Up to 3,160 people have now contracted cholera and 73 people have died across the country and health minister Camilo Simoes Lopes told IRIN the authorities are struggling to win the fight again the epidemic.

The majority of the victims are in the capital, Bissau, which has recorded 2,301 cases. "The situation is bad across the country,” Lopes said, “Only the Bijagos islands have been spared.”

The government and international organisations are focusing their efforts on Bissau though health teams are also travelling to more remote parts of the country to try to contain the disease’s spread.

The government has called on the international community to provide more drugs to treat the disease, according to Lopes. So far the United Nations has leveraged US$600,000 in emergency funds to fight the epidemic.

Agostinho Semedo, the director of the Simao Mendes hospital told IRIN, “We need money and logistical help to fight the disease – we don’t have enough beds or medicines at the moment to do it.”

The hospital is struggling to cope with the number of victims it receives each day. “The situation is beyond our control. People must respect the laws that have been laid down, and the government must do more… to control the situation."

The authorities have prohibited the sale of street food such as doughnuts, some sweets and sachets of water in a bid to stop the disease from spreading further. Semedo has also called on people to stop sacrificing animals at funerals, which he says may be a root cause.

Patients at the hospital have to lie on the ground because there are not enough beds to put them in. The UN Children’s Fund (UNICEF) plans to set up tents to shelter the sick but these have not yet been erected.

Lionardo Domingos Nancassa is one of 23 volunteers helping the government disinfect wells across the capital with chlorine.

According to Lopes others like him need to get more actively involved to prevent the disease from spreading further. "We have found people are not cooperating enough to abide by the hygiene measures imposed by health authorities," he said.

For Nancassa his mission is clear, “We have to come together to contribute to the fight against the epidemic that is wreaking havoc in our capital.”

IRIN 

Speaking at the unveiling ceremony, the secretary general of Gunjur Satay Kafoo, Mr. Lamin Manneh, said it was a pleasure for them as concerned Gambians and Gunjurians for provide safe clean drinking water for the people. He said that the project was sponsored by 27 Gunjurian youths from both home and abroad just for the love of their country and their village. He advised the water committee and the whole community to be watchdogs of the hand pumps.

According to Mr. Manneh, the Kafoo is also funding another project concurrently in Gunjur at the Nyamina football field in conjunction with the Gunjur Youth and Sport Development Association. He said that D185,000 was spent on the water project and D75,750 will go on the football field.

Mr. Manneh further urged the youth of the area to contribute to and take part in the Gunjur Development fund for the betterment of the village.

For his part, the chairman of the Gunjur Water Committee, Mr. Kilim Barrow, thanked the donors for their kind gesture. He called them real patriots and good sons of the land. Mr. Barrow promised that he and his committee will do their best to safeguard the pumps so that they will last a long time if not forever. He urged more young people to get involved in the committee as those currently involved are ageing.

Other speakers at the ceremony included Alhagie Sheikh Saibani Cham from the council of elders, Mr. Ahmed Bojang of Gunjur Satay Kafoo and Mr. Modou Janneh a youth representative. The ceremony was graced by the presence of people from all walks of village life.

Rising flood waters across West Africa are intensifying health risks for millions of people, and adding to the impact of the food price crisis. International aid is needed as heavy rains forecast to last until September could exacerbate health threats for conditions including malaria, diarrhoea and other potentially fatal communicable diseases.

"West Africa's annual floods bring with them not only the threat of vector-borne and communicable diseases, but it further endangers the lives of people already malnourished by the food price crisis," said Dr Eric Laroche, Assistant Director-General of WHO's Health Action in Crises Cluster.
Benin, Burkina Faso, Mali, Mauritania, Niger and Togo need urgent assistance. Flooding has caused widespread damage to bridges, roads, railway lines and other infrastructure vital for delivering health services and humanitarian supplies. Seasonal rains have also caused damage in Guinea-Bissau, Liberia and Sierra Leone.

