Photo: The Canadian Press

A child wears a face mask inside a hospital in the capital Antananarivo, Madagascar. 

As plague cases rose last week in Madagascar's capital, many city dwellers panicked. They waited in long lines for antibiotics at pharmacies and reached through bus windows to buy masks from street vendors. Schools have been cancelled, and public gatherings are banned.

The plague outbreak has killed 63 people in the Indian Ocean island nation, Madagascar's government says. For the first time, the disease long seen in the country's remote areas is largely concentrated in its two largest cities, Antananarivo and Toamasina.

Global health officials have responded quickly. The World Health Organization, criticized for its slow response to the 2014 Ebola epidemic in West Africa, has released $1.5 million and sent plague specialists and epidemiologists. The Red Cross is sending its first-ever plague treatment centre to Madagascar.

On Wednesday, Madagascar's minister of public health rallied doctors and paramedics in a packed auditorium at the country's main hospital, saying they're not allowed to go on vacation.

"Let's be strong, because it's only us. We're at the front, like the military," Mamy Lalatiana Andriamanarivo said. The outbreak could continue until the end of infection season in April, experts warn.

Madagascar has about 400 plague cases per year, or more than half of the world's total, according to a 2016 World Health Organization report. Usually, they are cases of bubonic plague in the rural highlands. Bubonic plague is carried by rats and spread to humans through flea bites. It is fatal about half the time, if untreated.

Most of the cases in the current outbreak are pneumonic plague, a more virulent form that spreads through coughing, sneezing or spitting and is almost always fatal if untreated. In some cases, it can kill within 24 hours. Like the bubonic form, it can be treated with common antibiotics if caught in time.

The WHO calls plague a "disease of poverty" caused in part by unsanitary living conditions. 

While the WHO says the risk of the epidemic spreading beyond the region is very low and does not advise restrictions on travel to Madagascar, Air Seychelles has cancelled all flights to and from the island until further notice.