Cholera Concerns Mounting in Sierra Leone

A cholera outbreak in Sierra Leone that made its way to the capital city of Freetown is spreading at an alarming rate. MSF reported an estimated 1,500 cases and 17 deaths in a July 31 press release. The WHO released new numbers yesterday that cholera has infected 5,706 people since the start of August. They single out Western Aread and Tonkolili as areas with the greatest burden.

Right now, the response is being led by major players such as the Sierra Leonean Ministry of Health, MSF, UNICEF and the WHO.  At the same time, neighboring Guinea is dealing with its own cholera outbreak.  According to MSF, the shared resivor  near the coast is a ‘breeding ground for the disease.’

“This ‘coastal cholera’ has already killed some 250 people,” says MSF epidemiologist Michel Van Herp. “The water reservoir allows the Vibrio cholerae bacteria to survive and go on to infect the population.” To respond, organizations are turning their focus onto improving hygiene.

“There is a massive failure to take cholera seriously in this region, and to publicize it,” said a West Africa cholera specialist to IRIN. “Ultimately, if you want to get rid of cholera you need to address the structural issues that cause it.” The money is there, “it is a question of tapping into it and taking responsibility for your citizens.”

An urban WASH consortium – made up of NGOs Oxfam, Action against Hunger, Save the Children, GOAL, and Concern – charged with helping the government improve sanitation in Freetown’s slums, has decided that improving and rebuilding public toilets is the only option, but keeping them clean is the real challenge, said Marc Faux, the group coordinator.

Community committees have been set up to run the toilets. Each is given four roles: collect money for their use (usually 100-200 leones per person [2 to 4 US cents] use the money to clean and repair the toilets; communicate the community’s sanitation concerns to political decision-makers; and make sure waste is dumped safely. Health officials say until each of these jobs is done well, use will continue to be low.

To date, most of the waste from public latrines has been dumped in nearby rubbish tips or into the sea. The NGO consortium is currently experimenting with a low-technology device that pumps waste into containers that can then be taken to trucks. Another method being tested is a device used to separate urine from faecal matter, which can then be turned into compost over an 18-month period.

Sanitation’s importance and challenge was driven home by UNICEF regional sanitation specialist Jane Bevan who told the New York Times, “If your area is flooded with rainwater, and if people are defecating in the open, it will get into the water supply. We know governments have the money for other things. I’m afraid sanitation is never given the priority it deserves.”

Sierra Leone agrees that the problem is sanitation, “Is it an indictment on our environmental and sanitation strategies or what will be the role of our line ministries in terms of pulling our resources together?” said Dr Kaifala Marrah, Chief of Staff in the Office of the President.

The challenge in Sierra Leone has been the rapid migration of people into cities explained Minister of Health and Sanitation Zainab Hawa Bangura to the AP. A declared national emergency and the flurry of reports point towards this becoming an emerging problem that is only being made worse by the arrival of heavy rains.

An appeal by the Red Cross for $1.2 million was made on August 16 to respond to the problem in Sierra Leone. MSF has been treating the problem for some time now and indicated that it will try to open more beds to accommodate an increase in patients. For the time being I will keep an eye on the latest news and be sure to share the latest developments.

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Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.