Cholera highlights urban risk factors

Poor sanitation and lack of garbage collection is a risk factor in the spread of communicable diseases like cholera. (Photo: David Gough/IRIN)

Poor sanitation and lack of garbage collection is a risk factor in the spread of communicable diseases like cholera. (Photo: David Gough/IRIN)

Nairobi, 10 June 2015 – A cholera outbreak in Kenya that is concentrated in the informal settlements shows how entrenched poverty can combine with poor urban planning to breed disasters.

An estimated 3, 459 people have been infected with cholera in the outbreak of whom at least 72 have died across Kenya, according to the most recent update. Of Kenya’s 47 counties, 11 are affected. A cholera outbreak alert was first issued on 3 February.

Heavy rains combined with poor environmental sanitation and hygiene practices and the consumption of contaminated food and water, especially in informal settlements, have been blamed for the spread of the waterborne disease.

Sharon Rusu, head of the UNISDR Regional Office for Africa, said: “This biological type of disaster requires a long-term response which addresses the underlying risk factors as advocated for in the Sendai Framework for Disaster Risk Reduction. Epidemics illustrate why we need to shift from disaster management to disaster risk management and to tackle the root causes which contribute to the spread of disease.”

Abbas Gullet, Secretary-General of the Kenyan Red Cross, said: “The situation is under control. We are working closely with the government to contain the outbreak. It is the underlying issues which need to be addressed. We need to see a scaled up effort to improve disaster risk management and this means tackling issues like garbage collection and sanitation. The donors and the host countries need to turn the promises into real action. The private sector can also play a role.”

Medical charity Médecins Sans Frontières (MSF) has expressed concern at the fast rate of cholera transmission in Kenya. “MSF is actually particularly worried about the scale and the spread of the epidemic in Nairobi due to the high population density, particularly as it is now diffused in almost all sub counties and informal settlements of the city,” said William Hennequin, MSF head of mission in Kenya.

Most slums in Kenya are located in risk-prone areas and this increases the exposure of their residents to hazards, says Mr. Mathias Spaliviero, the Senior Human Settlements Officer with UN Habitat’s Regional Office for Africa.

“The poor can’t afford to pay for regularized land, so they often settle in areas prone to flooding, on slopes and close to garbage dumps. So when there is a minor hazard, it creates a big impact,” said Spaliviero.

“When you have an area prone to flooding, waterborne diseases are also likely to occur,” he added.

“Urbanization can be a fantastic way to develop but if you urbanize in an uncontrolled manner the results can be terrible for the country,” warns UN Habitat’s Spaliviero.

A multi-dimensional approach is needed, he said. This includes: legislation empowering the local governments; social policies that support the vulnerable; municipal finance; systems that check speculation on land; enforcement of building codes; proper urban planning; and the resources for implementation.

Meanwhile, 14 of 47 countries (30%) within the World Health Organization’s (WHO) area of coverage in Africa have reported cholera outbreaks this year.

“A total of 20,058 cholera cases including 289 deaths have been reported,” according to WHO at the end of May. Of the cases, 90% are from Mozambique, the Democratic Republic of the Congo, Nigeria and Kenya. Cholera cases have also been recorded among Burundians who have recently fled their country for Tanzania.

WHO has provided support to cholera-affected countries in the form of medical expertise, oral cholera vaccines and the development of prevention and control plans.

In Kenya, the Cabinet has directed the Cabinet Secretary for Health to raise awareness on cholera prevention and to map all counties at risk. The Government has requested the Kenya Red Cross Society to support community level disease control and treatment besides social mobilization and hygiene and sanitation promotion campaigns.