Cholera in Angola

As number of infected people reaches 20,000, the response to the epidemic remains insufficient

Ten weeks after the first case of cholera was confirmed in Luanda, some 20,000 people have been infected, around 900 people have died, and the disease has spread throughout most of the country. On 25 April (last Tuesday), saw the highest daily toll to date, with 929 new cases and 25 deaths. Yet measures put in place for halting the outbreak remain grossly insufficient. Medecins Sans Frontieres (MSF) urges the Angolan government and international relief organisations to increase their efforts for stemming the epidemic.

"Everybody has been slow to respond," says Richard Veerman, head of mission for MSF in Angola. "Many factors have conspired to make this cholera outbreak one of the worst ever seen in Angola. But with what we know today there can be no excuse for not doing everything humanly possible to prevent the death toll from climbing much higher."

This week, MSF saw an average of 30 newly infected people and one death every hour. In one of MSF's treatment centres in Luanda alone, 240 new patients came in over a 24-hour period. The team quickly erected two new tents to expand the capacity of the already overcrowded facility.

The majority of cases of cholera are usually detected after an outbreak has peaked (the peak being the period in which the number of new cases per day is highest). "Today we have not yet reached the peak of this epidemic. Even based on conservative estimates, the toll of this epidemic will be extremely high," says Veerman.

Luanda was spared major outbreaks over the past ten years. Outlying parts of Angola saw no cholera for even longer; as people hardly travelled the country during the war the disease had little chance to spread from the shantytowns in the capital. As a result, there is little resistance among the population against the bacterium that causes cholera. Awareness of what people can do to protect themselves and their communities from infection is also very low.

"By all measures, this outbreak is out of control," says Luis Encina, MSF emergency coordinator for the cholera outbreak. "It is crucial that the authorities define and implement a national strategy for containing the spread of the disease, ensuring access to treatment facilities, guaranteeing availability of safe drinking water free of charge and improving sanitation. They should also set up a reliable system for collecting epidemiological data, and dramatically expand their campaigns for educating Angolans on the disease, particularly outside the capital."

MSF has ten cholera treatment centres in Angola: six in Luanda, one in Benguela, one in Malanje, one in 'Ndalatando, and one in Caxito. The organisation has 55 international staff and 330 national staff working on its cholera projects. To date 11,700 have been treated in MSF's centres.