Cholera Spreading Rapidly In Angola

Almost 1,300 Are Dead; Squalid Conditions Cited

JOHANNESBURG, May 17 -- Contaminated drinking water, poor sanitation and dense urban living have caused the worst outbreak of cholera in the history of Angola, with 1,298 dead and tens of thousands of others infected, international health officials said.

The outbreak began in February in Luanda, the rapidly growing capital where most of the more than 4 million residents live in squalid, trash-filled slums without reliable sources of clean water. It has since reached 11 of Angola's 18 provinces and, in some areas, continues to grow worse. Nationwide, officials report 600 new cases a day, more than anywhere else in the world and a pace more than four times faster than in the world's second-worst-hit area, southern Sudan. On Tuesday alone, 31 Angolans reportedly died from cholera.

"I have never seen anything quite like this," David Weatherill, a water sanitation specialist for Doctors Without Borders, a French medical aid group, said at a news conference in Johannesburg on Wednesday.

Cholera is caused by bacteria often found in contaminated water, though once outbreaks begin, the disease also can spread among people, especially in densely populated areas. Eating fish caught in contaminated water can spread cholera as well. Most people who are infected with the bacteria never show symptoms, but for those who do, the combination of frequent diarrhea and vomiting can cause dehydration and rapid death.

Weatherill and other aid officials said a slow response by the Angolan government and by the World Health Organization has hindered efforts to control the outbreak.

Doctors Without Borders treatment centers, rather than government clinics or hospitals, have treated more than 14,000 of the 17,500 people sick with cholera in Luanda, the group said. The government, meanwhile, has made little apparent effort to provide safe, free drinking water to slum dwellers during the outbreak.

Angola, along Africa's oil-rich west coast, was devastated by decades of civil war that ended in 2002. It has experienced a surge of economic growth recently, but its roads, housing, bridges and infrastructure remain in poor condition.

"Oil prices are up. Angola has a lot of oil," said Richard Veerman, the top Doctors Without Borders official in the country. "Some of those resources should be used to improve the water supplies and sewage systems."

He also said that the World Health Organization should have deployed resources faster and more extensively. "We have been feeling quite alone," Veerman said.

Jose Van Dunem, vice minister of health in Angola, acknowledged that years of migration to Luanda and other urban centers during the 27-year civil war had overwhelmed the government's ability to provide services. Still, he said, the government has allocated $5 million to provide clean water and other relief to those vulnerable to the epidemic. "We have been doing a lot since the beginning," Van Dunem said from Luanda.

Claire-Lise Chaignat, the head of WHO's global cholera program, said six officials from the agency had arrived in the past several weeks to augment the team already stationed in Angola. "We do what we can with the means we have," said Chaignat, speaking from WHO's headquarters in Geneva.

Treatment of cholera focuses on reversing the effects of dehydration. Most patients respond to oral rehydration salts, health officials say, though intravenous fluids and antibiotics are used in some cases.

Doctors Without Borders has laid particular blame for the recent crisis on a system of commercial water delivery in which tanker trunks pump water directly from rivers where fecal contamination is common.

For several years, UNICEF supported an Angolan government program in which the water in the delivery trucks was purified using chlorination tablets, but Doctors Without Borders officials said that when they visited a popular pumping area in April, only 10 percent of the water in 450 trucks a day was being purified.

UNICEF spokeswoman Brigitte Stark-Merklein, speaking from Luanda, said the agency provided only the chlorination tablets and had no staff at the pumping sites to make sure they were used properly.

Doctors Without Borders has since taken over the chlorination project to make sure all water trucks are treated, said the group's officials.