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15 August 2003 by Pekka Reinikainen in Nairobi Nearly two weeks after floods hit the north-eastern Sudanese city of Kassala, Red Cross Red Crescent workers are reporting a steady increase in cases of diarrhoea and malaria. “Pools of stagnant water are busy breeding flies and mosquitoes, and the whole spectre of water-borne epidemics is just around the corner,” says Robert Fraser, the Federation’s regional health and care coordinator, who has just returned from Kassala. “We need rapid preventive action on-site.” The countdown to water-borne diseases begins immediately after a flooding. It usually takes between ten and 14 days for the first clear signs of possible epidemics to become obvious to observers. Fraser says the situation in Kassala comes straight out the floods-to-epidemics manual: “Several thousand traditional latrines were flooded and their contents flushed onto the streets, pathways, porches and vegetable gardens when the Gash River turned nasty two weeks ago,” he explains. What followed has not eased the situation. On three separate occasions following the initial devastating flood, rising waters have turned the streets of Kassala into pools of garbage, excreta and debris. Several hundred new cases of diarrhoea and malaria are being reported every day at the eight Sudanese Red Crescent Society clinics and other functioning medical outposts. “In a flood situation, diarrhoea is always common. The real danger is that it develops itself into more dangerous diseases such as typhoid and cholera,” Fraser says. “It is always better, cheaper and easier to prevent an epidemic than it is to treat it. This is why the Red Cross Red Crescent has created ERUs – Emergency Response Units. When they are deployed in time, it is always an effective preventative measure.” “I was witnessing a lot of pools of water all over the affected parts of the city. Since the river was rising and falling, draining these pools effectively was and is extremely difficult,” he adds. “There was, all through my stay, a permanent operation to strengthen the flood barriers. With good cause: last Saturday, I even witnessed some signs of panic at the Kassala market place when the soaked dykes were not able to prevent the muddy water from entering the city for the fourth time,” Fraser reports. “In an emergency you always have to have a list of priorities. You seldom have the resources available to provide for every possible need. Therefore, you have to choose. In the case of Kassala, the initial local priority was to prevent further flooding.” Now, Fraser says, decisive action needs to be taken to curb the threat of serious epidemics, and at this point, that requires a three-pronged approach. “Most importantly, and this cannot be stressed too much, disseminating information about proper hygiene. If people are fully aware of the danger, this will effectively decrease the threat of epidemics,” he says. “Secondly, people showing symptoms of water-borne disease need to seek treatment immediately. We need to have them in the clinics fast.” The third important factor is securing access to safe water. To achieve this, one must first get rid of the contaminated water. Then, there has to be the capacity to produce enough safe water to meet the core needs of the affected population. That water then needs to be distributed efficiently. And, finally, families need to have a safe means of storing it for a minimum of one day’s consumption. The first part of a water and sanitation ERU from the German Red Cross – a mass sanitation unit to treat the contaminated water - arrived in Kassala on 9 August. On 14 August, a second unit – effectively a mobile water works to produce clean drinking water – arrived. Distribution is ideally secured with local resources. Thousands of jerry cans have been flown in from different countries during the past days to make sure that affected families each have at least two 20 litre cans for water. A family of five can manage with 40 litres per day even if they ideally should be able to receive 75. “You always lack resources. Therefore, selecting targets for interventions is a key element in an emergency operation. When you increase the level of hygiene education, you need to target the caretakers of families. They collect the water and they use it. Through them, your investment pays best dividends,” Fraser explains. In health interventions, the primary targets need to be families with toddlers or the elderly. Their immune levels are usually the lowest. “Fighting massive outbreaks of diseases should start with the weakest. In a nutshell: first mosquito nets should go to them,” Fraser says. “This is always an uphill battle. However, much can be done to ease the angle of the ascent,” he adds, warning that, in Kassala, the problem will not be overcome quickly -the flood season in this area usually lasts well into September. Related links: Floods in Kassala: latest update Sudan: appeals, updates and reports Responding to floods Emergency Response Units Make a donation |
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