A massive cholera epidemic is continuing to spread in Liberia, although the war that sparked it is subsiding. According to a WHO brief dated Sept 9, as of Aug 31 the cumulative number of cholera cases since the beginning of June was 10 043. The peak occurred July 7-13, when 935 cases were reported in one week.

The current epidemic was sparked by an escalation of the civil war that led to the flight of former president Charles Taylor. Several hundred thousand people fled their homes as a result of violence, looting, and rape committed by the fighting groups, as well as the fear of being caught in crossfire. Most of them camped in schools and churches in Monrovia under cramped conditions without adequate water, sanitation, shelter, food, and electricity. Increased rains worsened the hygiene situation. At the same time the health system broke down, with clinics deserted and disease surveillance not functioning.

WHO and Médecins Sans Frontières have been treating patients, but they are overwhelmed by the numbers, movements of displaced persons, and continued fighting outside Monrovia.

Even without war, most countries in sub-Saharan Africa suffer from cholera. WHO's representative in Uganda, Oladapo Walker, blamed the disease on lack of water and sanitation facilities, and neglect of simple procedures such as boiling water.

"Less than 20 percent of African people have access to piped water. Even where people have access there is often breakdown of municipal supplies", he said. "The way forward is information and education, encouraging people to boil water, and using chlorine."