The World Health Organisation has sounded the alarm over an outbreak of the plague in Madagascar.
It says 40 people have died since August, out of a total of some 120 cases.
The WHO says there is a risk of the disease spreading rapidly, and not everyone is aware of the crisis.
One resident said: “I don’t know anything about a disease outbreak. I really do not know what you’re talking about.”
There is concern that cases may start to spread in the capital, which has a dense population and a lack of good healthcare facilities.
Another resident said: “Our hospital can’t treat serious illnesses; they don’t have the facilities. They don’t even have medicine to deal with small cases.”
The plague is a deadly infectious disease spread between rodents, mainly by fleas, and humans infected can develop a bubonic form of plague.