WHO is responding by providing essential medicines, assessing the health status of the vulnerable populations - particularly children, women and the elderly - and helping raise badly needed humanitarian funding. Some US$ 418 million was requested for West Africa in 2008's revised Consolidated Appeal for the region, of which US$ 76 million was needed for emergency health care. To date, only 22% of the health funding needs have been met.
Endemic and epidemic communicable diseases are common in West Africa, with malaria being the main cause of illness and death in the region. Meningitis, cholera and yellow fever also claim scores of lives annually and cause great human suffering, which is only expected to be intensified due to the extra strains placed by the floods on the health sector. An estimated 5 million people also live with HIV/AIDS in the region, whose health care is further compromised by the flooding.

The destruction of agricultural lands and loss of crops aggravates the food security crisis in the region. Several West African countries are among the 21 worldwide identified by WHO as being most at risk from the food crisis. Burkina Faso, Mali and Niger are above the global emergency threshold for malnutrition, with over 10% of children under five years of age suffering from acute malnutrition and over 40% with chronic malnutrition. Acute malnutrition develops quickly in vulnerable populations and involves a rapid loss of weight and the greater potential for death, compared with chronic malnutrition (stunting), which develops over a longer time and affects the height and learning abilities of sufferers.

In Benin, the current flooding has displaced at least 150 000 people and raising fears of malaria, diarrhoeal diseases and respiratory infections, especially among children. WHO is helping supply clean water and provide appropriate sanitation, distribute bed nets and essential drugs, and undertake measles vaccinations for children. In Niger, 24 000 people have been displaced, while 12 000 have been displaced in Togo.

WHO

Disaster relief teams have fanned out across West Africa to assess how badly the region was hit during the past month of heavy rains. Tens of thousands were affected in Togo, Burkina Faso, Niger, Liberia and Mauritania according to the UN Office for the Coordination of Humanitarian Assistance (OCHA).

In Niger, more than 40,000 thousand people were affected by heavy rains which started on 14 July. In the country’s second most populated city, Zinder, hundreds are camping in the local elementary school.

Nobert Allale, a disaster relief manager at the Dakar-based International Federation of Red Cross and Red Crescent Societies (IFRC), says schools are a refuge for those without family or money to rent a new home.

Allale visited Zinder on 22 July, one week after the rains first hit. “The situation is stable now. Families have been given water and food. We are now in the process of distributing mosquito nets, pots and pans. We are past the emergency response phase.”

Allale says there is no plan in place yet for where these families will go once the school year begins October, “We need to look to long-term solutions. We know the rains will come. We cannot blame nature alone for these annual catastrophes. It is nature plus man’s inability to adapt. People live in mud homes in flood-prone areas. If they build on the same site year after year… this is what happens.”

In Togo, heavy rainfall has led to bridge collapse, and cut off most of the cell phone network. A team from the International Monetary Fund is expected 27 August to review flood damage as a part of its more than US$60 million commitment.

Major donors cut off most aid to Togo during recent years of bloody tumult, which included allegedly rigged elections and army crackdowns that sent thousands fleeing to neighbouring countries.

Donors are slowly coming back following Togo’s 2007 legislative election, which monitors said was mostly free and fair.

According to the World Bank, Togo has accrued more than US$100 million in debt since 2002 from past World Bank loans.

The European Union recently approved a five-year more than US$180 million loan, which will partly go toward rebuilding the country’s infrastructure.

Elsewhere in West Africa, Liberian government officials have said recent storms are the worst in recent history. They say heavy rainfall and construction on wetlands have pushed out about 1,000 from their homes.

Disaster relief coordinator Allale says IFRC is training a rapid response team of 10 members from throughout West Africa to be based in Niamey, from where they will be able to quickly reach an emergency.

“We learned from our mistakes last year when not all the disaster response staff had visas to get into emergency areas. This year, IFRC has paid for the visas in advance so the team will not be held up with paperwork. We are learning.”

IRIN 

At least 50 cholera cases have been recorded in Benin’s capital Cotonou since 24 July, according to local hospital officials.

These cases have been reported in the capital’s eastern districts of Enagnon, Dedokpo, and Segbeya, neighbourhoods that lack clean drinking water, waste disposal services, and indoor plumbing.

The government has set up a treatment centre next to Ayélawadjè health centre in eastern Cotonou to provide free medical assistance to affected people.

