Heavy rainfall is accelerating the spread of cholera in Sierra Leone and Guinea, where existing health risks such as poor hygiene practices, unsafe water sources and improper waste management are believed to have triggered the disease which has killed 327 people and infected more than 17,400 in both countries since February.
The UN Office for the Coordination of Humanitarian Affairs (OCHA) said Sierra Leone was facing its worst cholera outbreak in 15 years. Ten out of the country’s 13 districts have been affected and the government has declared the outbreak a national emergency.
Guinea’s capital, Conakry, has been the hardest hit in the country, with 3,247 cases so far. Cholera has also broken out in nine of Guinea's 33 districts, OCHA said.
“The onset of the rainy season in West Africa has caused an increase in cholera cases on both sides of the border between Sierra Leone and Guinea. The rains are particularly heavy in Sierra Leone this year,” said Laura Marconnet, an external relations officer with the UN Children’s Fund (UNICEF) in Sierra Leone.
Prevalence is high in the congested slum areas in the capitals of Guinea and Sierra Leone which have few clean toilets and most people defecate in the open, often dangerously close to open wells which are the source of water for most residents.
Freetown’s densely populated Mabella slum, with tin shacks and poor drainage, has been badly affected. There are several community water taps, but residents complain of lack of adequate toilets, which are usually clogged with water and waste during the rainy season.
“We have seen a dramatic increase in the last 5-6 weeks in cases especially in Freetown. The response is quite difficult in terms of coordinating resources,” said Amanda McClelland, the Africa emergency health adviser at the International Federation of Red Cross and Red Crescent Societies (IFRC). “The conditions in Freetown are the perfect storm for cholera.”
“We know we haven’t contained it by any means and it has the potential of increasing further and becoming a regional issue,” McClelland told IRIN.
On 17 August, Sierra Leonean President Ernest Bai Koroma declared the outbreak a national public health crisis. The authorities and aid groups have ramped up efforts to treat, inform people and improve sanitation to stem further escalation.
"We are moving quickly to increase our capacity to handle all the new patients that will arrive,” said Karen Van den Brande, head of Médecins Sans Frontières (MSF) mission in Sierra Leone. “Our present cholera treatment facilities are stretched to the limit with patients. Everybody is at risk.” A new quick-disbursing humanitarian funding facility is being used for the first time to help tackle the emergency.
Sierra Leone’s national water company has begun a major dam and pipe clean-up to help reduce the spread of cholera.
"There is every possibility that the pipe water system may have been infected since there are many broken water pipes flowing with water which need to be fixed in many parts of city,” said Martin Bash Kamara, deputy minister for energy and water resources. “People should take every precaution to purify the water by boiling it before drinking, cooking or other domestic purposes to avoid contamination."
West Africa has some of the world’s lowest rates of access to water and sanitation. Only 12.8 percent of Sierra Leone’s 5.5 million people have access to proper sanitation and 42.9 percent do not have access to clean drinking water; 28.9 percent defecate in the open, according to UNICEF. In Guinea, only 19 percent of the population has access to improved sanitation and 71 percent of its 10 million people have access to safe drinking water sources.
“This is the underlying cause for cholera outbreaks in West and Central Africa. Although measures for cholera response can help contain the spread of the disease and reduce the number of fatalities, it is essential to also tackle the underlying cause of this disease,” said UNICEF’s Marconnet.
The cholera outbreak has not peaked yet, said Marconnet and the rainy season is expected to last for the next two months. Treatment and other efforts to improve sanitation are expected to lower the rate of infection. Cholera is treatable and can be prevented through better hygiene.
“With increased coordinated efforts… we hope that the epidemic in the coming months will decrease due to scaled interventions,” said Charles Mugero of the World Health Organization (WHO) in Sierra Leone.
So far this year, more than 37,400 cholera cases have been reported in 15 West African and Central African regions.
In 2010, 36 percent of cholera cases globally were reported from Africa, which accounted for between 93 and 98 percent of cases worldwide between 2001 and 2009, according to WHO, noting Africa last recorded such a low rate in 1995. In 2010, 317, 534 cholera cases were reported to WHO, with more than 50 percent occurring in the Americas, notably in Haiti. However, the officially reported cases do not necessarily reflect all the occurring cases due to underreporting and other technical limitations.