The hospital in Majuro is overflowing, its doctors exhausted, its wards strained, budgets withered, and no end in sight. Every day, dozens more patients are wheeled in to wait in corridors.
An aerial view of the downtown area of Majuro Atoll, the capital of the Marshall Islands, which has been hard hit by a dengue outbreak. Photo: Marshall Islands Journal
A dengue fever outbreak in the Marshall Islands has entered its sixth month and despite border restrictions, mass spraying operations, countrywide cleanups and awareness campaigns, authorities say it's only getting worse.
"We just feel like we're fighting a war here," said Jack Niedenthal, the country's health secretary. "It's just been awful for the last six months."
"This is the worst outbreak in the history of the Marshall Islands," he added. "We've never had a six month state of health emergency."
Last week alone, the hospital on Majuro saw 160 cases of dengue fever, the worst week since the outbreak was first declared in July. It also saw its worst day so far, Monday, with 41 confirmed cases.
"For our hospital, 10 is a lot because these cases have to be closely monitored hour-by-hour, vital signs and you need blood platelet counts," Mr Niednthal said.
The dengue outbreak started on the atoll of Ebeye in July 2019, before spreading to densely-populated Majuro. The outbreak on Ebeye has been reined in, Mr Niedenthal said, but Majuro continues to be afflicted.
Since July, nearly 2200 cases have presented in hospitals, but it's suspected that as many as seven or eight thousand have had the disease. The population of the entire Marshall Islands is 53,000.
Late last year, in what was thought to be the peak of the epidemic, a State of Emergency was declared by former president Hilda Heine, which deployed a range of measures to clean up mosquito breeding areas and impose travel restrictions to outer islands, where an outbreak would be particularly devastating with few health resources.
Ministry of Health staff led a grounds cleanup in August to rid the main hospital of mosquito breeding locations. Photo: Jack Niedenthal
In December, it was thought the epidemic was on the wane and State of Emergency measures were eased, allowing people to return to their home islands for Christmas.
But since then, things have been worse than ever.
"The hospital has just been overwhelmed," Mr Niedenthal said. "Things are getting worse, not better."
At Majuro hospital, resources have been worn thin. Doctors and nurses are exhausted, their workload made worse by an outbreak of a severely virulent form of Influenza-A late last year, which struck down otherwise healthy adults.
Teams from a US charity, Rubikon, have been sent to help, and another team of doctors from the US was due to arrive this weekend, Mr Niedenthal said.
And dengue has this week returned to the outer islands, too. Cases have since been found on five atolls, although in small numbers that have so far been contained.
"Our outer island facilities, most of them don't have electricity of the means to do blood counts, so we have to medivac them [to Majuro] at great expense," Mr Niedenthal said, adding that the government was contemplating bringing back travel restrictions.
He added that it's not known what is behind the spike in recent weeks, but in some respects, guards were dropped when numbers started waning. For Christmas, he said, everyone moved around Majuro to large public gatherings.
In the meantime, spraying operations continue. Crews are spending every daylight hour finding places mosquitoes could linger, and telling communities of the need to clean their homes and wear repellant.
"This country has spent over two million dollars fighting this dengue disease, and maybe for big countries this doesn't sound like much but for us it's devastating," Mr Niednethal said.
"There's so many things we could've used to buy at that hospital, equipment and what not."
Red Cross volunteers have been active in distributing mosquito nets to residents in Ebeye (pictured) and Majuro. Photo: Roger Muller
The spread of dengue has added to the problems faced by the Marshall Islands, a remote and sprawling chain of atolls in the North Pacific. It's strained an already limited health system diverted funding from the national budget and other agencies, with the country facing the compounding effects of climate change.
Mr Niedenthal said climate change was almost certainly affecting the number of disease outbreaks. In November, hundreds on Majuro were forced to seek shelter for days when the capital was inundated by king tides.
"We had eight disease outbreaks last year, this is something we haven't seen before," Mr Niedenthal said. "It's so unusual for us to see these things, what else could it be? This is directly related to climate change."
"Dengue isn't something we see all the time here, the last outbreak was eight or nine years ago. It's a really dry climate here."