First cholera, now measles

Angola's fragile health system is struggling to cope with a measles outbreak that has already killed more than 25 children in the centre of the country, and is spreading.

Fatalities have been confined to the agriculture-rich highland province of Huambo, but cases have now been reported in the capital, Luanda, and the provinces of Cabinda and Lunda Norte in the north, Cuando-Cubango in the southeast and the coastal province of Benguela.

"The outbreak that hit Huambo is not isolated - we have been experienced low-intensity outbreaks across the country since last year," said Nicholas Velarde, a member of the WHO polio eradication team in Angola. "In the past few days we have recorded more than five confirmed cases from the provinces, and we treat this is a warning of a potential disaster. We do not have accurate statistics, but this could be another disaster if proper interventions are delayed," he told IRIN.

Although some of the cases could be dealt with in the ongoing nationwide anti-measles and -polio campaign vaccinations, which began early this month and will end on Friday, the WHO is preparing for an emergency.

Velarde said the national immunisation campaign to eradicate polio, measles and malaria among more than 3.5 million children had gone well so far, but Angola continued to suffer from the triple threat of cholera, measles and malaria because of serious capacity problems, which were a legacy of the 27-year civil war that ended in 2002, and government's failure to invest in basic health services since then.

"Angola has no capacity for disease surveillance control - it lacks a functional health and communications infrastructure. We are concerned with the current outbreaks, but our primary focus remains on capacity building in the relevant arms of government. The health services network needs to be strengthened - it is too weak," he said.

Karen Godley, head of mission for Swiss agency Medicines Sans Frontiers, told IRIN that their disaster response teams were withdrawing from some provinces because there had been an overall drop in the number of cholera cases. More than 2,100 people died and over 51,000 were infected in 15 of the country's 18 provinces since the outbreak began in February.

"The cholera epidemic is under control in Benguela, Huila [Province in the southwest], Cuando-Cubango, Namibe [Province on the south coast] and Kwanza Norte [Province in the north]. There is an overall decline in the number of new cases, and we are satisfied that the government can handle the situation. We have also left a lot of supplies behind to increase the response capacity of the institutions where we had cholera treatment centres," she said.

MSF would now concentrate on capacity building and disaster preparedness measures in the ministry of health, Godley said. The cholera outbreak was blamed on the absence of clean water and the state of environmental health in rural and urban Angola, and the government needed to invest more in public health infrastructure and services to improve the lives of its vulnerable people.