A cholera epidemic has recurred annually in Guinea since 2004 and has been almost uninterrupted since the mid-90s because of the degradation in the country's health situation. More than 7,000 cholera cases have been reported since the start of the year in Guinea - more than half of those occurred in the capital, Conakry.

Some 260 persons, to date, have died. The epidemic, even worse this time than in previous years, has mobilised a good number of health care personnel and other players in the sector. It has had a significant impact on the regular activities of a health care service with scarce resources at its disposal.

If structural measures to improve water and sanitation facilities are not taken, the same scenario may well be played out year after year. The warning has already been made by MSF epidemiologists: in view of the development in the number of cholera cases in Conakry, a quick interruption of the epidemic could hardly be expected.

Six months after the first cases emerged in the Guinean capital, some 3,730 cases had been recorded in the city's three cholera treatment centres (CTCs); all three are supported by MSF. In the week of October 8 to 14, there were still 147 cases in the three CTCs in the city, at Donka (central hospital), Dabompa (Matoto area) and Kaporo (Ratoma area), where MSF continues to work.

Despite the current low number of deaths (five during the reference week, two of whom died outside the treatment structures), the human cost of the epidemic is still as high as 120 deaths in the capital. Although the epidemic seems to be slowing down, it is important that vigilance remains high.

"Even if the number of new cases appears to be decreasing, more vigilance is required at this stabilisation phase because the teams are exhausted and have lost their motivation in fighting an epidemic that has lasted more than five months," explained Isabelle Lessard, MSF field nurse with experience in cholera intervention.

Conakry may be the most affected, but vibrio cholerae has not spared other areas of the country, including Fria, Boké and Kindia, where MSF teams have provided aid from time to time. "The disease can be fatal if it is not treated rapidly", explained Dr. Jean Claude Djoumessi, one of the MSF programme heads in Guinea.

"Patients generally get better after two or three days of treatment based mainly on intravenous and oral rehydration. So it is crucial for health structures to have the capacity to admit and treat these patients, and be supported if necessary." Nevertheless, cholera is still a preventable disease. Building awareness of the importance of better hygiene and treating drinking water contributes to reducing the number of cases within communities. However, this does not resolve the structural problems that give rise to the spread of the disease.

Such problems are well-known, such as the lack of urban sanitation measures and inadequate distribution of clean water. Occasional efforts to disinfect wells and latrines, spraying inside homes of those in close contact with patients, chlorination of drinking water during epidemics and even information campaigns can relieve these problems, but only on a temporary basis.

For medical workers, the epidemic has recurred annually in Guinea since 2004 and has been almost uninterrupted since the mid-90s because of the degradation in the country's health situation. Sergio Martin Esteso, another MSF head in Conakry, says, "If there is effective coordination and planning on the part of the players involved in preventing and responding to cholera outbreaks, then the worst can be avoided in 2008 and hundreds of lives can be saved."