Halting Cholera in an Overcrowded Refugee Camp in the DRC

First published December 19, 2023 by the World Health Organization

More than 6 million people have been displaced by recurrent armed violence and insecurity in eastern Democratic Republic of the Congo. Since the beginning of 2023, violence has escalated in six provinces – Ituri, Kasai, Mai-Ndombe, North Kivu, South Kivu, and Tshopo – forcing nearly one million people to flee their homes. 

Living conditions are dire in the displacement camps. Water supply, hygiene and sanitation services are inadequate – conditions that favour cholera outbreak. In Rusayo locality in North Kivu province, an outbreak of cholera since October 2022 has worsened the plight of the displaced. The nearest health facility is four kilometres from the Rusayo camp for the displaced, complicating care for severe cases, which have to be transported on motorbike to the treatment centre.

To help scale up health emergency response, World Health Organization (WHO) supported the establishment of a new cholera treatment centre on the outskirts of Rusayo camp. More than 1500 people, mostly children under five years, have received treatment since September 2023.

Rusayo IDP camp in Rusayo locality, lies at the foot of the Nyiragongo volcanic mountain around 15 km from Goma town, the capital of Nord Kivu province. The camp is home to over 143 000 people, living in extremely difficult conditions. They survive on two litres of water per day per person, well below the recommended quantity of 15 litres.

With an already fragile health situation and overcrowding on the site, cholera has become endemic.

Since the beginning of 2023 up to 10 December, more than 30 000 cases of cholera had been recorded in North Kivu province alone. The province hosts over 2 million displaced people. Cholera is extremely dangerous. It can cause severe acute watery diarrhoea. Symptoms appear between 12 hours and five days following ingestion of contaminated food or water. The disease can kill within a few hours if no treatment is given.

The new 50-bed Rusayo cholera treatment centre receives patients who often arrive very early.

“This is due to efforts made by community mobilizers we have trained with WHO support. They raise awareness about the symptoms and stress the need to go to the treatment centre as soon as the first signs appear,” explains Dr Lydie Fatuma, Medical Supervisor at the Rusayo camp cholera treatment centre.

Agnes Olive, 24, brought her 15-month-old son to the treatment centre. Eric had a slight fever, but it was the diarrhoea and vomiting that alerted Agnes. “The community mobilizers had told us that as soon as someone develops diarrhoea and vomiting, we should go straight to the hospital. That’s what I did,” says Agnes.

Following the same advice, 71-year-old Shangoma Shabunyere went to the treatment centre on his own. Satisfied with his treatment, he hopes to return to the camp soon.

“We’re glad to have a treatment centre close by, and the treatment is free of charge. I don’t have diarrhoea anymore. If they give me medication, I can go back to the camp,” he said.

Seeking care promptly is critical in saving lives.

To combat cholera in Nord Kivu, WHO is supporting the provincial health authorities. In addition to the cholera treatment centre, the Organization has built two 5000-litre water tanks, which are filled daily.

Oral rehydration points have also been set up the camp. These are the first steps in treating cholera. Patients rehydrate themselves to reduce the risk of arriving at the treatment centre in critical condition.

In addition to the recently established treatment centre, WHO has also delivered more than 78 tons of cholera treatment supplies to Nord Kivu and sent rapid response teams into the field to disinfect IDP tents and treatment centres.

“As soon as a case is confirmed, the household and nearby tents are systematically disinfected before the patient is discharged from the treatment centre,” says Dr Alain Mangolopa, WHO Field Coordinator in North Kivu.

“The response to cholera should be based on a holistic approach because any solution to the epidemic depends mainly on access to drinking water and sanitation services, as well as medical care,” he says.

Cholera has become recurrent Nord Kivu Province, a situation compounded by poor water and sanitation infrastructure in the displacement camps, high population displacement and the ongoing rainy season.

Given the health situation in the camps, the province is focusing on prevention. “We’re in the rainy season and we’re expecting outbreaks, so we’re stepping up our response in terms of water supply and prevention, particularly vaccination against cholera,” explains Dr Stephane Hans Batey, Head of the Nord Kivu Provincial Health Division. “We have already secured 2.6 million doses for IDPs and host populations.”

A two-round vaccination campaign kicked off on 11 December to cover eight most affected health zones.

From 28 September to 13 December 2023, the Rusayo treatment centre, where hospital stays do not exceed four days, treated nearly 1500 people without a single case of death.

Agnes Olive, with her son on her back, and two other patients discharged, returned home with the resolve to be more vigilant about hygiene and to avoid going back there.

“Before leaving, the doctor insisted on cleanliness and hygiene. I’m going to follow his advice,” Agnes says.

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