Rains and insecurity caused by Nigerian Islamist militants are aggravating a cholera outbreak in northern Cameroon which has killed at least 75 people and infected some 1,400 others since April. Water scarcity, poor public health care and risky hygienic practices have rekindled the disease which badly hit the country between 2009 and 2011, experts say.
Population movement during the current school holidays could help spread infections to other regions of Cameroon or even to neighbouring countries, said Félicité Tchibindat, UN Children’s Fund (UNICEF) representative in Cameroon.
The first cholera case was in a Nigerian family who were among a group of refugees fleeing to Cameroon from bombings and attacks by Nigeria’s Boko Haram extremist militia in April. Scarcity of safe drinking water, open defecation and other poor hygienic habits have exacerbated the cholera cases in northern Cameroon, Tchibindat said.
More than 26,000 cholera cases have been reported in Nigeria since the start of the year, according to health authorities.
“For the moment we are supporting health workers, conducting community sensitization, supplied water and cholera treatment kits. But given the insecurity, whether the community mobilizers can visit all the villages is a question we are still asking ourselves,” Tchibindat told IRIN.
“We are monitoring the situation. It’s a worry because there is a risk of regionalization towards Chad, Central African Republic if we do not curb the spread. We hope that the security situation will allow community mobilization to go on.”
Cameroonian authorities have set up a national committee to help bring the outbreak under control and are collaborating with neighbouring countries to curb cross-border infections, said Public Health Minister André Mama Fouda.
Weak health system
Cameroon’s Far North, North, Adamaoua and East regions suffer chronic shortages of health workers. Nationally, there are 1.43 healthcare personnel per 1,000 people. In the Far North Region, for instance, the ratio is 0.47 doctors for 1,000 people. Most of the staff deployed to the remote regions “feel that it is a punishment”, the UNICEF representative said.
“They think that their colleagues in Douala or Yaoundé have better working conditions,” she noted. “There is a big problem of staff retention.”
More than half of the country’s health workers are in the Central, Coastal and Western regions, which host the three largest cities of Yaoundé, Douala and Bafoussam.
“Most hospitals lack facilities to test and treat patients in good time,” said Peter Tambe, a health expert in Maroua, the capital of the Far North Region, where 97 percent of the cholera cases have been reported.
Cameroon’s northern regions are also the most deprived, with dire health indicators such as high malnutrition and low vaccination rates. Affording quality healthcare is therefore difficult due to costs. Around 40 percent of Cameroon’s 22 million people live in poverty.
Rising insurgent attacks
Boko Haram have repeatedly attacked gendarme posts and abducted civilians in the Far North which borders the insurgent heartland of northeastern Nigeria. In late July, suspected Boko Haram militants attacked the town of Kolofata and kidnapped the wife of Cameroon’s deputy prime minister and two other people. Since early 2013, the group has seized foreigners for ransom. They are believed to be still holding a group of 10 Chinese construction workers.
Worsening insecurity, despite a beefed-up military presence in the region, has curtailed cross-border trade between northern Cameroon and northeastern Nigeria and badly hit the local economy in this remote region of Cameroon.
Residents also complain that the threat of Boko Haram and an overnight curfew since June have made life difficult, with some unable to till their land for fear of abduction.
“We are facing a complex security and behaviour-change problems,” said Tchibindat, also noting that open defecation is most prevalent in the Far North Region. The 2009-2011 cholera outbreak, Cameroon’s worst ever, killed more than 700 people.
So far no Ebola cases have been reported in Cameroon, though neighbouring Nigeria recently reported its first case.