Identifier
Created
Classification
Origin
07NAIROBI1178
2007-03-14 11:06:00
UNCLASSIFIED
Embassy Nairobi
Cable title:  

SOMALIA DART SITUATION REPORT 19 - CHOLERA

Tags:  EAID PHUM PREL SO 
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VZCZCXRO4890
PP RUEHDE RUEHROV RUEHTRO
DE RUEHNR #1178/01 0731106
ZNR UUUUU ZZH
P 141106Z MAR 07
FM AMEMBASSY NAIROBI
TO RUEHC/SECSTATE WASHDC PRIORITY 8226
INFO RUCNSOM/SOMALIA COLLECTIVE
RUEHRN/USMISSION UN ROME 0131
RHEHNSC/NSC WASHDC
RHMFIUU/CJTF HOA
RHMFIUU/CDR USCENTCOM MACDILL AFB FL
RUEKJCS/SECDEF WASHINGTON DC
RUEKJCS/JOINT STAFF WASHINGTON DC
UNCLAS SECTION 01 OF 03 NAIROBI 001178 

SIPDIS

AIDAC

USAID/DCHA FOR MHESS, WGARVELINK, LROGERS
DCHA/OFDA FOR KLUU, GGOTTLIEB, AFERRARA, ACONVERY,
KCHANNELL
DCHA/FFP FOR WHAMMINK, JDWORKEN
AFR/AFR/EA FOR JBORNS
STATE FOR AF/E, AF/F AND PRM
STATE/AF/E FOR NGARY
STATE/F FOR ASISSON
STATE/PRM FOR AWENDT, MMCKELVEY
NSC FOR TSHORTLEY
USUN FOR AMAHONEY
BRUSSELS FOR PLERNER
GENEVA FOR NKYLOH
USMISSION UN ROME FOR RNEWBERG

SIPDIS

E.O. 12958: N/A

TAGS: EAID PHUM PREL SO
SUBJECT: SOMALIA DART SITUATION REPORT 19 - CHOLERA
UPDATE

REFS: A) NAIROBI 00255 B) NAIROBI 00720

NAIROBI 00001178 001.2 OF 003


SUMMARY

UNCLAS SECTION 01 OF 03 NAIROBI 001178

SIPDIS

AIDAC

USAID/DCHA FOR MHESS, WGARVELINK, LROGERS
DCHA/OFDA FOR KLUU, GGOTTLIEB, AFERRARA, ACONVERY,
KCHANNELL
DCHA/FFP FOR WHAMMINK, JDWORKEN
AFR/AFR/EA FOR JBORNS
STATE FOR AF/E, AF/F AND PRM
STATE/AF/E FOR NGARY
STATE/F FOR ASISSON
STATE/PRM FOR AWENDT, MMCKELVEY
NSC FOR TSHORTLEY
USUN FOR AMAHONEY
BRUSSELS FOR PLERNER
GENEVA FOR NKYLOH
USMISSION UN ROME FOR RNEWBERG

SIPDIS

E.O. 12958: N/A

TAGS: EAID PHUM PREL SO
SUBJECT: SOMALIA DART SITUATION REPORT 19 - CHOLERA
UPDATE

REFS: A) NAIROBI 00255 B) NAIROBI 00720

NAIROBI 00001178 001.2 OF 003


SUMMARY


1. The rate of new cholera cases is declining in most
areas of southern and central Somalia following repairs
to water and sanitation facilities damaged from recent
flooding. However, repairs are needed in Lower
Shabelle Region and Mogadishu, where insecurity has
thus far obstructed response efforts, allowing the
cholera outbreak to continue. Despite adequate
response efforts in most of southern and central
Somalia, non-governmental organizations (NGOs) in
northern regions have acknowledged that poor prevention
and early detection capacity resulted in high case
fatality rates in some areas, and are working to
address the issue. USAID's UN and NGO partners have
provided medical supplies and assisted in water and
sanitation repair activities, helping to prevent the
further spread of cholera. End summary.

BACKGROUND


2. The current cholera outbreak in southern and
central Somalia originated in Lower and Middle Juba
regions in December 2006 as a direct result of recent
flooding that had damaged water and sanitation
facilities. Health agencies acted quickly to contain
the spread of cholera (REF A),which is endemic in
Somalia. However, deteriorating hygiene conditions led
to new cases of suspected cholera in Hiran Region in
mid January and it has since appeared in Lower and
Middle Shabelle regions (REF B) and Mogadishu.


3. As of March 2, the UN World Health Organization
(WHO) had received unconfirmed reports of 3,633 cases
of acute watery diarrhea, including 143 deaths in
southern and central regions. Health organizations are
also responding to a limited number of suspected cases
in Mudug and Bari regions in northern Somalia.
Although WHO continues to refer to the cases as acute
watery diarrhea given insufficient sampling and

confirmation of the cholera bacterium in all locations,
many areas have confirmed the presence of the cholera
bacterium and suspected cases are consistent with the
case definition of cholera. As such, the USG Disaster
Assistance Response Team (DART) continues to refer to
the current outbreak as cholera.

