1. (U) On the early morning of 13 April, following
high tides, strong winds and torrential rains in
almost all districts of Djibouti, the river El Oued
suddenly burst its banks and flooded several areas
in Djibouti City affecting over 80 percent of its
inhabitants. Water rose over seven feet in many
neighborhoods, washing away people and belongings.
Fifty-nine bodies were eventually found and sent to
the city mortuary, however, it is estimated that
around 300 people died in this disaster. Others are
still missing and unaccounted for.



2. (U) Many houses in the affected areas were destroyed
causing displacement of several thousands of people who
sought refuge with relatives in other parts of the city.
Djiboutian officials have indicated that approximately
1,500 remain without shelter, although there is evidence
that many more have not been registered. These persons
were relocated to either the military camp of Sheik
Osman or Balbala 2 primary school in poor sanitary
conditions and scarce means to make a living. More
than one third of the displaced are children.



3. (U) The water and electricity infrastructure was also
heavily damaged. With the resulting drinking water
shortage, broken sewage pipes and environmental damage
from the flood, the threats of epidemic prone diseases
such as cholera were pressing health emergency. It is
estimated that around 300,000 people were vulnerable to
these outbreaks.



4. (U) The flood situation also disrupted provision of
basic health services because of the total or partial
destruction of four main health care facilities in the
area. Medical equipment, drugs, cold chain and
nutrition supplement stocks were lost. These centers
cover around 90,000 of the population. In addition,
two health care centers in the outskirts of the
affected areas faced increased demands of the displaced
population housed in neighboring schools. There are
plans to relocate the displaced to PK12, a neighborhood
at the outskirts of Djibouti City. Relocation
conditions in terms of shelter, water, food and
latrines are not yet well defined. On the national
level, French and American armies were mobilized to
help save those stranded in trees and roof tops,
collect dead bodies and animals from the city streets,
pump standing water away from neighborhoods into the
sea, repair washed away bridges and railway lines and
provide potable water to those in need.



5. (U) In the 1994 flood in Djibouti, a cholera outbreak
of 8,000 cases and 32 deaths were registered. Another
cholera outbreak was recorded in 1997 with 3,000 cases.
The current post-flood situation in Djibouti poses a
genuine emergency. The Minister of Health, Dr. Ali
Kamil, and his health emergency cell, have developed a
master plan for cholera outbreak. Four health centers
in the affected areas have been rehabilitated and water
restored. Health services are being provided to the
needy. The Ministry of Health (MOH) has also installed
an emergency surveillance system for epidemic prone
diseases, such as malaria and cholera, and strengthened
preparedness for facing an eventual outbreak of cholera
in the affected area. The cholera prevention program
includes regionally pre-positioning Emergency Health Kits.



6. (U) USAID Representative Janet Schulman worked very
closely with the Minister of Health, his health
emergency unit, World Health Organization (WHO)
Representative Jihane Tawilah and Office of Foreign
Disaster Assistance (OFDA) advisor Mia Beers to order
critically needed emergency drugs and equipment. On
April 28, WHO Geneva sent by charter plane
approximately 48 tons of emergency diarrhea medication
which were ordered for Djibouti's MOH. With the arrival
of these drugs and equipment, critical stocks lost in
the centers will be restored to enable the MOH to
respond to any cholera and typhoid outbreaks. Some
USAID funding is being used to support public
information campaign needs on ways to make water safe
at the household level using boiling and chlorination
as well as safe food preparation. Nonetheless, access
to safe water remains a basic requirement to prevent
cholera epidemics; more efforts need to be directed
towards providing safe drinking water as well as water
for food preparation and bathing.



7. (U) USAID/OFDA provided resources for WHO to bring
into Djibouti within two weeks of the disaster:
- 10 New Emergency Health Kits (NEHK) to cover drugs
and medical supplies for 10,000 people for
approximately three months.
- 40 kits each of WHO Kit D, containing drugs to treat
100 people affected by diarroheal diseases, including
cholera, and Kit F, containing medical supplies to
supplement Kit D.
-Laboratory Supply for water surveillance and cholera
testing, plus additional needed medication and supplies.
- Large water dispensers for administration of bulk Oral
Rehydration Solution.
- Public Health Supplies and equipment for cleaning and
disinfection (cresol, muriatic acid, chlorine and
others to be locally purchased).
- Chlorination supplies for water at household level.
- Support logistics for daily water and health
facilities surveillance for diarrheal diseases in the
next three months.
- Support for the development of public health
education material.



8. (U) Total USAID support for this disaster is $300,000.
The Minister of Health and his emergency health unit,
Schulman, and Tawilah were at the airport on April 28 to
receive the WHO shipment. The Djiboutian Presidential
Republican Guards were on hand to unload the medication
and supplies and to truck them to the central pharmacy
under the watchful eyes of two logisticians sent in with
the drugs by WHO Geneva.
RAGSDALE