXICO CITY — Gliding above her neighborhood in a cable car on a recent morning, Sonia Estefanía Palacios Díaz scanned a sea of blue and black water tanks, tubes and cables looking for rain harvesting systems.

“There’s one!” she said, pointing out a black tank hooked up to a smaller blue unit with connecting tubes snaking up to the roof where water is collected.

“I’m always looking for different rainwater harvesting systems,” she said, smiling. “I’m also always looking for places to install one.”

Driven by prolonged drought and inconsistent public water delivery, many Mexico City residents are turning to rainwater. Pioneering company Isla Urbana, which does both nonprofit and for-profit work, has installed more than 40,000 rain catchment systems across Mexico since the company was founded 15 years ago. And Mexico City’s government has invested in the installation of 70,000 systems since 2019, still a drop in the bucket for the sprawling metropolis of around 9 million.

But there’s little education and limited resources to maintain the systems after installation, leading the systems to fall into disuse or for residents to sell off the parts.

Enter Palacios Díaz and a group of other women who make up the cooperative Pixcatl, which means harvest of water in the Indigenous Nahuatl language.

In lower-income areas like Iztapalapa — Mexico City’s most populous borough — the group tries to keep systems functioning while also educating residents on how to maintain them. That includes brainstorming their own designs and providing residents with low-cost options for additional materials.

Palacios Díaz has lived with water scarcity in Iztapalapa as far back as she can remember. “Here, people will get in line starting at 3 in the morning to get water (from distribution trucks) up until 2 in the afternoon,” she said from her mother’s home. “There was a time in which we went for more than a month without a regular supply of water.”

Earlier this year, the reservoirs that supply the capital were perilously low. Authorities reduced the amount of water being released and neighborhoods not accustomed to water scarcity faced a new reality.

Entering the rainy season, most of Mexico was in moderate to severe drought. Mexico’s reservoirs are beginning to approach half their capacity, but they haven’t filled by much, according to recent reports by the National Water Commission.

The country depends on the rains — which normally peter out in October — to fill the reservoirs, but the drought has taken them so low that that might take years.

That’s encouraged many Mexicans like Palacios Díaz to turn to rainwater harvesting.

At the height of the pandemic, she taught classes on urban farming and water harvesting at a local community space. It wasn’t until her students said they wanted to learn how to install and understand their own systems that she seriously considered taking a government course. After enrolling in a training program in 2022 to become an installer, she met other young women from the city interested in water harvesting systems and they formed the cooperative.

Near the skirt of a volcano on the fringes of Iztapalapa, Lizbeth Esther Pineda Castro, another member of the cooperative, and Palacios Díaz adjusted a ladder to reach the roof of a small house. The two-story home inherited by Sara Huitzil Morales and her niece sits in Iztapalapa’s Buenavista neighborhood.

Huitzil’s mother had qualified for a free water harvesting system from Mexico City’s government in 2021. After the installation, Huitzil requested Pixcatl’s maintenance since she wasn’t sure how to take care of the system.

Sporting their navy polos with the Pixcatl logo, Pineda and Palacios Díaz cleared debris off the roof so the system only collects fresh rain.

“We also add a little bit of soap and chlorine to clean the pipes,” said Palacios Díaz as she swept the liquid down a connecting tube that leads to the harvesting system.

Downstairs, they joined the other members of the cooperative in a courtyard to look at the giant 2,500-liter water tank, enough to serve Huitzil’s needs for several months when filled. The colossal container stood nearly as tall as Palacios Díaz. Another cooperative member cleared a filter of leaves and dirt.

Last, Palacios Díaz plopped in a couple of chlorine pills to clean and disinfect the water. The frequency of the entire maintenance process depends on several factors, including how much water is in the tank, how much has been used, and whether it has rained.

Huitzil said before the harvesting system, she endured water shortages and rationing. The publicly available water was consistently dirty and “dark like chocolate.” She often used the water that remained from doing laundry to clean the courtyard. Sometimes when dirty water would arrive, she would put it in buckets and wait for the dirt to settle to the bottom, using the cleanest for showering.

The system has transformed her daily use of water, and she doesn’t have to think twice about whether it’s safe. The system initially uses six filters, plus three more if the water is to be used for drinking.

“The water is good, it’s so good!” said Huitzil. “My clothes come out very clean and the water is sweet. You can even harvest it to be cleaner to drink.”

With more than 1.8 million residents, Iztapalapa has been one of the primary beneficiaries of Mexico City’s harvesting system program. But after two years, the city stopped giving away free systems when many residents, facing economic hardship and sometimes struggling to maintain the systems, sold off their parts.

“It should be easy to maintain, but it’s tedious,” Palacios Diaz said. “Unfortunately, we find ourselves in a scenario in which we not only have environmental problems, but economic problems.”

