HAVANA, Cuba (AFP)—Cuba has been gripped by an outbreak of the viral disease chikungunya, as it battles shortages of clean water, food, fuel and medicine, during its worst economic crisis in decades.

Island residents have no choice but to ride out the ailment with little to eat or basic medicines to relieve fever and joint pain that can be debilitating but rarely fatal.

“Everything hurts,” 81-year-old Pilar Alcantara told AFP, lying weakly on a couch in her dilapidated living room in Old Havana.

“I can’t walk.” She lives alone.

The virus first emerged in Cuba’s western Matanzas province in July, but is now in all 15 provinces of the country of 9.7 million people.

Simultaneously, the communist island has been afflicted by outbreaks of dengue, Zika, Oropouche and yellow fever — all mosquito-borne, like chikungunya.

“Everyone here has gotten it (chikungunya),” Eva Cristina Quiroga, 74, said as she waited outside her building in Havana while it was being fumigated for mosquitos.

– Medicines ‘not available’ –

Francisco Duran, head of epidemiology at the public health ministry (Minsap) said more than 47,000 Cubans were diagnosed with chikungunya this week alone — double last week’s number.

Last week, he reported that nearly a third of Cuba’s inhabitants had contracted chikungunya or dengue in recent weeks.

Patients told AFP there is nothing to do but to wait it out — often on an empty stomach.

“You can’t even buy chicken,” complained Fidela Freire, 61, who said she was forced to endure the symptoms without any treatment as paracetamol, a common painkiller, is “not available at the pharmacy.”

Under US sanctions and its critical tourism sector left in ruins by the Covid-19 epidemic, a dearth of foreign currency has seen a steep decline Cuba’s medical services and prevention programs such as mosquito fumigation.

In Havana’s Jesus Maria neighborhood, where Alcantara and Freire live, garbage is piled up on the street for lack of fuel for removal trucks.

Conditions are even more dire in the country’s east, ravaged three weeks ago by Hurricane Melissa which caused significant structural damage, including to 642 clinics.

Cuba, long known for its medical and pharmaceutical expertise, was able to deal a swift blow to a previous chikungunya outbreak in 2014.

This time, the one-party state reports, the outbreak spiraled out of control due to “lack of hygiene, accumulated garbage” and people storing water in tanks to mitigate the intermittent availability of tap water.

According to Minsap, 20 Cubans were in a critical condition with chikungunya on Thursday.