GENERAL IMPROVEMENT IN SOUTHERN AND CENTRAL SOMALIA


4. Reports of new cases are declining overall in
southern and central Somalia, and WHO reports that
adequate medical supplies have been mobilized to Hiran,
Middle Shabelle, and Lower and Middle Juba regions.
WHO staff lead regular task force meetings in Hiran and
Middle Shabelle regions and in Kismayo and Mogadishu to
discuss and improve upon cholera response activities.
WHO has provided medical supplies to affected areas,
and humanitarian organizations are coordinating
surveillance, treatment, and water and sanitation
activities.

CONCERNING TRENDS IN LOWER SHABELLE AND MOGADISHU


5. WHO is particularly concerned over recent cholera
cases in Lower Shabelle Region and Mogadishu, where

NAIROBI 00001178 002.2 OF 003


insecurity presents significant challenges to relief
agencies. The number of suspected cases is increasing
in Lower Shabelle, due to an influx of internally
displaced persons from Mogadishu, who lack access to
clean water and sanitary facilities. By March 2, WHO
had received unconfirmed reports of 235 cases in Merka,
including 15 deaths, representing the highest incidence
in the region. Between early February and March 2,
health officials reported 151 cases with 15 deaths in
Afgoye, 112 cases with 7 deaths in Kattunwery, and 111
cases with 7 deaths in Qoryoley. From February 10 to
March 2, Sablale and Awdegle reported 61 cases,
including 12 deaths, and 17 cases have been noted in
Brava town since February 24.


6. In Mogadishu, WHO has reported 391 cases with nine
deaths between February 24 and March 2. Out of ten
samples collected from Banadir hospital, nine tested
positive for the cholera bacterium. WHO notes a need
for additional water and sanitation activities to
improve hygiene conditions, however, the limited
presence of international humanitarian organizations in
Mogadishu combined with ongoing insecurity
significantly limits the potential response.


7. Regular water and sanitation activities had been
temporarily suspended due to insecurity, however WHO
has requested that partners resume efforts in order to
improve sanitation and curb the spread of cholera in
Lower Shabelle. Mobile health teams are providing
treatment and WHO dispatched a diarrhea disease kit
with sufficient supplies for 100 severe and 400
moderate cases to both Lower Shabelle and Mogadishu.
USAID partner the UN Children's Fund (UNICEF) is
scheduled to distribute additional supplies within the
following week and is also pre-positioning supplies in
Baidoa and Mogadishu for future response efforts.


8. In addition to regular health cluster coordination
meetings in Nairobi, and cholera task force meetings in
Mogadishu, the Somalia Support Secretariat (SSS) health
cluster meeting chair may call ad hoc meetings in March
to further coordinate cholera response efforts between
local, international and UN agencies.

CHOLERA IN NORTHERN REGIONS


9. Although the overall number of cholera cases is
declining in Galkayo and Bossaso towns, health agencies
have expressed marked concern over the high case
fatality rates, particularly in Galkayo. With some new
cases in the past two weeks, health officials in
Galkayo have reported 66 cases, including 13 deaths,
resulting in a case fatality rate (CFR) of 19.6 percent
for the February 18 to March 5 reporting period. In
Bossaso, local officials reported 202 cases, including
10 deaths between February 16 and March 6, yielding a
CFR of 4.95 percent. Health experts noted that while
the outbreak has already been contained in Galkayo and
Bossaso, the unacceptably high CFRs were due in part to
poor application of institutional knowledge and
insufficient preparation and prevention activities.


10. The SSS chairperson for the health cluster said
that cholera prevention and early detection efforts,
particularly in these two areas, had been insufficient,
and indicated that health agencies were not adequately

NAIROBI 00001178 003.2 OF 003


prepared despite cholera being endemic in Somalia. The
NGO Merlin has drafted a lessons learned document
regarding the cholera situation in Galkayo and Bossaso
for review by the health cluster to enhance
preparedness for future outbreaks.

USAID PRIORITIZES HEALTH AND WASH INTERVENTIONS


11. USAID's Office of US Foreign Disaster Assistance
(OFDA) has long prioritized health and water,
sanitation, and hygiene (WASH) interventions throughout
Somalia with the aim of improving sanitation and
hygiene and reducing vulnerability to water-borne
diseases such as cholera. OFDA committed more than
$4.5 million for health and WASH activities throughout
Somalia in FY 2006, and has provided $2 million to date
in FY 2007 for additional WASH programming through
UNICEF in response to recent flooding and conflict.

COMMENTS


12. While Puntland has been more secure than southern
and central Somalia and has a functioning Ministry of
Health (MOH),it appears that a degree of complacency
has set in amongst the MOH, UN and NGOs. While most
recently international focus has been on southern and
central Somalia, the UN and aid agencies must maintain
vigilance and garner the same level of response for
cholera in the northeast and northwest regions of the
country.


13. In spite of years of NGO experience and decent
preparation efforts in most of Somalia, cholera is
again claiming lives. Until security improves and
health resources increase, Somalis will continue to be
vulnerable to this preventable disease.

RANNEBERGER