On 15th February 2018, a 60-year-old man was identified at the entry point in Sebagoro landing site, Kabwoya sub county, Hoima district presenting with vomiting, fever and acute watery diarrhea. On the same day, a total of three deaths were also reported with similar signs and symptoms. Ten stool samples were collected out of which seven samples grew Vibrio cholera confirming the outbreak.
The Ministry of Health officially declared the outbreak on 23rd February 2018. The outbreak spread fast due to limited or no access to safe water. The streams available as a source of water were contaminated especially in Maratatu camp in Hoima. Cumulatively, the total number of cases are 1,825 with 36 deaths as of 16th March, 2018. 85 per cent of cases are new arrivals from Democratic Republic of Congo (DRC). A decline in Cholera cases has been recorded in March due to stepping up of efforts to disrupt transmission by UNICEF, Ministry of Health, UNHCR, WHO, OPM and Uganda Red Cross.
UNICEF is responding to the Cholera outbreak with provision of WASH and medical supplies. UNICEF is providing both technical support and supplies to the affected districts. The support includes: one solar chlorine generator to provide chlorine for inpatient care and as drinking water purifier; 23,609 cartons of water purification tablets; 6,200 litres of Effective Micro Organism (EMO); 1600 cartons of laundry soap: 310 tarpaulin rolls; three diarrhoea kits and over 150,000 booklets, posters, flyers and leaflets with cholera messages in French, English, Swahili and host community local languages.
In addition, through its contingency partnership with Uganda Red Cross society, UNICEF is conducting hygiene promotion, social mobilization and risk communication. Other areas of support include paying allowances for health workers and village health teams coming from other health centres to support case management and conduct door-to-door communication for behaviour change; technical support on WASH and Health at national and district task forces, social Mobilization and Case management.
Ureport key cholera messages are being sent out to Ureporters in affected and at risk neighbouring districts including Hoima, Kyegegwa, Ntoroko, Kagadi, Kakumiro, Masindi, Kibaale, Kyenjojo, Kamwenge, Buliisa, Mubende and Kiruhura to increase awareness and control the spread of the outbreak.
According to UNHCR and OPM, although partners are responding to the outbreak, the health services are insufficient to meet the needs of the population. Many health centres in the settlements are experiencing a shortage of beds, drugs, and medical personnel. Refugees are reporting frustrations with the referral system, such as delays in being referred to regional hospitals and lack of follow-ups to ensure patients have received required medical treatment. 20 per cent of water needs are met through water trucking which is costly and unsustainable. Refugees require additional four litres of water per person per day in order to reach sphere standards. There is still need for additional household latrines and hygiene promoters to reach all refugees including daily new arrivals.
Uganda is currently home to 251,730 refugees from DRC of which 59,084 arrived in Uganda since 01st January 2018 with a daily average influx of 747 refugees compared to 60,000 refugees that were expected in 2018. Of the total population, 82 percent are children and women. DRC refugees had been coming to Uganda but the upsurge during mid-December up to date shows that all is not well in Democratic Republic of Congo and there is fear of reprisals among the Congolese forcing them to look for refuge.
This is due to renewed fighting in Ituri and North Kivu regions and intercommunal violence at Djugu territory in the DRC. Majority of the refugees enter Uganda through Lake Albert settling in Kyangwali refugee settlement in Hoima District and others are coming in through more commonly used border points in Kisoro, Kanungu, Ntoroko and Bundibugyo districts settling in Kyaka II refugee settlement in Kyegegwa district.