(Khartoum, Sudan) Fever, headaches and joint pain have plagued Amani Hassan’s daily life since January. In the midst of preparations for her daughter’s wedding, the 50-year-old tried to overcome her ailments with painkillers. After the celebrations passed, his health continued to deteriorate. And the excessive rations of painkillers ended up affecting his kidneys.

Until this employee of the Ministry of Industry of Sudan woke up in the hospital, at the beginning of March. He was diagnosed with dengue fever.

For the very first time, this virus carried by mosquitoes of the Aedes genus is indeed spreading in the state of Khartoum. The causes of the migration of this mosquito are not yet determined, but Sudanese doctors fear the worst.

As of March 13, 2,231 cases had been identified, including 1,076 around the capital. Usually, this epidemic is limited to the east and southwest of this giant of the Horn of Africa. But this year, the haemorrhages caused have caused 43 deaths, including two in the state of Khartoum. “Infected mosquitoes may have traveled by bus, car or plane,” says Asma Saad. This general practitioner is one of dozens of practitioners requisitioned to deal with this new health crisis.

Due to the lack of available space, a center to treat the most serious cases has opened in the wing of the University Hospital of Omdurman, a city neighboring Khartoum, which until then was used to isolate patients with COVID-19.

Sudanese clinics were already weakened by 30 years of military-Islamist dictatorship led by the kleptocratic Omar al-Bashir. They are now suffering from the freezing of several billion dollars in international subsidies – to sanction the coup of October 25, 2021, which interrupted the democratic transition started in 2019.

“We lack platelets and blood to transfuse dengue fever patients who suffer from haemorrhage,” says Asma Saad. The young woman has seen her working conditions deteriorate since the putsch. His double exposure to dengue fever and COVID-19 earns him no more than 10,000 Sudanese pounds (about C$23) a day – a sum that seems astronomical to employees of the Ministry of Health.

This public hospital finances most of the drugs, at least those offered. Many are out of stock. Additional examinations, blood or urine, for example, remain the responsibility of the patient. Smiling in his white djellaba as he spat blood a few minutes earlier, Muaz Jehal has already spent two-thirds of his salary on March 12 to pay for his treatments. However, dengue mainly affects working-class neighborhoods, such as the town of this primary school teacher in the suburbs of Omdurman.

The taps are often dry, forcing residents to store their water in tanks conducive to the proliferation of Aedes mosquitoes. The most dangerous, insists Mohammed Alhassan, representative of the World Health Organization (WHO) for the state of Khartoum, are the larvae. The latter nest on the walls of earthenware jars, the “zir”, where they can survive for months while carrying the virus.

Supported by the WHO, the Ministry of Health therefore invests television channels, radio antennas and public walls to disseminate prevention messages. The main recommendations are to clean and cover the water tanks as well as to shelter as much as possible behind a mosquito net.

But these instructions are struggling to be applied. At Omdurman hospital, the medical team tries to convince Amani Hassan to comply. The 50-year-old, sitting next to her bed, assures us that she will sleep tonight under her mosquito net. “An Aedes mosquito attacks during the day,” doctor Asma Saad repeats to her for the umpteenth time. The insect can then carry the virus from a sick individual to a healthy person.

Climate change could partly explain the establishment of this pest in Khartoum.

Over the past ten years, the rainfall that generally refreshes this arid territory between June and October has become increasingly irregular. “If there is a lack of rain, the mosquitoes can migrate to another area. While heavy rainfall concentrated in one area can lead to the development of mosquito species previously absent,” summarizes Adil Ismail, both a member of the technical committee for the control of emergencies and epidemics of the Federal Ministry of Health and president of the NGO Elebdaa Forum for Culture and Science.

This microbiologist fears that the authorities will fail to stem the epidemic before the next rains. The virus would then risk spreading to all 18 states, threatening to capsize a health system close to agony.