On Wednesday, more than 100 people gathered at the centre. One health worker who spoke with IRIN anonymously because he was not authorised by the Ministry of Health to comment on the outbreak said: “We have been seeing more and more patients in recent days. For the moment, we have things under control. We are the asking the population to help us fight the disease by observing basic sanitation rules.”

Dr. Paul Yada, an epidemic specialist at the African regional office of the World Health Organization (WHO), said while efforts like this camp are helpful to halt the epidemic, cholera is not only the responsibility of health officials.

He says cholera is most quickly spread in run-down urban areas that lack clean water sources or indoor plumbing. Yada says often, faeces in open spaces mixes with heavy rains, trash, dirty riverbeds and a neighbourhood’s castaways, forming a river of waste that infects a community’s drinking water.

“To really solve this problem, you need more people at the table than just health officials, and you need more resources,” says Yada.

The Benin government has renewed an education campaign on sanitation and what to do at the first signs of cholera infection.

Yada says countries’ responses to cholera outbreaks tend to be fast, but that follow up is poor.

“After an epidemic, people stop these education campaigns. The problem is, you cannot change someone’s behaviours in one week. You cannot stop teaching about sanitation just because the rains stop. This needs to go on year round. ”

Cholera is a recurring problem in much of sub-Saharan West Africa. Cases spike with the annual rains that generally fall between June and September, but infections happen year round.

The cholera bacteria is spread through contaminated food and water. If not treated, the first symptom of diarrhoea can lead to kidney failure, dehydration and death.

Last year, toward the end of Africa’s rainy season, ministers of health from across the continent signed an agreement to develop comprehensive action plans to fight cholera.

WHO representative Yada says none have been submitted to WHO’s regional office in Congo Brazzaville for funding.

IRIN 

Weeks of rains in Togo have forced thousands of people from their homes into temporary government-run centres set up throughout the capital, Lome.

Ramon Aloumoun, 48 years old, took some clothing and a few documents when he left his home 4 August with his wife and three children. “Everything else just washed away. Water reached the level of my bed, then tables. I am a welder and my tools in the garage are now gone. Everything.”

Togo’s head of Red Cross Disaster Relief, Victor Sodogas, estimates more than 6,000 people, including approximately 1,000 children, have sought shelter in six government centres that do not have designated sleeping quarters. “They just sleep in the processing areas. There are no mosquito nets yet in the centres, which may become more of an issue as the rainy season continues to push people into these shelters.”

Climatologist Michel Boko from the University of Cotonou in Benin says weather trends point to more flooding during this year’s rainy season, which typically is from May to September.

“Even though the rainy season has shortened in recent years, the annual rainfall amount has not changed, which means we are seeing more intense rains. Coupled with land degradation throughout sub-Saharan Africa, this makes for ideal flooding conditions.”

West Africa’s arable land has slowly been shrinking, which some scientists link to the earth’s increasingly warmer temperatures, or global warming. Boko explains, “Much of the region practices subsistence farming. Farmers abuse the land until it is easily eroded and cannot withstand rain.”

The regional disaster preparedness manager for West Africa, Jerry Niati, with the International Federation of the Red Cross (IFRC), says that while people cannot fight nature, they can prepare for it. But few do, he says.

“Most people are quick to respond, but slow to prepare. Mindset change is what needs to be done. We need to address underlying reasons. Why do we get flooding? What have we done to contribute to it? You get the community to propose solutions. People have to think of ways to reduce risks so they are not victims.”

Niati says preventing the worst impacts of flooding would cost less than responding to massive destruction.

Last year, floods throughout Africa displaced more than one million people, wiping out swaths of cropland, and sparking a fatal outbreak of cholera in sub-Saharan Africa. Niati says some of this can be avoided. “We don’t have to go high tech early warning system. We are already partnering with meteorological institutions that can provide us with data.”

But Niati says even advance warning does not change behaviours, “When we [IFRC] try to do emergency drills [with people in flood prone areas], they think it’s a hoax. And then the storms come, catching them unprepared.”

Disaster relief teams throughout West Africa advise populations, especially those in high-risk waterfront areas, to clean riverbanks, plant trees and mangroves to prevent landslides, build homes on higher ground, and to build dykes.

