Cholera has killed at least 94 people in northern Cameroon and is spreading, in what health officials say is the most severe outbreak in years.
"We are used to seeing cholera here during the rainy season, but we don't understand what's happening this year," Kuété Fotié Yves, health director in the district of Moloko, told IRIN. "We have not seen an outbreak of this magnitude in at least 10 years."
Moloko has had more than half the region's cases – 773 as of 3 August. "We are seeing some 30 new cases every day," said Kuété Fotié. By the end of July some 1,300 cases had been recorded in Cameroon’s Extreme North region.
Cameroon is one of several countries across the region where flooding this year has killed many and destroyed homes, livestock and crops.
Cholera is commonly called "the disease of poverty", and Kuété Fotié said: "Poverty is absolutely the foremost cause here – people do not have the means to observe even a minimum of good hygiene. You can tell people all you want to wash their hands with soap before eating, but what if they don't have money to buy soap?"
Health workers in northern Cameroon said a lack of access to latrines and safe drinking water was contributing to the spread of infectious disease in the region.
Water shortages are common in the north, and the existing wells cannot provide enough water – only 30 percent of people in rural Cameroon have access to safe water, and just 15 percent to sanitation facilities, according to a 2009 report by UN Children's Fund (UNICEF) in Cameroon.
"Generally, people do not have toilets here," director of the Moloko district hospital, Pierre Kollo, told IRIN. "They defecate in the open, flies are everywhere, and food in the markets is not properly protected."
He said health workers were being sent to villages with medicines, saline solution and other supplies, to limit the movement of infected people. Health workers said the Health Ministry, UNICEF and the Red Cross were providing supplies.
Cholera treatment is being provided free of charge, with the support of UNICEF, the Red Cross, the World Health Organization and UN Population Fund, health officials said.
In the village of Sirak the public school – currently unoccupied as students are on holiday – has been transformed into a cholera treatment centre. Célestine Wassouo, one of three nurses manning the centre, told IRIN they were receiving at least five new cases every day.
The centre is currently short of bleach – used as a disinfectant – and supplies for intravenous drips. There is also no electricity in the village. "We get by with flashlights and lanterns," Wassouo told IRIN.
Rebecca Djao, Extreme North region health director, said about 60 percent of the deaths recorded to date had occurred in villages. She said under-nutrition was complicating the situation. "This year cholera has come during a time of food shortages – we are in the lean period.”
Cholera outbreaks are common in northern Cameroon, but this year the epidemic has not only been more severe but also struck earlier than usual. In 2009 the first infection was recorded in September; this year the first case was detected in May, before the rains began.
Health officials said someone from a neighbouring country might have brought in the disease and somehow contaminated a water source, then the infection spread from there once the rains started.
One of Cameroon's most serious outbreaks in recent years occurred in 2004, when cholera killed 100 people in the commercial capital, Douala.