H5N1

Yemen: Over 460,000 cases of cholera registered to date this year

I gave up on covering Yemen's public health disasters sometime last year. It seemed pointless to report yet more cholera cases and deaths when nothing was done about it and the Saudi coalition kept blowing up sanitation infrastructure. 

But OCHA has been on the case: Yemen: Over 460K cases of cholera registered to date this year. The full report, and then a comment:

Recent flash flooding has accelerated the spread of cholera across Yemen, exacerbated by poor maintenance of waste management systems and lack of access to clean water for drinking or irrigation. 

As of today, the cholera outbreak has reached over 460,000 suspected cases this year, including approximately 200,000 children. This exceeds the 380,000 total suspected cases in the whole of 2018. So far this year, 705 deaths have been recorded from suspected cholera – versus 75 deaths in the same period last year or nine times more.  

This year, the UN and partners are running nearly 1,200 cholera treatment facilities around the country. However, funding remains an urgent issue. 

Background  

After four years of continuous conflict, the humanitarian crisis in Yemen is the worst in the world. A higher percentage of people face death, hunger and disease than in any other country.  The degree of suffering is nearly unprecedented.   

Eighty percent of the entire population requires some form of humanitarian assistance and protection, an increase of 84 per cent since the conflict started in 2015. Twenty million Yemenis need help securing food and a staggering 14 million people are in acute humanitarian need.   

The Yemen Humanitarian Response Plan requires $4.2 billion to deliver humanitarian assistance to more than 20 million people this year. As of today, only 32% of those requirements have been met. We urge all donors to promptly pay their pledges – including $2.6 billion in pledges made in Geneva more than four months ago. 

Funding is urgently needed to enable humanitarian partners to repair and decontaminate water and sanitation systems, expand epidemiological surveillance and treat patients as quickly as possible.

As long as Crown Prince Mohamed bin Salman persists in his hobby war, and no one demands that he stop, and "donors" continue to postpone their donations, the misery will continue and still more children will die.

WHO: Fast rollout of cholera vaccines for people in need in Mozambique

WHO AFRO has published Fast rollout of cholera vaccines for people in need in Mozambique. Excerpt:

10 April 2019, Maputo - The Ministry of Health in Mozambique has concluded a successful six-day emergency cholera vaccination campaign that reached more than 800 000 people in four districts affected by Cyclone Idai. 

The campaign was supported by around 1200 community volunteers and partners including the World Health Organization (WHO), UNICEF, Médecins Sans Frontières (MSF), International Federation of the Red Cross and Red Crescent Societies (IFRC) and Save the Children.  

“From start to finish, this campaign was one of the fastest ever, thanks to experienced people at the Ministry of Health, who knew there was a high risk of a cholera outbreak and made a rapid request for the vaccines as soon as the cyclone hit,” says Dr Djamila Cabral, Head of the WHO office in Mozambique. “The Ministry did an excellent job organizing the campaign and reaching so many people in such a short time. 

The oral cholera vaccine is one of the vital measures that can help save lives and stop the spread of this terrible disease during an outbreak.” The oral cholera vaccines, donated by Gavi from the Global Cholera Vaccine Stockpile, arrived in Beira on Tuesday 2 April and, within 24 hours, began reaching people in need. 

The vaccines were given to communities identified by the Government at highest risk – those without access to safe water and sanitation - in Beira, Dondo, Nhamatanda and Buzi districts.  

Vaccine uptake has been very high and the campaign has been well received by the communities. Remaining vaccines will be used for other at-risk communities that were not reached by the initial campaign.  

People develop protection against cholera approximately 7 days after receiving the vaccine. One dose of this oral vaccine provides around 85% protection against cholera for 6 months.

Cyclone Idai: ECDC joins emergency response as more cases of cholera and waterborne diseases expected

Via ECDC: Cyclone Idai: ECDC joins emergency response as more cases of cholera and waterborne diseases expected. Excerpt:

Thousands of people are currently displaced in Mozambique, Malawi and Zimbabwe as a consequence of the tropical cyclone Idai, which hit southern Africa on 15 March 2019. The cyclone caused hundreds of fatalities so far and an upsurge of infectious diseases such as cholera. 

