More than 400 cases of watery diarrhoea in quake camp

Over 400 cases of acute watery diarrhoea have been identified in a camp in the district of Muzaffarabad in Pakistani-administered Kashmir as the threat of a disease outbreak in the earthquake stricken region of northern Pakistan looms. Fifty-five cases of acute watery diarrhoea have also been reported in a mountain village in the Muzaffarabad district. “This situation is explosive,” said Dr John Watson from the World Health Organization (WHO) based in Muzaffarabad. Acute watery diarrhoea leads to severe dehydration and within four to five hours this can lead to vomiting and a dramatic drop in blood pressure. It can be fatal if not treated quickly. “A rapid response is what is needed and for communicable disease control in this area this is the most pressing thing as the mortality rate can be very high,” said Dr Watson. Over 2,000 survivors are crammed into filthy tents in the Old University camp in the city of Muzaffarabad, the capital of Pakistani-administered Kashmir. This is a ‘spontaneous’ camp, with survivors erecting tents and makeshift shelters and the conditions are squalid. There is no water and the stench of sewage hangs in the air. The existing sewage pipe is broken and there are no latrines, only rudimentary holes in the ground. Many residents of this camp have resorted to defecating in the grounds of the camp, along the wall that surrounds the compound. With the rainfall mixing the mud and excrement into running streams of sludge, the camp is a ticking time bomb for disease. “We have over 400 cases of acute watery diarrhoea in adults and children which has been spreading rapidly in this camp. The challenge is to treat patients as quickly as possible with as much oral and intravenous fluid as possible,” said Dr Watson. Resources are being stretched, as tackling acute watery diarrhoea is a full-time operation which requires a huge amount of supplies. “You need to be staffed 24 hours a day, so it’s very taxing for staff and it’s an enormous strain,” Dr Watson said. “You need boxes and boxes of IV fluid and boxes and boxes of rehydration solution and there’s all the paraphernalia - gloves, tables, chairs…. all this needs to come in one day, it’s a challenge to have everyone focused on this at the same time,” he said. Dr Salahuddin Loghari from Humanity First works out of a tent on the Old University camp. Dr Loghari sees 300 patients a day and the medical tents are always full of patients. To contain the situation two tents are being set up across the road from the camp especially for patients suffering from acute watery diarrhoea. Two of Naziran Awan’s eight children have had acute watery diarrhoea. All eight of them have been ill. As she talks, one of her children plays barefoot on a metal grate, underneath which flows raw sewage, spluttering out onto the dirt ground and around the child. “The food rations are not enough to feed my family,” Naziran said. “It’s been hard for my children.” Fifteen-year old Irambad Zulqiar also says that food rations are not enough. “We often feel hungry, but the hardest thing is the toilets, they’re really horrible. I hate living here,” Irambad says. Dr Loghari says that living conditions must improve if the threat of disease is to be tackled. “These people are pyschologically blocked. This is not a way of life, but there’s no way out for them,” Dr Loghari said. In such overcrowded, dirty conditions with no clean water there is also a fear of a cholera outbreak. Cholera is extremely contagious and the symptoms are similar to acute watery diarrhoea, with diarrhoea and severe dehydration. “For cholera the threat is quite real. It’s a race against time to get the latrines done,” said Lisbeth List, a medical coordinator at Medecins Sans Frontieres. List says that locating space for latrines is a challenge. The soil is also posing a problem. “It’s hard to dig deep enough as the soil is hard on top and sandy underneath, so you can only go down about two metres at the most, when ideally you’d want to go to 3 metres,” List said. “The situation is far from idea, and we should take the threat of cholera very seriously in case it should happen.”