Containing cholera in IDP camps

Torrential rain in northern Uganda has created conducive conditions for cholera to spread in the squalid, overpopulated camps where 90 percent of the population of Kitgum District live. Six people have died, and 504 have been infected by the disease. Nyeko Benson, 15, sits beyond the black plastic sheeting that creates a makeshift cholera ward at Kitgum’s government hospital. He is holding a hamper of food for his mother, who came to the facility that morning, violently ill with cholera. "Her eyes went black and started rolling in her head. And then she just fell down. It was very frightening. She had really bad vomiting and diarrhoea. We are very worried but praying she will get cured, because she is the only person to take care of us," he said. The odds are good that Benson's mother will recuperate: with proper treatment, survival rates for those afflicted with cholera are high. Benson's mother is one of almost two million civilians in northern Uganda who have been forced to abandon their homes by a two-decade war between the government and the rebel Lord's Resistance Army (LRA). Many of the internally displaced persons (IDPs) live in camps dotted throughout the region, fearing attacks by Joseph Kony's LRA rebels, who are infamous for abducting children and carrying out grizzly night raids. These camps are the perfect breeding ground for contagious diseases like cholera. Huts are built only metres apart, and sanitation is poor. Many people relieve themselves near streams rather than using the camp latrines. Queues for borehole water are long, leading people to drink from those same streams. Rain turns the camps to mud, and children are left to play in yesterday's sewage. When cholera hit Agoro 14 camp, new bylaws were introduced covering everything from where not to defecate to when not to attend funerals. It had some effect, but behaviour does not change overnight.

Joseph Kony, leader of the Ugandan rebel group, the Lord's Resistance Army (LRA).

Doctors fighting cholera in the camps have now called for cattle fairs to be banned until the epidemic is brought under control. They blame Sudanese cattle traders for introducing the waterborne disease to the district in mid-April. The traders’ continued cross-border movement threatens to intensify the outbreak, said Oringa Vincent, Kitgum's acting district health officer. More cases expected Cholera was introduced to northern Uganda at Agoro camp through cattle fairs in April. One month on, Oringa said, the district, which is near the Sudanese border, is bracing itself for a renewed outbreak. "It is still a very bad situation. We expect it to continue increasing over the next few days because of the rains. The Sudanese are still coming in to trade cattle. We had another market in Agoro yesterday. We have recommended that the cattle markets are stopped until the cholera is brought under control," he said. Senior officials from Kitgum were travelling to Agoro to discuss the feasibility of suspending cattle markets with local leaders. Around 2,000 people flock to the monthly market from Kitgum, the neighbouring districts of Gulu and Pader, as well as southern Sudan. The market is vital to the fragile camp economy but a dangerous mechanism for spreading diseases like cholera across the region. Cholera has raged in southern Sudan this year, killing over 500, according to aid workers. Since arriving in Agoro, the killer bug has swept through Kitgum's camps in a counterclockwise arc: Potika, Palabek Gem, Kitgum town and now the western sub-county of Naam-Okora, perilously close to the camps of Pader District. Kitgum District has set up 12 cholera treatment centres in coordination with humanitarian agencies, including the International Committee of the Red Cross, the United Nations Children's Fund (Unicef), the UN World Health Organization and the International Medical Corps (IMC). Patients are quarantined; cleaners wear gum boots, plastic overalls and gloves, and anyone entering or exiting is sprayed down with a chlorinated solution.

Northern Ugandans IDPs have been resettled to government-controlled camps, sometimes forcibly, in the face of the ongoing civil conflict.

Moses Kiwanuka, IMC's director in Kitgum, said the agencies have moved from fire-fighting to preparing camps unaffected by cholera for the disease's arrival. "Originally, we were chasing the cholera," he said. "We heard it was here; we came here. We heard it was there; we went there. But now the cholera is chasing us. We are a step ahead, sensitising areas before cholera has struck. That is how we are ambushing this epidemic." Before the recent rains, the rate of increase was on the wane, with 108 new cases weekly, down from 204 earlier this month. However, Oringa said, not enough money had been provided to the district to educate people on the importance of hygiene and sanitation. "Financial support is a big problem," he said. "Our biggest consideration is sensitisation, but road shows cost money. I went to the ministry in Kampala to ask for more money and came back with 500 litres of [oral rehydration] fluids. It was finished within the week." At the hospital, Nyeko said he was going to draw a lesson from what has happened to his mother. "We do not usually bother to use the latrine, because it is such a long way from our house. Now we are going to speak to the owner or build a latrine for the house, because this is too bad," he said. "We will also clean up the area near the house - cut down the bushes and throw away the rubbish - because we don't want this happening again."