Declaration of Cholera Epidemic in Djibouti

UNCLAS DJIBOUTI 001349 SIPDIS AIDAC USAID/DCHA FOR MHESS, GGOTTLIEB DCHA/OFDA FOR KLUU, ACONVERY, KCHANNELL, WMILLER DCHA/FFP FOR WHAMMINK, JDWORKEN AFR/EA FOR BDUNFORD STATE FOR AF/E, AF/F AND PRM USUN FOR TMALY BRUSSELS FOR PBROWN GENEVA FOR NKYLOH USMISSION UN ROME FOR RNEWBERG E.O. 12958: N/A TAGS: EAID SUBJECT: Declaration of Cholera Epidemic in Djibouti ¶1. Summary: The Minister of Health, Mr Abdilla Miguel declared a cholera epidemic in the poor parts of the city of Djibouti and other periphery areas last Friday, the 16th of November and requested international assistance to help with epidemic response. The Ambassador concurs that an adequate response is beyond the capacity of the Djiboutian government, it is in the interest of the US to provide humanitarian assistance. Ambassador hereby exercises his disaster assistance authority. End Summary BACKGROUND ¶2. The current cholera outbreak started in Djibouti in January 2007 with three peaks; in January of this year, April and the most recent surge in September which has affected more than 1000 residents in Djibouti city and surrounding districts of Dikhil and Tadjourah. It is believed to have spread from neighboring Ethiopia. To date UN Children's Fund (UNICEF),World Health Organization (WHO) have assisted the Ministry of Health with cholera kits and other resources, however, the caseload continues to mount while resources dwindle. CURRENT SITUATION ¶3. On November 16th, Minister of Health (MOH) of Djibouti called for an emergency meeting with his cabinet, the Djiboutian Republican guard, police, gendarmes, Djiboutian military and donors including the military at CJTF/HOA. The Minister explained that there has been more than 1000 diarrhea cases since early September 2007 and the numbers of the affected are increasing, with significant proportion of cases identified as Cholera (almost 60 percent); 15% are shigella and salmonella, with the remaining of unknown etiology. The Minister has requested support of NAMRU3 laboratory( US DoD Lab in Egypt) for identification of the unknown. The case fatality rate in Djibouti city is estimated by the MOH to be 2.7 percent, well over the accepted rate of less than one percent. ¶4. The MOH has set up a cholera camp near the Balbala hospital (poor urban neighborhood where most of the affected live) but is overwhelmed, with cases reaching beyond its capacity of 100 beds. The majority of patients arrive at the facility in severe condition, and are hospitalized for five days, whereas the patient would normally remain at the camp only for 8 hours. The Minister requested the support of the national police to provide security around the cholera camp to limit public access in order to avoid the spread of infection to visitors. Many family members who visit patients subsequently get infected. With more than 40 admissions per day; the capacity of the cholera camp is over extended. ¶5. The MOH announced that the main cause of this epidemic is due to the population sourcing water from untreated waterbeds and wells, poor sanitary conditions in overcrowded urban districts and human to human contact due to poor hygiene. ¶6. The Minister requested support to control the spread of the disease outbreak, outlining the need for additional treatment resources, both human and material, as well as inputs for community mobilization, health education via the media and for greater attention to water quality and sanitation conditions in the city and outlying districts. RESPONSE TO SITUATION ¶7. The MOH has prioritized its urgent needs and will eventually be assisted by US military with some medical supplies, WHO with cholera kits; UNICEF will support the GODJ with medical inputs and assistance with community mobilization and hygiene education however faces a funding shortfall. Because of the magnitude of the health crisis, the mission is requesting US Agency for International Development (USAID) Office of Foreign Disaster Assistance (OFDA) to fund UNICEF Djibouti $100,000 to procure needed treatment supplies and facilitate an intensive health, sanitation, and hygiene campaign to prevent the spread of disease. DISASTER DECLARATION ¶8. As Chief of Mission, I hereby declare that a disaster exists in the City of Djibouti, Dikhil and Tadjourah districts and request that the USG international disaster assistance funding be made available to assist the affected population. The Government of Djibouti is not able to respond adequately to the emergency needs, and has asked for, and is willing to accept, international assistance and it is in the interest of the USG to help. SYMINGTON