A protracted drought followed by the onset of the rainy season in southern Angola has triggered a sharp increase in cholera cases, mainly concentrated in Cunene province, where over 1,000 infections and 48 deaths were recorded during a two-week period in November, according to figures from the Ministry of Health.
Cholera is a highly contagious disease associated with poor sanitation and access to safe drinking water. It is endemic in Angola, where nearly half of the population live in conditions conducive to the spread of the illness, according to the World Health Organization (WHO).
A year-long outbreak that started in the slums of the capital, Luanda, in February 2006 and spread to 16 out of 18 provinces, resulted in over 80,000 reported cases and 3,000 deaths.
So far, the current outbreak has remained almost entirely confined to Cunene, although neighbouring Huila province has also recorded some cases. Since January 2013, the country as a whole has recorded just over 5,600 cholera cases and 190 deaths, about 70 percent of them in Cunene.
Supply of safe water dried up
A drought that started at the end of 2011 is now affecting over 1.8 million people, with five provinces in the south worst affected, among them Cunene. Acute malnutrition rates as high as 25 percent in areas experiencing food shortages due to the drought have left children highly susceptible to waterborne illnesses including cholera, notes a November statement from the UN Children’s Fund (UNICEF).
Pedro Kawilila, a UNICEF representative based in Cunene, says the drought has also forced people to resort to drinking “very dirty water”. Cunene’s largely rural population rely on “chimpakas” - natural and man-made depressions in the ground that store rainwater – primarily as a source of water for their livestock. However, at the height of the drought, when wells and boreholes ran dry, they started collecting stagnant water from the chimpakas for domestic use.
“Cunene is a province that has a problem with the supply of safe water,” commented Manuel Eduardo, a WASH (water, sanitation and hygiene) specialist working as a consultant for UNICEF in Cunene. “What’s needed is a strong programme in terms of people being able to treat water at home, and construction of more boreholes. There are boreholes, but some have dried up and others haven’t been maintained.”
Open defecation is the norm in the province, added Eduardo. “They don’t construct latrines, and before the rain they didn’t have enough water to wash their hands and so on.”
The lack of safe water and sanitation meant that even before the onset of the rainy season, UNICEF had reported over 1,500 cholera cases in Huila, Cunene and Benguela provinces between January and July, resulting in 62 fatalities. “When the rain started in October, it made it worse,” Kawilila told IRIN in a phone interview. “Because of open defecation, the rain swept that stuff into water sources.”
Poor access to health care
A humanitarian worker who asked not to be named, confirmed that an already worrying cholera caseload had risen steeply after the rains began, and pointed out that the figures in the government’s weekly epidemic bulletins only included those who had sought assistance at health facilities. “We don’t know the real situation because a lot of people don’t have access to health centres,” she told IRIN. “It could be very high.”
According to the WHO, cholera is easily treatable with rehydration salts, but if left untreated can result in death within 24 hours.
“Cunene is a very difficult province, because people’s homesteads are very dispersed and the roads are so bad; it’s difficult for these people to reach health posts,” said Eduardo. “The idea now is to locate strategic places where we can set up [temporary] cholera treatment centres.”
UNICEF is providing tents for these centres and since the establishment last week of a commission to address the crisis, the government is also starting to supply military doctors as well as tents, gloves, beds and rehydration treatment. A shortage of such supplies and a lack of trained health workers hampered earlier attempts to respond to the outbreak.
“Before the rain started, it was treated as diarrhoea - no one wanted to talk about cholera,” said Kawilila. “Relatives that were caring for the sick weren’t being given gloves, so they were getting infected also. There are still places we need to go to train health workers in cholera treatment.”
“The government now is responding in terms of the emergency,” said Eduardo, but in terms of a long-term response to prevent further outbreaks, “there is not enough happening.”