Cholera

MSF has completed a seven month-long emergency cholera intervention in Papua New Guinea.

During the response to Zimbabwe’s cholera epidemic earlier this year, medical teams from Doctors Without Borders/Medecins Sans Frontieres (MSF) started to work in prisons across the country to treat cholera patients and prevent the spread of the deadly disease. As the four-month intervention is concluding, MSF’s project coordinator in Zimbabwe, Pip Millard, gives insight into the challenge of curbing an outbreak in penitentiaries.

MSF, already working in Lae, was able to mobilize quickly and assist the ministry of health in responding to the outbreak. Initially, an isolation ward was set up in the Angau Hospital, but when cases increased, a treatment center was constructed in the front of the hospital.

A high number of cholera cases have been found in the small city of Wasu in the first known cholera outbreak in Papua New Guinea in 50 years. Doctors Without Borders/Médecins Sans Frontières (MSF) is assisting health authorities by treating people affected by the already deadly outbreak at the local Angau hospital.

In Murwira Clinic, southeastern Zimbabwe, Dennis Taronga is receiving antiretroviral (ARV) therapy with the help of MSF. Taronga, a husband and father of three who used to work as a builder, contracted cholera in January 2009 in the historic cholera outbreak that infected nearly 100,000 people and left thousands dead. This is his story.

In February, MSF released the report “Beyond Cholera: Zimbabwe’s Worsening Crisis” to draw attention to the humanitarian crisis ravaging Zimbabwe, most visibly expressed by the unprecedented cholera outbreak, which claimed thousands of lives. Now, six months later, the cholera has died down and the new unity government has been in charge for half a year. What has changed? MSF’s head of mission in Zimbabwe, Rian van de Braak, answered questions about the current situation.

Interview with Jane Boggini, MSF nurse and field coordinator, just returned from Zimbabwe where she worked during a major cholera outbreak.

Doctors Without Borders/Médecins Sans Frontières (MSF) has seen an increase in cholera patients in some urban areas of Zimbabwe, despite the reported downward trend at the national level.

Jane Hannon, a 39-year-old nurse from Baltimore, was in Manicaland Province in eastern Zimbabwe during November and December 2008. Here, she talks about trying to help people with cholera in the middle of a large-scale, rapidly spreading outbreak, in a country that has fallen into extreme disrepair.

Luis Maria Tello, MSF emergency coordinator in Zimbabwe, encountered a devastating scene when he arrived in the town of Chegutu, 100 miles south of the capital Harare, on December 12, 2008. “The situation was absolute chaos. There were no beds and patients everywhere,” said Tello. “People were dying of thirst because there was no water. Dead people were lying everywhere."

MSF has treated nearly 56,000 patients for cholera since the outbreak began in August 2008. The cholera epidemic in Zimbabwe is still far from being over, and MSF is finding increasing numbers of cholera patients in Harare for the third week in a row.

Dealing with cholera is different than other emergencies I have worked on. It was the speed of it that made it so different. When you enter an area with many people sick from cholera or a clinic completely overloaded with cholera patients, you know lives will soon be lost.

I was awakened in the night by a phone call from a nurse on night duty who had been told that four children were seen along the road too sick to continue their walk to the nearest CTU.

Zimbabwe's political and economic breakdown has led to abysmal access to public healthcare; a collapsed infrastructure; a crushing HIV epidemic; political violence; food shortages and malnutrition; internal displacement and displacement to neighboring countries. Above, more than three million Zimbabweans have fled to South Africa, including these children taking refuge in a church in Johannesburg.

The widespread cholera outbreak continues throughout Zimbabwe. As previously reported, the focus of the outbreak has shifted from urban to rural areas, but cities are still a concern.

Harare/Johannesburg/New York, February 17, 2009 —Zimbabwe's humanitarian crisis continues to rapidly deteriorate, causing appalling suffering, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) warned today. The organization’s medical teams have now treated almost 45,000 people for cholera, an estimated 75 percent of the total number of cases in the current outbreak, and the crisis is far from over.

A cholera outbreak in Malawi that began in November has escalated considerably, with the number of cases growing by more than 100 percent in January. So far, 1,142 patients have been treated and 39 people have died.

Last week, the massive cholera outbreak in Zimbabwe exceeded the World Health Organization’s (WHO) worst-case scenario prediction of 60,000 suspected cholera cases. For the third consecutive week, this was the heaviest week for new cholera cases since the beginning of the outbreak, with approximately 10,000 newly affected people.

The cholera outbreak in Zambia that began on October 3, 2008, deteriorated dramatically in the month of January. Some 1,169 cases had been reported by January 21 in the capital, Lusaka.

Some 207 new admissions to a cholera treatment center (CTC) near the Zimbabwean capital Harare were received in a 24-hour period yesterday.