According to the World Health Organization (WHO) and as of 30 March, more than 500 deaths have been reported in Mozambique, 172 in Zimbabwe and 59 in Malawi as a result of this cyclone. Cholera cases continue to rise: over 1428 cases and 1 death reported in Mozambique, with 89 people still in treatment centres, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). UN OCHA estimates that 1.6 million people have been affected by cyclone Idai in the three countries, as thousands of houses have been destroyed or flooded.  

Heavy rains, floods, the shortage of portable water, disruption of healthcare services and overcrowding are major factors known to increase the risk of waterborne infections such as cholera and typhoid, but also malaria and measles. 

The areas affected by the cyclone will likely experience infectious disease outbreaks and the number of related deaths is expected to increase in the coming days. A cholera vaccination campaign with 900 000 doses of oral vaccines from the global emergency stockpile has already started this week. 

ECDC has deployed an epidemiologist under the EU Civil Protection Mechanism to assist in the emergency response in Mozambique. The mission will support the humanitarian response with public health assessments and epidemiological advice. ECDC is also producing a risk assessment on the health risks related to this event.

WHO: Cholera vaccination campaign begins in Mozambique

WHO has published Cholera vaccination campaign begins in Mozambique. Excerpt:

An oral cholera vaccination campaign to protect survivors of Cyclone Idai begins today in Beira, Mozambique. Funded by Gavi, the Vaccine Alliance, the campaign will be carried out by the Mozambique Ministry of Health, with support from WHO and other partners, including UNICEF, the International Federation of the Red Cross and Red Crescent Societies (IFRC), Médecins Sans Frontières (MSF) and Save the Children.  

There has already been one reported cholera death and almost 1500 reported cases following the cyclone, which caused severe flooding in Mozambique, Zimbabwe, Malawi and Madagascar after making landfall in March. Nine cholera treatment centres, with 500-bed capacity, are already admitting patients.  

“Cyclone Idai’s trail of devastation has left the city of Beira’s water and sanitation infrastructure in ruins, providing the perfect conditions for cholera to spread,” said Gavi CEO, Dr Seth Berkley. “This cyclone has already caused enough devastation and misery across south east Africa; we have to hope these vaccines will help stop a potentially major outbreak and prevent yet more suffering.” 

“Hundreds of thousands of people are living in terrible conditions in temporary settlements without safe drinking water and sanitation, putting them at serious risk of cholera and other diseases,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “The key thing is to make sure that people can access rapid treatment and clean water and sanitation. The oral cholera vaccine is a vital emergency measure that will help save lives and stop the spread of this horrible disease.” 

WHO is supporting the Ministry of Health to coordinate the oral cholera vaccination campaign, including working with partners to ensure an appropriate cold chain storage and providing logistical support.    

Cholera is endemic to Mozambique, which has had regular outbreaks over the past five years. About 2 000 people were infected in the last outbreak, which ended in February 2018.

OCHA in Mozambique: Cyclone Idai & Floods Flash Update No. 11, 27 March 2019

Via ReliefWeb, an OCHA report: Mozambique: Cyclone Idai & Floods Flash Update No. 11, 27 March 2019. Excerpt:

HIGHLIGHTS 

• On 27 March, the Government confirmed five cases of cholera at the Munhava health centre in the city of Beira and some 2,500 cases of acute watery diarrhoea in Beira district.  

• A humanitarian assessment team identified nearly 1,500 people unreached people in need of support in Matarara in Chimoio district. Food drops were carried out to provide immediate assistance and follow-up is ongoing. 

• Nearly 136,000 people were accommodated in 161 sites across Sofala (119 sites), Manica (27 sites), Zambezia (11 sites) and Tete (4 sites) as of 27 March; an increase of more than 9,200 people from 26 March. 

• More than 92,000 houses were identified as totally destroyed (50,772), partially destroyed (25,769) or flooded (15,784) as of 27 March; an increase of more than 1,300 since 26 March. 

• Health partners have raised concern over menstrual hygiene as most girls and women in IDP accommodation sites reportedly do not have access to clean water and safe spaces to hang sanitary materials. 

