General Context
Pandemic A (H1N1): There is an overall slight decline in the incidence since 4 weeks mainly due to the declining trend in South Africa. Twenty seven (27) countries are now affected in our Region with a total case load of 13,583 and 102 deaths. Floods in West Africa which affected 635,273 people and killed 187 others are subsiding but we continue to monitor the health consequences. Other humanitarian concerns include political crises in Guinea and Niger, disease outbreaks, the complex emergencies in central African countries and the food crises in the horn of Africa.
Situation in Countries
Acute crises
Angola: According to officials, the number of Angolans who have returned home from the Democratic Republic of Congo following a mass expulsion campaign is close to 50,000. The returnees, of whom around half are children, are sheltering in temporary transit camps close to the DR Congo border. An assessment mission led by the Ministry of social affaires and reintegration, Justice and UN ( IOM, WHO, UNICEF, UNHCR, UNFPA) from 18 to 20 October 2009 in Zaire province found that drugs are insufficient, water provided by trucks is insufficient, most of the people are getting water from the rivers and sanitation very limited (not enough latrines). So far there is no report of disease outbreak.
CAR: Continuous worsening of the security situation in the Southern-East (Zemio, Haut- Mbomou) following repeated armed attacks by the LRA rebels against civilians. The latest reports stated the arrivals in Bambouti of 1,511 IDPs from neighbouring villages, 21 people abducted in the village of RAFAI of which 3 children are missing. It has also been reported on the 19th of October 2009 that 406 refugees arrived in Zemio from DRC and 3,393 others were on their way to Zemio. The humanitarian needs are huge in this area recently vacated by humanitarian workers after the attack on a humanitarian convoy.
Chad: Insecurity marked by several criminal activities continues in the East. Disease outbreaks: Acute Watery Diarrhoea in Abeche, in week 42 a total of 83 new cases without death (89 cases without death in week 41) were reported. From week 1 to 42 of 2009, a total of 3,642 cases without death have been reported. The trend is now stable.
DRC: The number of DRC nationals expelled from Angola entering DRC has significantly subsided in both Kasai and Bandundu provinces, but remained high in Bas-Congo Province, growing from 2,000 in July 2009 to 18,000 in September 2009. Currently the daily rate of DRC nationals crossing the border has decreased from 500 to 150, according to IOM Angola. The security situation in North Kivu remains tensed and volatile following clashes between the FARDC (National Army) and the FDLR rebels in the area of Lwibo and Ntoto. Ten people have been killed and several were injured. In South Kivu the situation is volatile in the territory of Shabunda just after the confrontation between FARDC and FDLR on the Nzibira-Kigulube road. About 25,000 people have been displaced running away from the fighting. In the Orientale province, Lord Resistance Army (LRA) rebels activities are still reported in Haut-Uele. Cholera outbreaks: In South Kivu 438 new cases with 4 deaths were reported in week 42 making an overall total of 8,539 cases with 93 deaths (CFR: 1%) from week 1 to 42 in 200. In North Kivu, 88 new cholera cases without deaths were reported in week 42 making a cumulative total of 5,358 cases with 59 deaths (CFR: 1%) from week 1 to 42 in 2009. WHO is supporting response activities for the cholera outbreaks and is also reinforcing disease surveillance activities especially in the area of population displacement.
Ethiopia: In the Oromia Region, violent conflict in Borena and Guji zones displaces over 30,000 people. Reports indicated that tension remains high in the area and many of the people have already been displaced from their homes, while others are at risk of being displaced. In some districts food security situation continues to deteriorate and reports of malnutrition have been observed for the past few weeks. In Guba Koricha and Achar 243 and 415 children are in Outreach Therapeutic Programmes respectively, while agencies are taking care of increased number of malnourished cases in Kurfa challie. In Borena zone where 25,000 people are presently in need of water, further shortages of drinking water was reported with families having to travel for 15 km to fetch water in some places. AWD continues to be a major health problem in Oromia, Amhara, SNNPR and Afar Regions. Reports from WHO field consultants indicate a significant reduction in the incidence of reported cases and affected districts. However the continuous presence of risk factors in most of the regions is still a major concern for government and humanitarian partners. This week 10 districts have reported 48 cases and 3 deaths.
Kenya: Floods, the El Nino rains have started across the country. Most parts of Northern Kenya have received rainfall but no flooding reported so far. WHO and UNOCHA organized a capacity building workshop for El Nino, flooding and diseases outbreak preparedness and response for key stakeholder stakeholders in the north eastern province. The outbreak of cholera has cumulatively affected 41 districts nationwide with a total of 9,965 cases, 196 deaths (CFR: 2%) since January 2009. So far the outbreaks have been contained in 26 districts. WHO has made available essential drugs, technical guidelines and also provided logistical support.
Niger: Floods in Agadez: As of 23rd October 2009, the re-housing of affected people is over in the 5 sites receiving the 1,250 households. Distribution of food and nonfood items is ongoing, health assistance is provided by a mobile clinic managed by MSF. From week 39 to 42, reported cases of malaria are decreasing from 821 cases in week 39 and 782 cases in week 42. Malnutrition: in week 41, a total of 5,157 cases with 2 deaths were reported. A cumulative total of 147,268 cases with 366 deaths of malnutrition were reported from 1rst January to 18th October in 2009. Political situation is still tense in the country.
Countries Under Surveillance
Guinea: The situation remains very tensed after the bloody demonstration of the opposition on the 28th September 2009 were officially 58 people were killed and 684 others injured. WHO and other health partners supported the health facilities with trauma kits and various mass casualty management items.
Mozambique: We are monitoring the political environment in preparation for the 2009 elections in October 2009. Outbreak of Typhoid Fever: As of 11 October 2009, a cumulative total of 252 cases with 25 deaths of typhoid fever have been reported since the onset of the outbreak (5th May 2009) with an overall CFR of 9.9 %. In total, 15 villages have been affected among them 10 in Malawi and 5 in Mozambique.
South Africa: Pandemic A H1N1: Since the peak of the outbreak in the 32nd week of 2009 (3 to 9 August), there has been a steady decline in the number of new laboratory-confirmed pandemic influenza cases reported to the NICD. Although this trend is believed to be a true reflection of the pandemic's progression among the South African community, it is likely attributable to multiple factors, including more focus on testing only severe cases and a reduction in public interest resulting in fewer clinically mild patients submitting specimens. As of 26th October 2009, a total of 12,598 laboratory confirmed cases with 91 deaths were reported.
West Africa Floods: We are still monitoring the health consequences of the floods which affected 635,273 people and killed 187 others mainly in Burkina Faso, Ghana, Niger, Senegal and Sierra Leone. Adequate response has been provided to the population with the support of WHO and others humanitarian partners.
Zimbabwe: We are still monitoring the resurgence of cholera. As of 25th October 2009, a total of 95 cases with 3 deaths (CFR: 3.1%) were reported in 7 of the country 62 districts.
Pandemic A H1N1 in the WHO African Region: The number of confirmed cases is slightly declining since few weeks. As of 19th October 2009, a total of 113,583 confirmed cases with 102 deaths have been reported in 27 countries. All the countries have activated their national emergency preparedness and response plans.