Niati admits these suggestions are not always practical, “People cut down trees for charcoal. Relocating people from a high-risk waterfront area can be difficult. So we have to be creative. But we need to engage the community to raise its awareness about the alternatives if they do not prepare.”

Togo’s government announced last week that rains starting 15 July have led to the collapse of nine bridges and stranded thousands.

IFRC’s Niati says recovery is a long road. “It is not just an issue of housing or bridges. This is not just flooding because flooding [brings out] other issues. For example, people will have more problems in coming seasons because their crops have been washed away. We need to learn from our experiences. These are recurring situations, and it seems no one is learning.”

IRIN

A cholera epidemic sweeping across Guinea Bissau has now infected 1,077 people - three-quarters of them in the capital Bissau - and killed 25, leading experts to ask why lessons from previous epidemics have not been taken on board.

Cholera killed 400 people and infected 25,000 across the country in 2005. “We wrote reports and made many recommendations to the government after the 2005 cholera outbreak but none of them were ever implemented, and so we are left to start all over again,” said Augostino Betunda, joint director of services at the Bissau centre of epidemiology, which is charged with diagnosing the disease.

Since then, water and sanitation infrastructure in the capital has hardly improved, according to Betunda, and still only one in five people can access piped water in the capital.
Instead most city-dwellers construct cheap wells for themselves. “Everyone builds their own wells in this country and they can only afford to build cheap ones, which then fall into a state of disrepair and allow toxins to pass through them, infecting the well water,” said Betunda. The few public wells the government has built are in rural areas.

Experts from UN agencies and non-governmental organisations (NGOs) are developing a new set of long-term recommendations to improve the water and sanitation infrastructure in Guinea-Bissau so that the country can avoid future epidemics. But a water specialist in Bissau is worried it will not spark the change that is needed.

“It is always the same problem. We do evaluations, we do reports with lots of conclusions, but in the end it often just comes down to lack of money and poor organisation,” he told IRIN.

Emergency measures

In the short term the UN children's fund (UNICEF) is trying to control the spread of the disease in the capital under the coordination of the Ministry of Health, and an emergency team of non-governmental organisations.

They are disinfecting wells in contaminated areas and the city’s eight reservoirs with bleach; and are sending teams house-to-house to inform people how to disinfect their wells, to spread public health messages and to distribute bleach.

The problem is that with almost daily heavy rains, this bleach is quickly diluted and it needs to be reapplied regularly to have any impact. But Nicolas Le-Goff, a water consultant with UNICEF is hopeful the slow-reacting disinfection solution they are using should only need to be reapplied once a week.

Identifying the source

Meanwhile government partners are pushing for better diagnostics of the source of the disease. The epidemiological centre has sent teams out across the city to try to establish if it is being passed mainly through contaminated food, water, or other methods, but Le-Goff says these surveys do not ask enough questions to give them the answers they need.

While the surveys ask people’s name, address, age and gender, “they need to cover where they have travelled, what is their main water source, what they have eaten, which markets they frequent, whether they have participated in traditional practices involving food and drink,” he told IRIN.

For Betunda the centre cannot improve its diagnostics capacity without more money. The centre runs on no electricity – it has a generator but it was never installed because they cannot afford the fuel to run it - and up to 80 percent of the centre’s budget has to go on staff salaries. “We weren’t paid last month, but we did get our salaries in May,” Betunda said brightly.

There is “next to no” budget for water and sanitation in the government budget, according to a government official, and while UNICEF installs water systems in health centres and schools, and NGO the International Committee for the Red Cross has improved water supplies in some towns and cities, there is no agency that has made water infrastructure its one and only priority.

But for Betunda, ultimately it is up to the government to take the reins. “It is the government’s responsibility to build up water infrastructure here - and if they don’t do it what else can we do,” he exclaimed, adding “Why are people always left to fend for themselves in this country?”

IRIN

As we look forward to the end of the rainy season in the country, heavy rain falls is being a curse for concern during the past weeks. Residents of Dippakunda, Manjai and Ebotown were once again victims of the heavy rain fall due to the areas bad topography and landscape.