SITUATION OVERVIEW 

On 27 March, the Government confirmed five cases of cholera at Munhava health centre in Beira City, according to the National Director of Medical Assistance, Ussene Isse. The authorities also reported some 2,500 cases of acute watery diarrhoea (AWD) in Beira district. A total of 900,000 cholera vaccine doses, which will be effective for six months, are expected to arrive in Mozambique by 1 April and micro-planning for the vaccination campaign is underway. 

The number of internally displaced people (IDPs) accommodated in 161 sites across Sofala (119 sites), Manica (27 sites), Zambezia (11 sites) and Tete (4 sites) has risen by more than 9,200 people, to nearly 136,000 people, as of 27 March. More than 92,000 houses were identified as totally destroyed (50,772), partially destroyed (25,769) or flooded (15,784) as of 27 March; an increase of more than 1,300 since 26 March. 

More than 3,200 schools were destroyed and nearly 91,000 students are affected, including those whose schools are being used as accommodation sites. The Ministry of Education is preparing a timeline to address the forced break in schooling as the authorities work on transferring IDPs from schools into new accommodation sites to allow schools to reopen. 

An assessment team identified nearly 1,500 people in Pambanisa, Matarara, in Chimoio district, in urgent need of assistance. A food drop to last three days was carried out to assist them immediately and response is ongoing. An airdrop of shelter kits by helicopter is scheduled. 

In Dombe, health centres are reportedly out of medical supplies and essential medicines and most are running without electricity. A private company has set-up a generator for the hospital in Sussungenga district, which is now fully operational. 

Water supply has reportedly been reestablished in Beira, with 60 per cent of the pipes in the city having running water, according to WASH partners. A special water trucking operation is being run by the Government pending the repair of all damaged infrastructure. UK aid flights reportedly transported materials for the repair of the water systems in Beira, while WASH partners have provided technical support, fuel and water treatment chemicals for the systems.

Cyclone Idai crisis deepens as first cases of cholera confirmed in Mozambique

Via The Guardian: Cyclone Idai crisis deepens as first cases of cholera confirmed in Mozambique. Excerpt:

The first cases of cholera have been reported in the cyclone-ravaged Mozambican city of Beira, complicating an already massive and complex emergency in the southern African country.  

The announcement of five cases of the waterborne disease follows days of mounting fears that cholera and other diseases could break out in the squalid conditions in which tens of thousands have been living since Cyclone Idai struck on 14 March, killing at least 700 people across the region.  

The first cases of the disease were confirmed in Munhava, one of the poorest areas of the hard-hit port city of Beira, the national director of medical assistance, Ussene Isse, told reporters. The city of roughly 500,000 people is still struggling to provide clean water and sanitation.  

“We did the lab tests and can confirm that these five people tested positive for cholera,” said Isse. “It will spread. When you have one case, you have to expect more cases in the community.” 

The World Health Organization is dispatching 900,000 doses of oral cholera vaccine to affected areas from a global stockpile. The shipment is expected to be sent later this week.  

Cyclone Idai smashed into Mozambique at about midnight on 14 March before tearing through neighbouring Zimbabwe and Malawi, displacing hundreds of thousands of people and flooding an area of 3,000 sq km.

WHO EMRO: Resurgence of cholera, AWD in Yemen

Via WHO EMRO, a report from Geert Cappelaere, UNICEF Regional Director in the Middle East and North Africa and Dr Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean: Two years since world-largest outbreak of acute watery diarrhoea and cholera, Yemen witnessing another sharp increase in reported cases with number of deaths continuing to increase.

MUSCAT/ AMMAN/CAIRO, 26 March 2019 – “In Yemen, since the beginning of the year until 17 March, nearly 109 000 cases of severe acute watery diarrhoea and suspected cholera were reported with 190 total associated deaths since January. Nearly one third of the reported cases are children under the age of 5. This comes 2 years since Yemen witnessed the world-largest outbreak when more than 1 million cases were reported. 

“We fear that the number of suspected cholera cases will continue to increase with the early arrival of the rainy season and as basic services, including lifesaving water systems and networks have collapsed. The situation is exacerbated by the poor status of sewage disposal systems, the use of contaminated water for agriculture, unreliable electricity to store food and families’ displacement as they flee escalating violence especially in Hudaydah and Tai’z.  

