DRC- Cholera

While the Democratic Republic of Congo (DRC) is facing an outbreak of Ebola virus disease in the east of the country, cholera continues to spread in other regions, where limited access to safe water and sanitation infrastructure is contributing to transmission of the disease.

Since June this year, a cholera outbreak has been affecting the Popokabaka health zone, in DRC’s Kwango province. As of 22 July, 345 suspected cases and 21 deaths were reported across 26 of the health zone’s 35 health areas, representing a case fatality rate of 6.1 per cent. Médecins Sans Frontières (MSF) is supporting the Ministry of Health in the response, including through patient care, epidemiological surveillance, and water, sanitation and hygiene activities.

The outbreak in Popokabaka was officially declared on 25 June, after the National Institute of Biomedical Research confirmed the presence of Vibrio cholerae. The three health areas in the provincial capital – Secteur Popo, Cité Popo 1 and Cité Popo 2 – accounted for 200 cases, or 58 per cent of all reported cases.

Considering the potential spread of the disease, MSF deployed an emergency team to support the health authorities in the response. The team is supporting medical care at Popokabaka General Referral Hospital, where a cholera treatment centre has been established to provide care for patients with severe forms of the disease.

Four treatment units have also been set up in four health areas to bring care closer to communities, alongside 31 oral rehydration points providing faster treatment for patients showing symptoms. Since the beginning of the intervention, 450 patients have received care, including 175 at Popokabaka General Referral Hospital.

Treatment alone is not enough

Rapid treatment is essential to prevent patients’ conditions from deteriorating and reduce the risk of death. But healthcare alone cannot end a cholera outbreak. In Popokabaka, as the disease continues to spread, access to safe water remains limited, while hygiene and sanitation conditions remain inadequate. A significant proportion of the population relies on rivers for their daily water needs.

According to an assessment conducted by MSF, 61 per cent of the population has access to less than 15 litres of safe water per person per day, the minimum requirement in humanitarian emergencies, according to the World Health Organization. Only 38 per cent have access to functional latrines, while open defecation remains widespread.

These conditions increase the risk of water sources becoming contaminated and facilitate the transmission of cholera, which is primarily spread through the consumption of contaminated water or food.

Bwenbo and her one-year-old child, Salabia, at Popokabaka General Referral Hospital. Suffering from cholera, the child was brought to the hospital that same day to receive the necessary care.

“We can treat a patient with cholera, rehydrate them and save their life. But if, once they return home, they still do not have access to safe water or latrines, there is a very real risk that the disease will continue to spread,” explains Dr Materne Cirimuanua, medical lead for the Popokabaka response.

The outbreak is taking place in a fragile humanitarian context, marked in particular by violence linked to the Mobondo crisis in western DRC, in which intercommunal conflict has forced many people to flee their homes. This has been compounded by overlapping population movements, including the arrival of more than 2,000 Congolese people expelled from Angola.

As the rainy season approaches, the risk of contamination of water sources could increase further. Heavy rainfall can contribute to the contamination of water points if sanitation infrastructure is inadequate or water sources are not sufficiently protected.

To address this risk and improve access to safe water, MSF has established 36 chlorination points. However, these measures are not enough to meet the population’s needs. Additional efforts and better coordination between the different organisations involved are needed to provide sustainable solutions to water, sanitation and hygiene needs.

“The rainy season can make the situation even more difficult when water sources are not adequately protected and sanitation infrastructure is limited,” Materne says. “Action is needed now to reduce the risks, strengthen access to safe water and bring healthcare services closer to the communities that need them.”

A response that must reach communities

Access to healthcare is another major challenge. The Popokabaka health zone has 35 health areas but only one general referral hospital. Some communities can only be reached by canoe, motorcycle or on foot, which can delay access to care for people needing medical attention.

MSF’s emergency team has therefore sought to bring care closer to people living in the worst-affected areas, including by setting up cholera treatment units. At the same time, the team is supporting epidemiological surveillance to monitor the evolution of the outbreak and rapidly identify new hotspots.

Within communities, community health workers and health promoters are also raising awareness about cholera prevention measures and the importance of good hygiene practices.

“In an area where access to safe water remains limited and some communities are difficult to reach, containing the outbreak will require a coordinated response combining healthcare, surveillance, safe water, sanitation and prevention,” Materne says.

“In the context of Popokabaka, MSF calls on health authorities and other stakeholders involved in the response to strengthen their efforts to sustainably improve access to safe water and sanitation, thereby reducing the risk of new cholera outbreaks.” ​