afrol.com, 26 March - As the population cautiously returns to Bujumbura Marie after last month's fighting in the capital of Burundi, a joint World Health Organization - Ministry of Health evaluation mission is warning of the potential for epidemics of cholera, measles and malaria in the most affected zone of Kinama.
Mission members, who visited the area on 16 March, say urgent action is needed to maintain minimum hygiene, re-establish water and sanitation structures, control disease-bearing insects and re-build health facilities and immunisation services in the area.
Hutu rebel militias of the Forces nationales de liberation (FNL) had started attacking northern and eastern suburbs of the Burundian capital Bujumbura on 24 February. Government forces immediately responded with armoured vehicles. In the heavy fights, which lasted for two weeks, hundreds of civilians were killed, ten of thousands displaced and material destructions were large. Yesterday, fresh mass graves were found in Burundi.
Currently the international community is working with a list of 53,000 people displaced in this conflict who scattered into numerous sites to the north of the city and into the neighbouring rural provinces. Last week the Mayor of Bujumbura reported that most of the populations of Kamenge and Cibitoke have returned to their homes, but fewer than a third of the 50,000 people resident in Kinama.
The WHO-MoH mission estimated more than 20% of homes and buildings have been severely damaged in Kinama, and a further 40% partially destroyed.
At least six health facilities have also been destroyed or are no longer working due to destruction and pillaging. Though the commercial water supplier has re-opened water lines, only 13 of the 26 good water sources in the area before the crisis are now functioning. Electricity supply has also not yet been restored.
Other public health concerns highlighted by the mission include bad evacuation of waste water due to blocked sewer pipes, the presence of large numbers of human and animal corpses and unexploded ordinance.
The ministry of public health, UN agencies and international NGOs have moved rapidly to address these problems. Médecins Sans Frontières has helped reopen two health posts in Kinama, supplying essential drugs and staff support, and set up the cholera monitoring system in collaboration with WHO. Dutch NGO Memisa/COPED is working with local health officials on deploying a mobile clinic, and government teams have teams removing bodies, most importantly to avoid further traumatising returning populations.
Activities are being co-ordinated by the national emergency management committee for health chaired by WHO.. The group, which includes all key national and international health players, has convened several times a week even while the bullets flew, in order to review sites and health facilities for the displaced and those returning to their homes, allocate responsibility for essential health services and organise essential drugs and supplies. The group has also set up an early warning system for epidemics based on WHO advice and guidelines.
However, the WHO-MoH mission members urged increased vigilance and activity as people start returning to their homes. "With the return of the population there is potential for an explosion of outbreaks of cholera, measles and malaria in Kinama," they note.
For now, the team recommends the immediate creation of a new health centre to serve populations in the districts of Gitega, Bururi and Bukirasazi, the provision of emergency drug kits, the urgent restart of routine vaccination against childhood diseases, daily monitoring of the epidemic situation in new centres and an immediate public education drive promoting personal and environmental hygiene. In addition, Kinama health centre should be rehabilitated, the activities of private health centres encouraged and teams recovering human and animal bodies reinforced.
Burundi's recent troubles come against a backdrop of 1.2 million people (over a sixth of the population) either internally displaced or refugees, a dramatic increase in malnutrition rates in part due to drought-affected harvest, and the devastation and traumatic effect of biggest malaria epidemic in Africa for the past 10 years - some 2 million cases between October 2000 and end January 2001.
Sources: WHO and afrol archives