As of January 7, MSF has seen more than 16,000 patients with suspected cases of cholera in Zimbabwe. Currently, MSF teams are seeing an overall decrease in the number of cases at the projects where they are working. However, the UN has reported a major spike in cases – on January 6 1,080 new cases and 19 deaths were reported while January 5 saw 675 new cases and 59 deaths.

As a result of its worst cholera epidemic in recent memory, Zimbabwe declared a national emergency in early December. Cholera rapidly spread throughout Zimbabwe’s provinces and then into neighboring countries, particularly South Africa. According to the South African Department of Health, there have been more than 900 suspected cases. Recently South African authorities in the northern province of Limpopo declared Vhembe district, which borders Zimbabwe, a disaster area.

A second cholera outbreak has hit Chegutu, a town 100 km south of Harare, where more than 100 people have died since the first cases appeared on November 24.

An update of each area where MSF is present in North and South Kivu provinces and across the border in Uganda.

There was no major fighting reported in North Kivu this past week, but sporadic skirmishes between armed groups continued to drive civilians out of their homes and into the forests for days or during the nights, where they hoped to avoid being harassed. The overall improved security for Doctors Without Borders/Médecins Sans Frontières (MSF) medical teams allowed staff to redeploy to areas where they had been running projects, and carry out evaluations and mobile medical clinics in the surrounding areas. In all MSF projects in North Kivu, cholera cases have been decreasing.

MSF has seen more than 11,000 patients since August in Zimbabwe’s worst cholera outbreak in years and has opened dozens of cholera treatment centers throughout the country. Cases have been found in nearly all provinces. More than 500 national and international MSF staff members are working to identify new cases and to treat patients in need of care.

MSF has been treating cholera in Zimbabwe since the latest outbreak started in August, and will continue to care for patients throughout the country as long as is needed.  The outbreak has reached many provinces of the country and is greatest in the capital, Harare, and its suburbs, where MSF has set up two cholera treatment centers

An MSF nurse is standing in the middle of dozens of cholera patients lying on the dirt in the backyard of Beitbridge’s main hospital. Cholera has overwhelmed this border town of about 40,000 like contaminated wildfire.

In Zimbabwe’s capital Harare, MSF is responding to a major outbreak of cholera, which the local Ministry of Health has declared “the biggest ever in Harare.” MSF has set up cholera treatment centers (CTC) in Budiriro Polyclinic and Harare Infectious Diseases Hospital, where 500 patients have been treated to date and, on average, 38 new patients are admitted every day.

More than 10.000 people have been affected by a cholera outbreak that has devastated Guinea Bissau since May. The epidemic has already caused the deaths of 190 patients. After reaching epidemic levels, there has recently been a significant decrease in the number of admissions to the main cholera treatment center (CTC) opened in the capital, Bissau.

MSF is treating people affected by the recent cholera outbreak in the Zimbabwean town of Chitungwiza.

MSF has been responding to an outbreak of cholera in the Arua district of northwest Uganda since early January 2008. In the Oli neighborhood of Arua town, MSF is supporting a cholera treatment center (CTC) in collaboration with the Ugandan Ministry of Health. Medical staff at the Oli CTC have admitted up to 40 patients per day.

Since December 2007, cholera outbreaks have affected thousands of people in the cities of Lubumbashi and Likasi in southern Katanga province, Democratic Republic of Congo. For the last three weeks, however, the number of new patients at MSF clinics in these areas have been decreasing.

Cholera cases are still on the rise in Katanga province, in the southwest of the Democratic Republic of Congo (DRC). Since late September, a total of 4,029 cases have been reported by MSF emergency teams in the cities of Lubumbashi and Likasi. At least 97 patients have died.

Brussels, January 29, 2008 — Since the beginning of January, MSF has recorded more than 1,700 people with cholera in the cities of Lubumbashi, Bukama, and Likasi. All these people came from the poorer areas where bad hygiene conditions combined with high population density contribute to the flaring up of this extremely contagious disease.

Endemic in West Africa, cholera has once again struck in Guinea. The arrival of the rains at the end of May, notably in the capital, Conakry, has created an ideal breeding ground for the disease to spread. Faced with an increasing number of cases, Doctors Without Borders/Médecins Sans Frontières (MSF) has boosted its direct support of the local health services.

New York, 11 April 2007 – Since cholera was confirmed in Mogadishu on March19, 2007, the international humanitarian medical aid organization Doctors Without Borders/Médecins Sans Frontières (MSF) has treated more than 800 patients. However the recent worsening violence is making it increasingly difficult for patients to access MSF's cholera treatment center (CTC), which opened two weeks ago. The fighting is also preventing MSF national staff from reaching other areas of the city.

