Onslaught of Disease Attacks War-Weary East Africa

GENEVA, Switzerland, December 8, 2006 (ENS) - Prolonged flooding in the Horn of Africa has placed up to 1.8 million people at risk of infectious diseases such as cholera, measles, malaria as well as nutritional deficiencies, the World Health Organization, WHO, said today.

Since October, unusually heavy rains have swept across Ethiopia, Kenya and Somalia, and the downpour is forecast to continue for months.

"The floods are expected to continue until at least the end of December if not into early next year," said Dr. David Okello, WHO's representative in Kenya.

"We are already experiencing a serious situation where people are dying from diseases related to the water and sanitation situation," said Dr. Okello. "Malaria will become a very serious problem in the weeks to come."

In Ethiopia, some 40,000 cases of acute watery diarrhea have been reported, including 403 deaths. In Somalia, 100 cases have occurred, most in children under five years of age, according to the World Health Organization, WHO.


Aid workers help Ethiopians stranded by the flooded Awash river. Children have to be carried as far as five kilometers (three miles) as they cannot swim or walk in the muddy water. (Photo by Melese Awoke courtesy WFP)
The rising tide of infections is due to a combination of displacement, living in crowding conditions, lack of clean, safe water, and the destruction of sanitation systems, says the global health organization.

Insecurity in war-torn Somalia is escalating and people fleeing the conflict are seeking refuge across the border in Kenya. This will sharply increase the number of people living in camps and increase the potential for health risks.

Water and sanitation systems are disrupted and normal water sources have become unsafe for drinking due to the impact of flood waters and other contaminants.

"In one of the worst affected regions in Kenya, the Garrissa district, people were forced to get water from contaminated sources as the two liters per person that were available did not meet their basic needs. The recommended quantity is 10 times more," said Dr. Michelle Gayer, a WHO communicable diseases expert, after a visit to the area.

"Many roads are cut off, some people have reached temporary camps while others are stuck in their homes without enough food or medical care," she said.


The UN World Food Program has launched an air operation to reach marooned flood victims in Kenya. High energy biscuits are being distributed to 200,000 people. (Photo courtesy WFP)
Outbreaks of cholera, with deaths, have been reported and can be expected to continue in the near future, Dr. Gayer says.

The region is endemic for many health problems, including cholera, diarrhea, malaria, shigellosis, Rift Valley fever, measles, meningitis and malnutrition. Many health indicators are worryingly low, said the doctors, including vaccination coverage rates.

"The WHO priorities in the region are to improve the water and sanitation systems, the surveillance of disease outbreaks, the running of health services and food and nutrition," said Dr. Okello.

"We will also institute indoor residual spraying to fight malaria, and immunize children in the camps at least against measles, one of the top child killers," he said.

Three times the number of people are seeking medical care now as compared with the weeks before the floods, but access to health centers is hampered by damaged roads and bridges. Many health workers cannot get to work and patients cannot get to the health centers.

Due to previous droughts, people in the region have experienced severe food shortages and high rates of malnutrition so their immunity is weakened, making them more vulnerable to diseases.

"WHO is ensuring a stockpile of essential drugs for the treatment of waterborne diseases and equipment for laboratories and others, said Dr. Okello. WHO is also helping the Ministry of Health in controlling the water quality.

A key WHO concern is the major gap in outbreak preparedness. The Horn of Africa region lacks laboratory capacity for confirmation of epidemic-prone diseases and stockpiling of emergency medicines and equipment. No isolation facilities have been identified, while the health facilities have poor infection control.

Meanwhile, in arid eastern Chad, there are no floods, but health workers are struggling to keep up with increasing numbers of refugees while they themselves are under attack.

WHO staff was forced to withdraw from the town of Abéché with other UN staffers following an attack on a warehouse and staff in the past 10 days.


International Rescue Committee doctor Hafiz Abbas is on his morning round among the many patients in a camp outside El Fasher, Sudan. (Photo by Peter Biro courtesy IRC)
Only a skeleton staff remains in the 12 refugees camps scattered along Chad's border with Sudan where hundreds of thousands of refugees who fled the fighting in Darfur are sheltered.

In the eastern region, which has been hosting more than 234,000 Sudanese seeking refuge from the conflict in Darfur since 2003, the rebellion has also displaced an estimated 63,000 Chadians this year.

After a series of violent attacks over the past two months, at least 50,000 civilians in southern Darfur have fled to the arid countryside.

Villages have been burned, civilians shot, water sources, crops, and food stocks destroyed.

Doctors Without Borders/Médecins Sans Frontières, MSF, is providing surgical assistance to the wounded. The international medical humanitarian organization has set up fixed and mobile health clinics, and is distributing plastic sheets, blankets, and food.

Thousands of families, forced to flee because of violent attacks, are scattered over inhospitable terrain south of the town of Muhajariya, Sudan. They are living in small groups under bushes and trees, hiding from the scorching sun during the day and cold at night. Their food is running out, and they have little or no access to clean water.

Every day MSF staff members are confronted with the suffering, despair, and misery of people who are trying to continue their life in any way possible but with little resources.


Displaced family camps in the open near the town of Muhajariya, Sudan. (Photo courtesy MSF)
"I can't sleep thinking about these people," said Jonathan Henry, MSF's project coordinator in Muhajariya. "One woman told me she was at home with her seven children when the fighting started. Armed men burned her house and all her property. They shot at her children as they ran to get away. Now she's displaced and she wants to get as far away from Muhajariya as quickly as possible. I just don't see where they can go."

There are no places where displaced people can seek health care, says MSF. Their general health status is precarious, and can be expected to worsen given their living conditions.

People have difficulty in getting medical care partly because aid agencies cannot reach them. Since the beginning of 2006, MSF teams have been the victims of more than 40 security incidents of varying severity, many of which have taken place on the roads supposedly under control of the Sudanese government.

The insecurity means that today, MSF is only able to use one road in the whole of Darfur, an area the size of France. All other transport is carried out by UN helicopter or plane.

"We have not had access to the rebel areas in the Jebel Marra for more than six weeks," MSF head of mission Jean-Sebastien Matte said in November. "We managed to care for about 500 cases of cholera before then, but there were certainly 300 to 400 more that we were unable to see. This means that these people may have died because a lack of medical care."

Dr. Innocent Nzeyimana, coordinator of the WHO sub-office in Abéché, said that "as violence intensifies, the number of persons wounded by fighting is becoming a serious concern," adding that "local personnel is not sufficiently trained nor local resources sufficient to handle these cases."