“Our teams in Yemen are working day and night with a wide network of local partners to respond and stop the further spread and transmission of the diseases. Focusing on 147 priority districts, additional health, water, hygiene and sanitation supplies are being mobilized. Rapid response teams have been deployed. A total of 413 diarrhoea treatment centres and oral rehydration centres are operational in all 147 priority districts. 

"Partners are repairing water and sanitation systems. In the past weeks, we scaled up chlorination activities to disinfect water in 95 priority districts and provided fuel and spare parts to keep going water supply and sanitation networks. A round of oral cholera vaccine campaign reached over 400 000 people in several districts. 

"Meanwhile, community-based awareness raising reached 600 000 people in house-to-house campaigns since early 2019 to provide families with hygiene practices and improve reporting symptoms and seeking treatment.  

“UNICEF and WHO are committed to continue scaling up the response to assist immediately the people affected and to prevent the disease from spreading further. We are doing everything possible to avoid the 2017 scenario including the timely use of proven effective measures, including oral cholera vaccination. However, we face several challenges, including the intensification of fighting, access restrictions and bureaucratic hurdles to bring lifesaving supplies and personnel to Yemen.  

“UNICEF and WHO are calling to lift all restrictions on our humanitarian operations to respond to the spread of the disease and other areas. Our humanitarian teams must have full access to reach every child, every woman, every man in need of medical and other humanitarian assistance. 

“Above all, we jointly reiterate the calls for the fighting to end. It is time for the 4-year long war to come to an end. If not, Yemen will continue to be trapped in a web of diseases, malice and sink deeper in endless humanitarian disasters, with the most vulnerable paying the highest price.

Mozambique: Cyclone Idai & Floods Flash Update No. 9, 25 March 2019

Via ReliefWeb, an OCHA report: Mozambique: Cyclone Idai & Floods Flash Update No. 9, 25 March 2019. Excerpt:

HIGHLIGHTS 

• The official death toll was 447 people as of 25 March, according to the Government. 

• Nearly 129,000 people are sheltering in 143 collective sites across Sofala (more than 97,600 people), Manica (more than 14,800 people); Zambezia (more than 9,600 people); and Tete (more than 6,800 people).  

• The entire District of Nhamatanda in Sofala Province has been affected by Cyclone Idai and related floods, and nearly 15,000 people are sheltering in 14 sites across the district.  

SITUATION OVERVIEW 

As of 25 March, the official death toll was 447, with more than 1,500 people injured, according to the Government. 

Authorities and aid agencies have highlighted the need for increased support in the management of dead bodies across the affected districts, as mortuary services are reportedly constrained. Nearly 129,000 people were accommodated in 143 sites across Sofala (103 sites), Manica (26 sites), Zambezia (10 sites) and Tete (4 sites), as of 25 March, an increase of more than 20,200 people since 24 March, across the affected areas. Some 72,260 houses are reportedly totally destroyed (36,747), partially destroyed (19,733) or flooded (2,184), with more than 497,700 hectares of crops damaged. 

Reports of acute watery diarrhoea cases are increasing in areas impacted by the cyclone and floods, although the exact number of cases is yet to be confirmed. Health partners are in the process of identifying suitable locations for the establishment of treatment centers and it is expected that the figures of those infected will become clearer as people report to the centres. Key messages on the signs and symptoms of diarrhoea, when and where to seek help, prevention and general hygiene are being conveyed on local radio with the support of the Community Engagement Group.  

On 23 and 24 March, a joint government-led multi-agency rapid needs assessment was conducted in Donbe, Matara and Sussundega, in Chimioi District, Manica Province. More than 13,300 people affected by Cyclone Idai and floods were identified in six locations: Chimoio, Gondala, Macate, Matarara, Sussundega and Vanduzi. The number of deaths in the district is reportedly rising, as the flood waters recede, with nine bodies found in Donbe this week. Efforts are underway to improve management of dead bodies, as mortuary facilities were either destroyed and/lack enough facilities and capacity. 

Priority needs in the affected parts of the district are food, with specific requests for cereals, vegetables, oil, salt, and biscuits, and non-food items, including kitchen sets, blankets, plastic sheeting and mosquito nets. 

The Provincial Governor has reportedly expressed concern over the potential for an outbreak of various water and vector-borne diseases, due to the challenging sanitation conditions and limited access to clean drinking water in the accommodation sites and surrounding areas. The Department of Health is planning to increase hygiene promotion activities, while Public Works Department will review the status of water provision in the shelters.