 Inhabitants from these areas continue to suffer from this natural disaster, some have their compounds flooded whiles others have their fences and houses collapsing. It has cause a lot of damage to the inhabitants.

 Speaking to this reporter, Modou Jallow of Dippakunda described the tragedy as a natural phenomenon which cannot be stop by any human being, he went on to say that this area of Dippakunda is not suitable for  habitation because the soil has high water holding capacity which is more suitable for the production of rice. On sounding people’s opinion on the year’s rain fall, a woman who identified herself as Fatoumatta Drammeh a vendor at the Serrekunda market, said this year’s rainfall is causing much havoc than good. She went on to say that, the area is very close to the Bakoteh dumpsite and a lot of diseases can be contracted from the stagnant water.

 A shopkeeper at Dippakunda chupe town said ‘’ the last two rains of 20 and 21 July, 2008, respectively causes a lot of damages to his shop, the wind was very strong, and  that  it took away  his corrugated roof which cost him a lot of money to repair ‘’ James Gomez  a taxi driver who normally transports people’s goods and from Westfield to Sukuta village said he started plying the road some five years ago ,but the rains this year are very heavy coupled with the poor  status of the road made  transportation very difficult.

Speaking to this reporter, a compound owner in a settlement near by called Manjai kunda also said the last two rains has caused a lot damage to his house which he built some five years back and most of his livestock have contracted diseases, they are dying gradually’’.The drainage in these areas is very poor, no passage for the water to pass through.

 A farmer at Ebou Town described this year’s rainfall as excessive and plentiful which can endanger their production. Because the running water washes away the topmost part of the soil which is the most fertile part of the soil thereby causing erosion and depletion of soil nutrients and minerals? He said some people have started evacuating as water continues to flood their compounds causing loss of properties.

A metro logiest; predict that this years rainfall will be more than last years. Preventive measures should be taken into consideration by both government and the civilian population and come up with a possible solution to remedy the situation as quickly as it is possible, since some of these victims affected are low income earners with a large family to take care.  The communities are appealing to NGOs, government of the Gambia and philanthropist to come to their rescue through the National Disaster Relief Fund.

Recurrent outbreaks of cholera in the western province of Nyanza are caused by widespread water contamination, including seepage from latrines, health officials said.

"The major contributor to the recent outbreaks in the area was unsafe water," Shahnaaz Sharif, the senior deputy director of medical services in Kenya's health ministry, said. "In Kisumu, many wells are built near the latrine; eventually the sewage seeps into the wells."

The high water table in the area was a contributing factor, Sharif said. Tests done on water samples from Kisumu and Nyando, two of the most affected districts in the province, indicated that 75 percent of sources were contaminated.

"People need to be made aware of water safety, by fetching their water from a safe source and boiling it," Moses Atuko, the emergency health manager at the Kenya Red Cross Society (KRCS) said. At least 80 percent of cholera transmissions are attributed to a lack of access to safe water.

"Sanitation is health; you have poor sanitation you have poor health," Atuko said.

In addition to encouraging the proper use of latrines, there was a need to increase the number of latrines in households, not only for hygiene but also for cultural reasons, as local customs did not allow men and women to share toilet facilities, he added.

The KRCS, in partnership with the Ministry of Health and other NGOs, was sensitising people in the affected areas to the importance of good sanitation and discouraging practices such as bathing and washing clothes in the rivers.

According to Atuko, this "was a tall order", since many people in the region used Lake Victoria and the rivers as their main sources of water.

However, he added, the number of cholera cases had fallen. "Last week, we only reported four cases; four weeks ago, there were more than 100 cases," he said.

The health ministry is enforcing public health laws by discouraging hawking of food in open markets and streets. It also conducted mapping of water sources for chlorination and was promoting the use of water purifiers.

"We have to enforce proper eating standards," Sharif said. "We are discouraging roadside cooking."

According to the World Health Organization (WHO), inadequate food safety and hygiene are also major contributors to the sporadic outbreaks of the disease.

Cholera is caused by the bacterium Vibrio cholerae and is characterised by watery diarrhoea, vomiting, muscle cramps and severe dehydration. Treatment is mainly by rehydration and up to 80 percent of cholera cases can be treated successfully using oral rehydration salts.

IRIN