In Tanzania, protecting refugees from cholera

Refugees at the Nyarugusu Camp receive the Oral Cholera Vaccine. (c) UNICEF Tanzania/2015/Thomas Lyimo

Last week the Oral Cholera Vaccine, OCV, was administered at the Nyarugusu Refugee Camp, in Kigoma Region, Tanzania, to over 106,000 refugees from the Congo and – more recently – Burundi, out of an estimated camp population of 120,000 (children under the age of one were not vaccinated, hence the discrepancy in numbers). Medicins Sans Frontiers (MSF), who administered the vaccine, administered to Muslims observing Ramadan after sundown. We had been concerned whether the whole eligible community would receive the vaccine – and they did!

This is a significant event not only for the huge numbers of people who have been given the vaccine but also because it’s the first time the OCV has been administered in an emergency situation in Tanzania Mainland. Previously we simply relied on WASH (water, sanitation and hygiene) interventions, by sensitizing the people on good practices to help prevent diseases. However, given that refugees are still arriving from Burundi, this compromises our WASH interventions as facilities are no longer sufficient to meet the growing numbers. What makes OCV special is that it can help to fill this gap easily and quickly.

I’m a Health Specialist at UNICEF and as such my part in the OCV campaign has been to support the social mobilization task force – which is a key aspect of the campaign’s success. In the camp, in partnership with the Tanzanian Red Cross Society, we have trained 121 health information volunteers – community workers from the refugee community. They conduct household visits providing key messages not only on the OCV, but also cholera prevention through appropriate hand washing at critical times, and safe latrine use.

In addition, we’ve trained a theatre group that moves around the camp delivering shows that highlight the same issues. Another way we get the message out in the camp is through a vehicle that broadcasts messages loudly via megaphone. We’ve also engaged community leaders and religious leaders – in the camp and in the host communities outside the camp – in our effort to relay our message more broadly.

In addition to administering the vaccine, social mobilization about water, sanitation, and hygiene will continue. (c) UNICEF Tanzania/2015/Thomas Lyimo

Cholera is an illness that thrives when humans are forced to share a congested space with inadequate water, sanitation and hygiene facilities, such as the ones we saw in Kagunga where many refugees transited from Burundi. A person can contact cholera by drinking contaminated water and eating contaminated food. In Kagunga the emergency situation came about abruptly and on difficult geographical terrain that made it difficult to address the water and sanitation issues in a timely manner. As a result cholera took hold: there were about fifteen deaths in Kagunga village and eight while in-transit from Kagunga to the Nyarugusu Camp. The host communities surrounding the Nyarugusu Camp were also affected with cholera. Seven villages recorded cases, and there were eight deaths among Tanzanians.

And that’s why, as valuable as this vaccine is, as important a role it plays, I believe it must be considered as a complement to efforts to preventing cholera through improved WASH interventions – and not a replacement.

UNICEF, along with other agencies, is working very hard to improve the WASH situation which is critical not just for the prevention of cholera but other diarrhoeal illnesses too. Nyarugusu camp was designed to accommodate 50,000 refugees at capacity – but it hosts more than double its capacity now.

The terrifying thing about cholera isn’t just how quickly it spreads, but how quickly it kills, through dehydration. It manifests with abrupt and profuse diarrhoea and vomiting which causes dangerously swift dehydration. Unattended, a patient can die within hours of onset of the illness.

Our multi-pronged efforts to get the key messages on cholera and cholera prevention out have been successful; I estimate we’ve reached 92 per cent of the population in the camp with this campaign.

It’s important to sustain this effort though, as the refugee population continues to rise, at a rate of 1,000 people a week, and it’s imperative that we don’t become complacent just because the vaccine has been given – there are other diarrhoeal diseases that can kill and spread quickly. The OCV will provide a huge boost as cholera is one of the biggest killers in refugee communities, but we need to consider comprehensive WASH interventions as a symbiotic relationship that we must support.

Thomas Lyimo is a Health Specialist working at UNICEF Tanzania.