N’Djamena, Chad – Médecins Sans Frontières (MSF) is working with the Chadian Ministry of Public Health to cope with an outbreak of cholera in the east of the country. The beginning of an emergency response has been hampered by difficult access, as well as the lack of health infrastructures and staff trained to manage the disease. Today, the epidemic continues to spread.

The first suspected case of cholera was registered on 14 August in the health district of Koukou in the Sila region, near the Sudanese border. So far, 176 cases have been identified in treatment units. To date, 22 people have died, while the disease has spread to nine villages and is likely to reach others.

Although the number of deaths has decreased slightly since the beginning of the epidemic, the mortality rate of 16.1 per cent is still high. The number of cases could vary considerably in the coming weeks, so it is too early to draw any conclusions. More than ever, it is essential that all parties involved in any way in managing the epidemic join forces.

MSF’s emergency response team in Chad was quick to arrive in Koukou to investigate the first suspected cases. Cholera treatment units were then established in two of the villages with the most cases. The team has also set up an epidemiological surveillance system, hygiene awareness-raising and water treatment activities. The possible threat of cholera spreading to other villages and to the Goz Amir refugee camp, where 33,000 Sudanese are living, remains a cause for concern.

Difficulties in treating and accessing patients

The MSF-supported cholera treatment unit in Marena village was the first to treat patients affected by the disease. Despite the decrease in case numbers, there is still a regular stream of patients. The situation is more precarious in a second treatment centre in Dogdoré. Before MSF arrived, patients in this unit were taken care of by the only nurse in the health centre in Dogdoré.

Access to Dogdoré has been slowed down by wadis (rivers and streams), which have overflowed due to torrential rains. The flooding has several times prevented teams from accessing the site of the health centre with their equipment.

Treatment and prevention

MSF’s activities are aimed at providing medical treatment to suspected cholera cases in the specific treatment units. To stop the disease from spreading, MSF is also raising awareness among the communities of the importance of using chlorine-treated water and is promoting hygiene and hand-washing with soap. Water treatment activities (the treatment of water points with chlorine), soap distribution, as well as the repairing of wells and manual motor-driven pumps are also part of the package necessary for preventing the disease. Oral rehydration points will soon be set up in numerous strategic places according to medical needs.