New York, November 29, 2006 — Following the latest outbreak of the cholera epidemic that resurfaced with the arrival of seasonal rains, the international humanitarian medical organization Doctors Without Borders/Médecins Sans Frontières (MSF) has reopened its previous intervention in Lubango in southern Angola. Since the beginning of November, the number of patients has continued to rise—1,427 to date—and mortality remains very high.

Since mid-July, cholera has emerged in various areas in Pakistan-administered Kashmir. Though the number of patients with cholera is decreasing in some areas, in other areas the number of infections is rising.

Eight people —including a child under five— have died from cholera in Mornay, western Darfur, in the last two weeks. The Doctors Without Borders/Médecins Sans Frontières (MSF) team has already treated more than 60 patients. This tragic situation occurred after various aid agencies withdrew assistance to people living in the Darfur displaced persons' camps.

Although the number of new cholera cases nationwide continues to slowly decrease, the outbreak in Angola has spread to provinces further from the capital, Luanda. Since February 13, when the first case was officially reported in Luanda, more than 43,000 cases have been reported nationwide and more than 1,600 people have died. In the last 24 hours, more than 280 people became infected and eight died.

The number of new cholera cases is slowly but regularly decreasing. Since February 13, when the first case was officially reported, close to 38,000 cases have been reported nationwide and more than 1,350 people have died. In the last 24 hours, more than 360 people got infected and eight died.

While the number of new cholera cases in Angola has decreased over the last few days, the epidemic is still ongoing. Since February 13, when the first infected patient was officially reported, more than 34,400 cases have been reported and more than 1,200 people have died.

Luanda, Angola, May 17, 2006 – The disastrous state of the water supply and sanitation infrastructure in Luanda and other large cities is the principal reason for the rapid spread of cholera in Angola. As of May 14, more than 34,000 people have fallen ill with cholera (17,500 in Luanda alone) and over 1,200 have died. Though the Angolan authorities have taken some initiatives to limit the spread of the disease, the international humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) calls for a dramatically stepped up emergency intervention by the Government of Angola and international agencies.

Luanda, May 5, 2006  - More than 27,800 people in Angola are now infected with cholera, up from 20,000 approximately one week ago. More than 1,100 people have already died, and the disease has spread to ten provinces. Doctors Without Borders/Médecins Sans Frontières (MSF) is operating cholera treatment centers in seven provinces and has treated more than 16,000 people and delivered more than 320 tons of medical and logistical supplies since the outbreak began in February.

Luanda, 13 April 2006 – As the outbreak of cholera is rapidly spreading in Luanda, capital of Angola, and to other parts of the country, the international humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) urges the Angolan authorities to officially declare the outbreak and immediately take all the necessary measures needed for controlling it.

Luanda, Angola, April 7, 2006 — With the number of cholera cases increasing rapidly in and around Angola's capital Luanda, the international medical organization Doctors Without Borders/Médecins Sans Frontières (MSF) calls on Angolan authorities to quickly provide more resources to contain the growing outbreak.

MSF has treated more than 500 people suffering from cholera in Malakal, a port town on the Nile river. This city, home to 125,000 people, is one of the three biggest cities in southern Sudan.

Doctors Without Borders/Médecins Sans Frontières (MSF) is once again responding to a cholera outbreak in one of Africa's capital cities.

Barcelona, February 22, 2006 - Doctors Without Borders/Médecins Sans Frontières (MSF) has started an emergency intervention in southern Sudan in response to a severe cholera outbreak in Juba town. The first suspected cases in the region were reported at the end of January in the town of Yei, southwest of Juba. Since then the disease has spread quickly. On February 6, the first suspected case was identified in Juba. The cholera outbreak was confirmed a few days later. After 15 days, by February 21st, 1,864 cases and 45 deaths recorded.

Some 35,000 people have sought refuge on the banks of lake Upemba in the Democratic Republic of Congo (DRC), fleeing attacks on their villages and military operations in central Katanga province. Meanwhile, on January 6 an outbreak of cholera 30 miles north of lake Upemba, lead to 340 people being admitted for treatment in 10 days, including 14 deaths.

West African countries, including Liberia, Guinea, Mauritania, Guinea Bissau, and Burkina Faso, are facing a particularly bad cholera outbreak this year. In most countries, a large number of patients come from the capital cities. MSF, already active in fighting cholera across the region, has sent in more staff and supplies in response to the outbreaks.

Following a new outbreak of cholera in the Burundian capital Bujumbura, Doctors Without Borders/Médecins Sans Frontières (MSF) is re-opening its specialized treatment center for the disease.

The cholera epidemic that emerged around mid-June in Chad is still raging, with more than 2,000 people infected, including 100 deaths.

In early July, MSF reacted to an outbreak of cholera among refugees sheltering in the Cibitoke region of western Burundi.