May 28, 2015

While there is no sign that the recent influx of Burundian refugees into western Tanzania will ease anytime soon given the dire nature of the political situation in Burundi, the cholera epidemic that has emerged in western Tanzania as a result of overcrowded camps and unsanitary environments among refugees has improved, but holds uncertainty to its abatement.

That uncertainty is due to the fact that while many refugees are housed in official camps, these areas are still ill-equipped to deal with the thousands of desperate and displaced refugees that have crossed the borders to seek refuge in the country, which have mired the national and international community’s efforts to effectively curb the cholera outbreak in the refugee camps in Kagunga, Tanganyika Stadium, and Nyarugusu refugee camp, leaving gaps for high risk infection transmission, according to a World Health Organization representative.

“The prompt response by WHO, UN Agencies, the Ministry of Health and Social Welfare and other partners has greatly contributed to reducing the number of cholera cases but the crisis is far from over and significant challenges remain ahead,” said WHO Representative for Tanzania, Dr Rufaro Chatora who recently visited the area to access the humanitarian crisis and identify ongoing needs.

He noted that despite significant improvements, especially at Kagunga, the crisis remains dire in the region.

“The pressure has now shifted to Tanganyika Stadium and Nyarugusu refugee camp where the sudden increases in population have resulted in very limited access to clean water, poor sanitation and inadequate access basic health care services,” he said.

The situation in western Tanzania underscored the need for the international community to further strengthen coordination mechanisms to scale-up the provision of health care services and basic shelter, food, water and protection services to high risk populations.

For example, pregnant women, children, elderly people- who are most vulnerable to health risks and need special attention- including people living with HIV/AIDS or people with chronic illnesses have limited access to essential medical care.

Many of the refugees also have malaria, and some with current illnesses have no access to their medicines because most of them fled Burundi without taking essential items.

Since mid April, thousands of people have fled Burundi to seek refuge in neighboring countries including Tanzania, Rwanda, and DRC, due to violence and riots that erupted after the Burundian President declared his intent to run for a third term presidency, which many in the country and the international community say violates the country’s constitution and the Arusha Agreement that was signed in 2012, ending the civil war in the country.

According to the United Nations High Commissioner for Refugees (UNHCR), over 50,000 refugees have arrived in Tanzania as of May 25, with 5929 refugees reported to camp at Kagunga, 40519 in Nyarugusu, and a fluctuating number of about 4000 at Tanganyika Stadium due to rapid arrivals and departures.

Dr Chatora added that the priority of the international response system is now to step up their coordinated response efforts to meet the health needs of the asylum seekers and local populations in and around the Kigoma region, including intensifying treatment and prevention of cholera, and ensuring adequate supply of medicines and supplies, and improving access to clean water

The WHO, who is coordinating its efforts through the Ministry of Health and Social Welfare (MOHSW), has dispatched and mobilized 12 health experts to the area to help support management of the cholera outbreak in Kagunga and Tanganyika Stadium Cholera Treatment Centers, and is providing medicines and supplies to all three sites to treat more than 60,000 people for cholera, acute watery diarrhea, and common diseases like malaria for three months.

WHO said it also has deployed international experts in Outbreak and Disaster Management, Surveillance and Data Management.

Other national and international agencies, including UNHCR, United Nations Children’s Fund, United Nations Population Fund, International Rescue Committee, Red Cross, Médecins Sans Frontières, Tanzania Water and Environmental Sanitation, CARITAS, Plan International, and World Food Program, have also stepped up their assistance to help reduce health risks.

The situation in western Tanzania could very well represent a test for WHO, the UN and the rest of the international health community and emergency response system, which was widely criticized for their lackluster response and ill-equipped handling of the 2014 Ebola outbreak in West Africa, to see how well they handle the current cholera outbreak in Tanzania.

Lessons learned from the Ebola outbreak and the needs to restructure how the organization and its peripheries respond to global health emergencies and health threats were top of the agenda at the recently concluded annual “World Health Assembly” meeting that took place in Geneva, Switzerland, where WHO and member stakeholders mulled over the response system to the Ebola outbreak and gleaned lesson learned and gave the director of organization the green light to reform the global emergency and response system so the organization can prepare and respond rapidly, effectively with flexibility to global emergencies and disease outbreaks.

As part of its efforts to accelerate research and develop vaccines, and drugs for diseases and other health threats that currently do not have any medicine for, the WHO will establish a two-year pilot program with an initial investment of US$100-million contingency fund to provide financing for in-field operations for up to three months. The contingency will then be evaluated as needed.

To respond swiftly and effectively to global emergencies, WHO said it will create a “clear and effective command and control systems” that will manage mechanisms across all the three levels — headquarters, regional and country offices — of the health organization.

In addition, to improve preparedness and response for future health emergencies in a timely manner, WHO will create an emergency program whose core principles will emphasize predictability, humanitarianess, accountability, timeliness as well as adaptability and flexibility that will serve as a guide for responding to all hazardous health emergency situation.

The health organization will work with governments to help countries better prepare for emergencies by strengthening their national health systems and taking steps to improve functioning, transparency, effectiveness and efficiency of the International Health Regulations.

While no death or new case were reported in the cholera outbreak in western Tanzania as of May 25, 4408 people were diagnosed and treated.

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