In the aftermath of the floods that have affected the Zambeze valley in Mozambique, displaced people are now under threat of cholera outbreaks as a result of poor living and hygiene conditions in camps.

Although there has been a slight stabilisation in the last week, water levels in the Zambeze valley remain alarmingly high. Powerful storms regularly come in to ruin the scorching sun's drying efforts. This unstable and unsure situation means that most families have no hope of being able to go back to their home in the near future.

More than a hundred thousand people have had to seek refuge in camps, sometimes quite far away from their village. Some families have been relocated to transit camps, waiting to be moved to a new place.

Now, about two weeks after the water level peaked, cholera is spreading in some camps in Mutarara district because hygiene conditions are not satisfactory. Typically, cholera is spread through dirty water and human stools.

"Camps without proper latrines or clean water delivery are particularly at risk," said Dr. Richard N'kurunziza, from MSF. "Transit camps are particularly affected because not enough efforts have been made to ensure that hygiene conditions are acceptable in those places. And just a few days without adequate hygiene conditions are enough for the disease to spread."

Treating and preventing further spread

MSF has now extended the cholera treatment camp located next to Mutarara Hospital, and built a new one in Bawe, about five kilometres north. MSF teams systematically trace people who come with cholera symptoms to see where they come from, and then identify the source of transmission.

"A few days ago, we discovered that two people with cholera came from one same camp," said Dr N'kurunziza. "We went there and realised that a number of new people had arrived in the camp, making the number of latrines and water supply clearly insufficient. People were defecating around the camp, and drinking water from the river: this is a recipe for disaster."

Cholera never comes as a surprise with this kind of natural disaster, but there have been some gaps in the precautionary measures taken. Although coordination between the different relief agencies has been good, there has been some gaps and not all promises were fulfilled. In one case, NGOs delivered a water tank to a camp, but only brought the water five days later.

Decisive measures are needed

Because many cases came from Bawe, a village that is now surrounded by three camps (more than 9,000 people), the MSF logistical team built a cholera treatment centre there.

"We cannot be sure how many people will be treated here," said Jean Pletinckx, who is charge of the construction. "But we do not want to take any chances, and we are quite sure that this place is a source of contamination. By building the centre here, we also want to avoid further spread by people walking all the way to Mutarara to get treated."

Up to now, more than 330 people have been treated in centres supported by MSF across Mutarara district. And this number may well rise now before it goes down. Expected rains and more population displacement due to the possible opening of the Kariba Dam may make the situation worse.

Treating people is crucial to save lives, but this work would be a waste of time and energy if efforts are not made to stop contamination at the source. MSF health promoters are working in the camps to convince people to build latrines and use them. At the same time, logistics team work to make sure that clean water is available in the camps that MSF is supporting.

As of today, MSF has provided clean water to eight camps in Mutarara, Mopeia, Morrumbala and Chinde districts. More than 600 latrines have been provided in those camps and work continues to make the them as safe as possible.

As the effort to evacuate people from the affected zones is reaching completion, it is crucial for MSF teams and other actors to continue working hard to prevent the spread of disease. Living conditions in camps can be very difficult but people should have basic hygiene conditions while there.