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Poor sanitation hampering fight against cholera in IDP camps

[Uganda] IDPs colleting water from a well in Bobi camp near Gulu.
IDPs collecting water from a well near Gulu town. (IRIN)

Poor sanitation and congestion in internally displaced persons’ (IDP) camps in northern Uganda are hampering efforts to control a cholera outbreak that has killed five people in Gulu district and infected 449 others, health officials said on Monday.

Vincent Oryem, a medical doctor working for the UN World Health Organization (WHO) in Gulu, said the health agency was working with local authorities to try and control the epidemic, but congestion in the IDP camps was making health management very difficult.

"In Pabbo [the largest IDP camp, housing some 64,000 people], where we have recorded 382 cases, the poor-sanitation problem has been worsened by the heavy rains and there has been no decrease in cases reported. In the second largest camp of Amuru [48,000 people], we have had 35 cases and this keeps on going up," he said.

"We hope that we will be able to control the epidemic better during the dry season when we shall have fewer rains," Oryem added.

The IDP camps which are scattered across northern Uganda are home to approximately 1.6 million people displaced by a 19-year war between rebels of the Lord's Resistance Army and Ugandan government forces. Several of the camps are near Gulu town, 380 km north of the capital, Kampala.

Due to the crowded nature of the camps, little space remained to build pit latrines, Oryem explained. Decongesting the camps by moving residents to other locations had proved problematic.

"We have identified a number of sites. The army has agreed to give them security and we have encouraged people to go there, but all these places are lacking social services like schools, health centres and water facilities," he said.

Many of the water points at the camps were contaminated with cholera, Oryem observed. WHO had initiated a bucket-chlorination programme - a process of treating water with chlorine to kill harmful organisms.

Together with local authorities, he added, WHO was also mobilising people through radio talk shows advising them to observe good hygiene and sanitation practices.

With water distribution limited to five litres per person per day, however, few people felt they could afford to use what little water they had to wash their hands after visiting the toilet.

Twenty people had died of the disease countrywide and hundreds remained infected by Monday. In the northwestern district of Arua, at least 10 people had died out of 123 cases reported over the past two weeks.

"Water is the main problem in the area. The land is sandy, and this has made it difficult to construct proper pit latrines. People's hygiene practices remain very poor, but we have intensified health education in the communities involving both political and health workers," Patrick Anguzu, the Arua district director of health services, explained.

Seven other people had died of the disease in Nebbi and Kampala.

A spokesman for the Ugandan health ministry, Paul Kaggwa, said health officials had tried to evacuate places prone to cholera outbreaks, especially in Kampala, but unnamed politicians had frustrated their efforts.

"In Katanga [a slum in Kampala] several people have been living near a sewer, but efforts to ask them to leave the place have attracted intervention from politicians. Cholera has not gone because these areas have remained dirty and personal hygiene is poor," Kaggwa said in reference to the outbreak in the capital that had claimed five lives.

Kaggwa said cholera was a recurrent problem and health management alone was insufficient to control it.

"Poor sanitation remains the main problem, and this will need more than health management. There is no way we are going to fight cholera when issues of health management are turned political," he said.

Kaggwa said the health ministry was helping vulnerable districts prepare for epidemics by putting mechanisms in place to quickly identify and address cholera outbreaks.

"We also equip them to manage the cases reported through the provision of enough drugs to health centres," he added.

Cholera is an acute water-borne intestinal infection that causes diarrhoea and vomiting. It can quickly lead to severe dehydration and death if not treated promptly.

This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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