An epidemic of cholera has broken out in the Korem feeding center in the Ethiopian highlands, killing 20 persons a day, said the administrator of Doctors Without Borders, the French voluntary organization that runs the camp.
"Right now, I have 50 new cases a day, and if I don't act very quickly in the next few days, I won't be able to avoid a disaster," said Dominique Leguillier.
His on-the-record statement, made on the day of a meeting here between the Ethiopian government and aid donors from around the world, climaxed five months of rumors and not-for-attribution reports from relief officials here that the highly infectious bacterial disease has broken out in several of Ethiopia's famine-relief centers.
The Ethiopian government has refused to acknowledge the existence in Ethiopia of cholera, which causes severe diarrhea and vomiting and is spread primarily by human feces. Instead, government officials here maintain that the feeding camps are infected not with cholera but with "acute diarrhea."
While insisting on that distinction, the government asked donors today for an emergency airlift of "urgently needed medical items" of the kind that are normally used to treat infectious gastrointestinal diseases such as cholera.
Earlier this week, the United Nations office for emergency operations in Ethiopia brought in an infectious disease expert from the World Health Organization in Geneva to look at possible evidence of cholera. As part of his investigation, Dr. Dragutin Savic is scheduled to tour several highland feeding camps this weekend.
In neighboring Somalia, an outbreak of cholera late last month in a U.N. camp for refugees from Ethiopia has killed 1,600 persons in three weeks, The Associated Press reported. Cholera deaths are still being reported in Somalia, but a U.N. spokesman in Geneva said the outbreak has tapered off.
Five months of behind-the-scenes bickering over medical semantics broke into the open at the donors' meeting here when Leguillier addressed Dawit Wolde Giorgis, head of the government's Relief and Rehabilitation Commission.
"I have 20 deaths a day because of a disease that we cannot name. I am importing medicines, and I have to lie about the name of the disease," Leguillier said.
Dawit then asked the French relief official what difference it made whether the disease is called acute diarrhea or cholera.
"If I can tell suppliers that it is cholera, I can get the drugs much more quickly," Leguillier replied.
Echoing off-the-record remarks of officials from two other major relief agencies here, Leguillier said in an interview that it was vital that the disease at Korem be called cholera so that the camp could be quarantined and medical investigators brought into Ethiopia to track down the source of the disease.
"It is cholera, and we should call it cholera so we can isolate people at Korem. If we cannot call it cholera, these people can go where they want and will spread the disease," Leguillier said.
He said cholera was first diagnosed at Korem 13 days ago, based on expert knowledge of the disease's symptoms and not on a laboratory test. The Ethiopian government says that many diseases are similar to cholera and that, lacking laboratory proof, there is no reason to declare a cholera emergency.
Without quick action, Leguillier said, the disease will increase by hundreds of cases daily among the 25,000 famine victms at Korem. Emergency quarantines also are needed at two feeding centers near Korem -- Alamata and Kobo -- to head off an outbreak of cholera that threatens about 45,000 persons there, Leguillier said.
He said that Kobo had 40 new cases of the disease daily, according to a week-old report, and Alamata had 1,000 cases, with 100 deaths.
Diplomats and relief officials here speculate that the Ethiopian government has been unwilling to use the word "cholera" because of fear that news of the disease will scare off buyers of Ethiopian coffee and meat, which are major sources of hard currency for the financially strapped government.
Doctors here, however, say that fear is largely groundless. They say the disease is carried primarily by the water supply in places such as the feeding camps, where large groups of people lack adequate sanitation facilities.
"You will make medical history if you manage to acquire cholera through your coffee," said one doctor here, who spoke on the condition that he not be identified.
Many relief officials here said this week that they fear their organizations would be expelled if they were to speak publicly about cholera.
There is speculation here, too, that the government is unwilling to declare a cholera outbreak because resulting quarantines could interrupt its resettlement program, which has moved more than 330,000 people in the past five months from the northern highlands to lowland areas of the southwest.
At the cholera ward set up this past week at Korem, the disease is treated by laying patients on a cot that has a hole cut out of the middle, feeding them frequently with a liquid containing salt for rehydration and, for severe cases, giving intravenous feedings of a liquid called Ringer lactate solution.
The government's request for emergency medical supplies today asked for 300,000 bags of Ringer lactate solution and 500,000 packets of oral rehydration salts.