Cyclone Idai: 'We will have cholera, we will have malaria'

Via The Guardian: Cyclone Idai death toll passes 750 with more than 110,000 now in camps. Excerpt:

Cyclone Idai’s death toll has risen above 750 in the three southern African countries hit 10 days ago by the storm, as workers try to restore electricity and water and prevent an outbreak of cholera. 

In Mozambique the number of dead has risen to 446, with 259 dead in Zimbabwe and at least 56 dead in Malawi. 

All numbers for deaths are still preliminary, said Mozambique’s environment minister, Celso Correia. As flood waters recede and more bodies are discovered, the final death toll in Mozambique alone could be above the early estimate of 1,000 made by the country’s president a few days after the cyclone hit, said aid workers.  

Nearly 110,000 people are now in camps more than a week after Cyclone Idai hit, said Correia, the Mozambican government’s emergency coordinator. As efforts to rescue people trapped by the floods wind down, aid workers across the region are bracing for the spread of disease, including cholera and malaria.

Helicopters and boats have been used to rescue some people stranded for days on rooftops and in trees. Some survivors have been digging through rubble with their hands to search for loved ones, while government and aid agencies have been flying in help. 

“We will have cholera, we will have malaria. It’s unavoidable in this situation, so the government is opening a cholera treatment centre already,” Correia told reporters. 

The International Committee of the Red Cross said it had recorded some cases of cholera so far but the UN was unable to confirm the reports.

No food, no shelter, no livelihood: Families in Mozambique hit by Cyclone Idai

Via The Guardian: No food, no shelter, no livelihood: families in Mozambique hit by Cyclone Idai. Excerpt:

Beneath the crumbling arcade of the municipal council building in Beira, in Mozambique, a group of families has set up a dismal camp. They sleep on dirty concrete pavement and cook with branches from the trees brought down by Cyclone Idai which swept through southern Africa last week. 

Winds of more than 100mph triggered devastating floods and more than 400 people were killed, according to government sources. Land and environment minister Celso Correia said that the situation in the country was now critical. 

Laila Jorge, a mother of three, was one of those caught by the storm. A street vendor of alcoholic drinks, she was living in Zona B, a poor area of the port city of Beira, where shacks were once located close to the sea. “When the wind came, it took off the roof and blew down the wooden walls of my house. We had to run because we thought that we were going to die. There was waist-deep water [from the storm surge] in the street, so we ran here. We didn’t have our shoes and our feet got cut from glass we couldn’t see. We stopped when we got here because it was dry and because it was empty.” 

Jorge and the others have lost everything, she added. Her pots and flipflops were donated by workers cleaning up the damage and who took pity on them. Apart from that, they have received no aid.  

Near Jorge, several children are gathering water in large plastic bottles from a deep puddle that has overflowed from the fountain pool in the square opposite. Next to them, a boy of about eight is washing tiny sprat-like fish that glisten in a pot. Jorge said the fish were washed up by the cyclone and stranded in the pools of standing water left in the city and were now being collected by local boys. “Dead or alive, we’ve been eating them,” she said, “because it’s all we have to eat.” 

Jorge said dirty water being scooped up and carried by the children from the square was for cooking and washing, not drinking, but added that her children aged three, five and seven all had diarrhoea. 

Despite a huge global-aid appeal that has raised tens of millions across the world, including in the UK, many like Jorge have yet to see assistance. For their part, international aid officials have admitted they were initially blindsided by the nature of the catastrophe. They had focused their initial efforts on Beira, which the Red Cross initially thought was largely destroyed by the cyclone. They did not foresee the arrival of devastating floods that would hit huge areas of the countryside more than a day later.

That wrongfooting had consequences. Badly needed helicopters, required to rescue people in the countryside sheltering in trees, on roofs and in electric pylons, were slow to arrive. “We could see from our first aerial surveys that Beira had been badly hit,” Jamie LeSueur of the Red Cross told the Observer. “What we weren’t able to predict was the scale of the flooding that would follow.”  

Even now officials admit they have yet to get a full picture of the scale of the disaster. They merely describe it as “overwhelming”.