Mpox, mining, and vulnerabilities of women and children in eastern DRC [EN/AR]

Authors: Marie-Rose Bashwira, Isidore Murhi Mihigo, Diane Duclos

This brief presents considerations for contextualising and responding to the mpox outbreak in the mining towns of South Kivu province in the Democratic Republic of the Congo (DRC). The brief focuses on women and children living and working in artisanal and small-scale mining (ASM) areas. Although mpox is endemic in certain provinces in the DRC, a nationwide outbreak of mpox (clade I) was declared in late 2022. In 2023, the number of confirmed cases of mpox in the DRC was the highest in Africa, with about 595 cases. A new strain was identified in Kamituga in September 2023, referred to as the new strain of clade I or clade Ib. This outbreak is characterised by widespread human-to-human transmission, unlike previous outbreaks which were primarily characterised by animal-to-human contact.

In Équateur province in north-western DRC, most documented cases were in children, while in South Kivu in eastern DRC, cases were documented in women (including women who engage in transactional sex) and children under the age of 15, including newborns. The DRC Ministry of Public Health and Hygiene has approved two emergency mpox vaccines and is putting in place a series of preventive measures, starting with awareness and hygiene, in a context where many health districts lack timely access to diagnostics and vaccines.

This brief highlights relevant socio-political contexts related to ASM, livelihoods, population mobility, and conflict and public health interventions. It discusses considerations for mpox vulnerabilities and access to healthcare for women and children. This brief draws on a SSHAP roundtable discussion on mpox in the DRC held in May 2024; conversations with experts and health actors active and/or knowledgeable in the region and outbreak; the authors’ own expertise on women’s and children’s lives in ASM areas in South Kivu; and academic and grey literature.

Key considerations

• Consider the heterogeneous and rapidly changing picture of mpox in DRC when identifying populations and interventions. Contextualise response plans to the socio-economic landscape in the mining towns in South Kivu province, including to shifts in transmission dynamics and spatial distribution of cases.
• Incorporate a detailed understanding of how local mining economies impact people’s vulnerability. Women working in mines face a range of intersecting health, economic and safety challenges. Understanding women’s livelihood strategies is critical to developing appropriate responses to mpox and to avoid inadvertently economically penalising women. For example, enforcing isolation measures or curtailing movements of suspected cases without considering social protection and loss of income could result in women and children potentially adopting risky mitigation strategies.
• Strengthen healthcare infrastructure in ASM areas and include gender-sensitive programmes. The ongoing mpox outbreak is revealing – and potentially exacerbating – structural barriers to access healthcare. For example, women represent a large proportion of workers in mines, and they may be less likely to have savings to pay for healthcare (for themselves and dependents) due to discriminatory employment patterns, which could hinder access to mpox diagnosis and care.
• Recognise and address the movement of people in mining areas across regions and borders to support their livelihoods in mpox preparedness plans and containment strategies. Securitisation and public health responses to mpox that curtail movement could harm vulnerable workers who are dependent on accessing commercial routes and corridors to survive. Mpox preparedness plans and containment strategies should therefore mitigate protection and surveillance risks at borders.
• Prioritise access to mpox detection and vaccination for pregnant women and children. Women and children in mining communities are particularly vulnerable to mpox. Women, who often handle food and care for children, are at risk of contracting the virus and spreading it within the household. Children and pregnant women are at risk of developing complications and death from mpox. Risk communication and community engagement campaigns should consider risks of stigmatisation when addressing vulnerability.
• Avoid stigmatising communities and social groups by associating them with the mpox virus. With the spillover of the virus in neighbouring countries, there is a danger of singling out specific groups. For public health measures to be effective and to foster social cohesion, it is important to avoid stigmatising communities and social groups associated with the mpox virus. Stigmatisation can lead to discrimination, avoidance of health services and increased isolation, thereby exacerbating the outbreak’s impact.
• Avoid the use of ‘sex worker’ when referring to populations at risk of mpox. Transactional sex dynamics need to be better understood in relation to women’s discrimination and poor working conditions in mines and in consideration of overall livelihood strategies. Greater understanding of women’s livelihood strategies in ASM – which can involve commercial sex and less visible forms of transactional sex – will inform appropriate and inclusive interventions.
• Incorporate a conflict-sensitive lens in all mpox responses in eastern DRC. Eastern DRC, and particularly South Kivu province, is characterised by ongoing conflict, social fragmentation and complex humanitarian needs. When responding to outbreaks like mpox, it is vital to incorporate a conflict-sensitive lens and rights-based approach to ensure that interventions do not exacerbate existing tensions and that the human rights of all individuals are upheld.
• Involve women and women-led associations in mpox responses. Involving women and women-led associations is essential for developing effective public health strategies for mpox that consider the unique needs and perspectives of women. There are women-led community-based organisations (CBOs) locally rooted and trusted by women in communities, which can act as socio-cultural navigators for national and international organisations rolling out mpox outbreak responses in ASM.
• Listen to children’s voices and engage them in mpox responses. Children in ASM zones face unique challenges and vulnerabilities. In addition to health, protection and physical dangers, they may also experience limited access to education, healthcare and other essential services. Children are at a high risk of developing complications from mpox. School-based and mine-based interventions targeting children should be explored, recognising that we need to better understand connections between child labour in mines and school attendance.
• Integrate mpox responses with health, protection and economic empowerment programmes for women and children in mines. Women in mines often face unique health risks and economic challenges, which can be exacerbated during health emergencies like mpox outbreaks. Community-based programmes that provide protective measures against mpox while promoting women’s economic independence can help mitigate the socio-economic impacts of the virus, ensuring that women are not only protected but also economically empowered during health crises.