Loreta Castro Reguera, an architecture professor at Mexico’s National Autonomous University, focuses much of her work on water and urban design. She said rainwater harvesting is a great solution because during Mexico’s rainy season residents can use rainwater instead of water from the Cutzamala system — a reservoir that provides water to Mexico City and the State of Mexico.

Palacios Díaz dreams of rainwater systems in markets, malls, and other community spaces. The cooperative is also working on designs personalized for their clients’ needs — whether for a low-cost system or to fulfill a greater demand for water.

As women, she and the other members of Pixcatl want to set an example for those who want to get involved in water harvesting.

“I think it’s really beautiful we can inspire young girls and show women in another context,” said another member, Abigail López Durán, “that we can also use tools and aren’t afraid to get hurt.”
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GENEVA — U.N. agencies warn that the demolition of a critical water facility in Rafah in the southern Gaza Strip increases the risk of infectious diseases as people are forced to drink unsafe water while sanitary conditions continue to deteriorate.

“Until recently, that reservoir served thousands and thousands of internally displaced people who had sought refuge in Rafah in the area,” James Elder, UNICEF spokesperson, told journalists at a briefing in Geneva on Tuesday.

“Now without it, vulnerable children and families are likely to be forced again increasingly to resort to unsafe water, so putting them again at all those risks that we see time after time, day after day in Gaza — dehydration, malnutrition, diseases,” he said.

The Israeli daily Haaretz reported Monday that the troops blew up the central reservoir “on the orders of the brigade commanders” but without receiving permission from the senior level of the Southern Command. It added that the incident was being investigated by Israel’s Military Police as “a suspected violation of international law.”

Infections spreading

Elder said the destruction of the Canada Well reservoir “is yet another grim reminder of the assaults on families who already are in desperate need of water.”

“We have seen spikes in diarrhea, in skin infections — all due to a lack of access to hygiene and a lack of access to water,” he said, noting that people in emergencies require a minimum of 15 liters (almost 4 gallons) of water per person per day.

Now, the range of water availability in Gaza has been reduced to between 2 and 9 liters per person, per day, and some people are getting just a fraction of that, Elder said.

“Somehow, people are holding on, but of course, we are now in that deathly cycle whereby children are very malnourished. There is immense heat. There is [a] lack of water. There is a horrendous lack of sanitation, and that is the cycle,” he said.

The World Health Organization reports a surge in infectious diseases in the Gaza Strip. As of July 7, it has recorded nearly 1 million cases of acute respiratory infections, 577,000 cases of acute watery diarrhea, 107,000 of acute jaundice syndrome and 12,000 of bloody diarrhea. It also has recorded nearly 200,000 cases of scabies, lice, skin rashes, chicken pox and other illnesses.

Polio threat

The recent identification of circulating vaccine-derived poliovirus type 2 in Gaza’s sewage system is of particular concern. Under prevailing conditions in Gaza, there is a high risk of spread of this paralytic, deadly disease within the Palestinian enclave and across borders.

“Having a vaccine-derived polio virus in the sewage very likely means that it is out there somewhere in people,” WHO spokesperson Christian Lindmeier said. “It most likely is in the population, but that does not necessarily mean that we see an outbreak of cases.

“But of course, we need to be prepared. We need to be utterly prepared. And we need vaccinations, and we need vaccination campaigns,” he said.

WHO Director-General Tedros Adhanom Ghebteyesus has announced that the organization will be sending more than 1 million doses of polio vaccine to Gaza to avert the spread of the disease.

“While no cases of polio have been recorded yet, without immediate action, it is just a matter of time before it reaches the thousands of children who have been left unprotected,” he said, adding that infants under 2 are especially vulnerable “because many have not been vaccinated over the nine months of conflict.”

Before Israel began its military offensive in Gaza following a brutal attack on Israel by Hamas militants on October 7, nearly the whole population of Gaza had been immunized against polio.

However, due to the impact of the conflict, “coverage of polio now is around 89%, down from around 99% before the conflict,” UNICEF’s Elder said. “Hence, there is an increased risk for children. Now, if the child gets the full course of the vaccine, then the risk of the child getting paralyzed by polio is negligible.

“This is why it is so critical that all children are immunized. But the mass displacement, the decimation of the health infrastructure, the tremendously insecure operating environment — they all make it much more difficult, hence putting more children at risk,” he said.

Cases of polio have declined by 99% since WHO launched its global polio eradication campaign in 1988.

WHO reports polio now is endemic only in Pakistan and Afghanistan. However, more than 30 countries, including Egypt and Israel, are subject to outbreaks. The reemergence of polio tends to occur in areas of conflict or instability and within countries with poor health systems.

“We were very, very close to eradicating polio fully,” WHO spokesperson Lindmeier said. “As you know, wartime, unfortunately, creates the situation where it is very difficult to get that last mile. And it has been less than a mile that we needed to go.

“There are a few pockets around the world. Hopefully, Gaza will not become another one,” he said.
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