Central Africa Republic: Cholera Emergency Plan of Action (EPoA), Operations Update n°1 (MDRCF021)

Situation Report
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This Operation Update aims to extend the operational timeframe by one month from 23 November to 23 December.

The extension will allow for completion of activities that have not been done due to security incidences that hampered implementation according to the original plan and to address mistakes in the approved budget.

  1. Budget line 51: The DREF is supporting the incentives of 20 supervisors working for 36 days (3 days per week) for three months with a daily per diems of CHF 9.9 for each. However, the approved budget has considered the supervisors’ incentives for only one day a week.

  2. Budget line 68: IFRC vehicle rent: the unit price for vehicle rent is XAF 2,100,000 per month which was supposed to be multiplied by three months but in the approved budget it was instead divided by three which was not sufficient for one month rent.

  3. In general, savings have been made on items including pool testers and tarpaulins. After launching a tender for the selection of the item providers it became apparent that most of the unit prices have changed. In addition, the RDRT was living in the IFRC guesthouse rented by the Global Fund programme in CAR and thus savings have been made on accommodation. All these have resulted in savings for the operation.

  4. Due to security issues (outlined below) the operation lost implementation time, particularly in Bangui, Begoua and Bimbo. In the one-month extension, the operation plans to complete activities as per the original plan such as community group discussions and cleaning and disinfecting of school latrines.
    Therefore, the National Society requested for the review of the budget to cover the actual needs of the DREF operation and to extend the time frame up to 23 December 2017 in order to complete the outstanding activities.

A. Situation analysis

Description of the disaster

According to the MoH and WHO situation report dated 7 August 2016, from 27 July to 5 August 2016, at least 36 cases of acute watery diarrhoea with severe dehydration were reported. In addition, eight deaths were reported in the village Mourou-fleuve, in Ndjoukou District, Kemo Province. A further, nine cases of acute watery diarrhoea with severe dehydration, including five deaths were recorded between 5 and 10 August 2016 in villages Zawara, Danga and Massamba in Damara district and one case at the Bruxelles quarter, in Bangui. On 10 August, the Pasteur Institute Bangui confirmed the presence of Vibrio cholerae in the sample taken from the affected cases that originated from Zawara.

On the 10 August, 2016, the Minister of Health during a press conference declared the state of emergency for the cholera epidemic outbreak in the Central Africa Republic. The risk of spread of cholera was very high and the situation was most likely going to worsen if this was not addressed in a timely manner due to the high mobility of the population as well as the rainy season which lasts into November. According to the MoH and WHO, the cholera epidemic outbreak reached the capital, Bangui, on 1 September 2016, with at least four positive cases in the 2nd and 3rd districts specially in Benzvi and Boeing neighbourhood of the city. The most affected areas remained the districts of 1st, 4th and 7th in Bangui city.

According to CAR health cluster meeting report of 20 September 2016, from the 5 July to the 20 September 2016 some 266 affected cases had been registered with 21 deaths (lethality rate: 7.8%). However, the same report, indicated that at least 3 new suspects cases were detected in Bangui during the period of 17 – 19 September 2016 and five others from Ndjoukou District (where the epidemic outbreak started) from 16 – 18 September 2016. Out of the last new cases, none of them was found positive.

The CAR health cluster meeting, held on the 8 November 2016, revealed that the laboratory results of the sample taken on the 266th suspected case was found negative to the vibrio cholera. This case was therefore removed from the linear list, thus reducing the number of registered cases to 265 cholera cases including 139 children under 15 years old, with some 20 deaths (lethality rate: 7.5%). In addition, eight cases of infection to vibrio cholera and one case of serotype Inaba were confirmed by the Pasteur Institute of Bangui. The last confirmed case was registered in Bangui on the 23 September 2016. The country is expecting the government to declare the end of the epidemic shortly.

While the prevailing situation has seen a drop of the number of affected cases as of 2 October 2016, the MoH has requested its partner humanitarian organizations to continue with the implementation of prevention activities. These activities including social mobilization, communication and community-based awareness on the knowledge of the disease, the risk factors, the universal prevention measures, community-based epidemiological surveillance and hand washing techniques. Further, the MoH has requested the support of the WHO to strengthen the capacity of health facilities in terms of care and management of positive cases, pre-positioning of treatment kits as well as the medicines for the treatment of water-borne diseases, especially in the risky areas. According to the MoH, there is a need to strengthen the national contingency plan for future responses.

The implementation of the DREF's activities were delayed by three major security incidents which did not allow the volunteers to complete the planned activities on time. All these incidences took place in Bangui.

The first incident took place on 2 October 2016, when a commander of the Central African Armed Forces (FACA) was shot dead in his vehicle. This incident caused a wave of violence in Bangui City, with shooting near the headquarters of the Central African Red Cross. The ensuing violence resulted in the deaths of several people. During this period, all the staff of the Central African Red Cross evacuated their office for a whole week. On the ground, door-to-door activities were suspended for the duration of a week.

On 17 October 2016, while humanitarian activities were resuming at a small scale, a civil society leader organized a protest demonstration calling for the departure of the country's International Forces (MINUSCA). This event created clashes between demonstrators and international forces. This other incident ended in the death of several people. For a second time, volunteers were forced to suspend to activities.

Two weeks after this incident, on October 31, 2016, a clash between two armed groups killed the two respective leaders. This last incident created heavy gunfire in the city of Bangui. Once again, the volunteers were forced to stop their activities. This other truce will last two weeks. Insecurity in Bangui resulted in six to eight weeks’ loss of work. These events have impacted on the implementation of the operation particularly in Bangui, Begoua and Bimbo and the 10 teams that have been working in these locations.

In addition, schools have also been affected by these different waves of violence. Schools officially reopened in September 2016, but given the repetitive violence in the city of Bangui, parents have been reluctant to enrol their children in school. Since then, schools are gradually starting to reopen. In the extension, the National Society is prioritizing the completion of community group discussions and the cleaning and disinfecting of school latrines.