Three simultaneous cholera outbreaks are currently affecting 24 countries in West and Central Africa, causing 85,000 infections and 2,466 deaths since the beginning of the year, according to the UN Children’s Fund (UNICEF). The size and scale of the epidemics mean the region is facing one of the biggest cholera crises in its history. Case Fatality Rates (CFR) are alarmingly high, ranging from 2.3% to 4.7% and can be much higher at district level in countries such as Cameroon where some areas register CFR of 22%. According to the World Health Organisation (WHO) guidelines, CFR should remain below 1% with proper treatment.
Three multi-country epidemics are ongoing, according to UNICEF, each with separate strains: the Lake Chad Basin, affecting Chad, Cameroon, Nigeria and Niger; the West Congo Basin, with impacts in the Democratic Republic of Congo (DRC) and the Central African Republic (CAR); and Lake Tanganyika – which encompasses DRC and Burundi. In Chad and Nigeria, the epidemic had already started in 2010 and is the worst in Chad’s history, with 16,000 cases and 433 deaths largely driven by the country’s vast territory and large-scale population movements.
In DRC, the outbreak was reported in March 2011 and in only three months a total of 3,896 cases, including 265 deaths have been reported, with an overall CFR of 7%; these numbers have continued to grow over the past months. In north-eastern Nigeria containing the disease has been hampered by high population density and sporadic conflict, while in CAR health authorities declared an outbreak just two weeks ago. Smaller cholera epidemics in Benin, Côte d’Ivoire, Ghana, Guinea, Guinea Bissau, Liberia, and Togo are being contained.
Following its late 2010 cross-border epidemiological study of the Lake Chad Basin, which looked to identify the key cholera hotspots and how the infection was spreading across borders, UNICEF now calls for cross-border coordination to be enhanced at all levels. The study is currently in its second phase, analysing how better to act on the findings from last year’s work.
A review of the current funding status of cholera-related projects in existing United Nations (UN) consolidated appeals integrated in the Consolidated Appeals Process (CAP) presents a rather bleak panorama due to considerable underfunding. This seems to indicate the likelihood of a launch of a dedicated UN common appeal for the regional cholera outbreak. Currently, 12 countries are covered by a consolidated appeal and all appeals but one include cholera prevention and response projects. However, with the exception of Chad, levels of funding are worryingly low, just two and a half months before the end of the year and the appeal period.
With discussions underway around the need for a dedicated regional plan to combat the epidemic, we may look at other major cholera crises for reference regarding donor response to needs. At the end of 2005, West and Central Africa faced another cholera epidemic which spread to ten countries where a total of 51,976 cases and 814 deaths were registered over a period of three months leading up to the launch of the UN flash appeal. The West and Central Africa Region 2005 Flash Appeal requested US$3.2 million to support UNICEF, WHO and United Nations Office for the Coordination of Humanitarian Affairs (UN OCHA) activities in response to the outbreak, and to support the preparation of affected countries ahead of the forthcoming cholera season. Of the 47 projects listed under the appeal, only one was funded, together with a contribution of US$1.2 million of overall funding for UNICEF, pending allocation to specific projects. On the whole, only 44% of the needs identified within the 2005 regional appeal were met.
Figure 3: Unmet requirements and funding received for the 2005 West and Central Africa regional cholera appeal. [Source: Development Initiatives based on OCHA FTS data]
More recently, in October of 2010 and only ten months after the earthquake that devastated the country, Haiti experienced its first case of cholera since records of the disease exist (WHO keeps a registry on existing cholera cases since 1949). 507,398 cases were recorded in just three months with case fatalities reaching 2.2% and causing 5,286 deaths, as reported by the Centre for Research on the Epidemiology of Disasters (CRED). In terms of financial support for the emergency, an analysis of the funding status of cholera-related projects within the 2011 Haiti consolidated appeal indicates that 80% of the needs are currently met. By comparison, only 59% of the overall appeal needs were met in the same period. Moreover, data gathered by the Office of the UN special envoy for Haiti tells us that 97.3% of pledges made by donors for the cholera emergency were met, as of September of this year.
Figure 4: Pledges and contributions – both disbursement and confirmed commitments – for the Haiti cholera and earthquake crisis. [Source: Development Initiatives based on data published by the Office of the Special Envoy for Haiti]
Such inequity between funding for past and present cholera epidemics in West and Central Africa and the cholera outbreak in Haiti makes you wonder whether the geographical location of the crisis may carry more weight than the nature of the emergency.