The immediate effects of the eruption in terms of wounded and deaths is less severe then was initially feared. It is estimated that between 100 and 150 people died during the eruption of last week. This includes 50 to 100 deaths as result of the explosion of a fuel station.
In Goma about 4.5km2 is affected by the lava flow, which is about 13% of the populated area of Goma (OCHA, 26.1.2002). OCHA estimates that 100,000 people are directly affected by the eruption. Most people have found shelter in the houses of family or friends. 5 health facilities have been destroyed, among them the hospital of CBK Virunga.
Approximately 10,000 people are staying in different community shelters (often schools) and 40,000 people are staying outside Goma (Sake, Rutchuru, Bukavu or in different places in Rwanda).
The WHO team in Goma has continued to work in close co-operation with health authorities, the other UN organizations and NGOs. The medical inspection in Goma offered one of their rooms to be used by the WHO team as the office of WHO was completely destroyed.
Co-ordination of health interventions
General health co-ordination meetings as well as co-ordination meetings on specific topics such as disease surveillance and measles vaccination were organized by WHO, ASRAMES, a local NGO and the health authorities.
International aid was very fast in place. Most organizations had previous experience in Goma, and in general the aid was professionally organized and technically correct.
The WHO team did visit may temporary shelters and advised organizations working in water and sanitation on different occasions of their findings. In general water and food supplies were fast in place, while the construction of latrines took somewhat longer.
The RCD authorities have declared that all health care should be free of charge for a (initial) period of 30 days. ECHO will pay the primes for health staff during this period. We have seen a sharp increase of visits to health centres. This is most likely not related to any increase in morbidity but to the fact that some private health care providers lost their assets and the health care being free of charge.
A rapid survey of health facilities conducted by WHO on 25-27 January shows that with the exception of the facilities destroyed by the volcanic eruption, all health service points are operating. Health services in the Goma Zone de Santé are well-organized, due to support of the non-governmental organizations ASRAMES, Caritas, International Rescue Committee, MERLIN, Medicos en Catastrophe, Médecins du Monde, SANRU, Save the Children Foundation, and MSF-Spain. With the government, ASRAMES operates a drug logistics system throughout the Zone. It was agreed that all pharmaceutical donations are distributed through ASRAMES.
Detection and response to epidemic-prone diseases
WHO worked together with Congolese health officers and CEMUBAC, a project from the Free University of Brussels to adapt the epidemiological surveillance system to the new circumstances. Data are now collected on a daily basis in stead of weekly. Preparedness of epidemics such as cholera, shigellosis, meningitis, etc. took place. The provincial reference laboratory, run by the local NGO AMI-KIVU is capable to test drinking water, and samples of patients on most disease such as cholera and shigellosis. MSF-Spain supports the cholera treatment unit in the General Hospital while Safe the Children is supporting a diarrhoea treatment unit in the Catholic hospital in Goma. Many agencies have brought in supplies and pharmaceuticals to treat patients with cholera.
One case of cholera has been confirmed. As cholera is an endemic disease in eastern Congo this does not mean that there is an epidemic. All partners involved are on alert.
High priority interventions
Measles vaccination is one of the most effective measures to reduce mortality. As measles vaccination coverage is as low as 60% the risk that an epidemic will develop is large. The provincial EPI unit with support of WHO, UNICEF and MSF, is preparing a mass vaccination campaign.
Even before the Nyiragongo eruption, the population of North Kivu was under extreme social, economic and physical stress, with mass population movement into Goma to escape the war, economic collapse, limited access to health services due to high costs relative to family income, and high mortality. In a joint assessment mission of UNICEF and WHO in mid-2001, high mortality resulting from the war and virtual collapse of coping capacity of households were confirmed. The present crisis in Goma is a unique and unanticipated event: a major natural disaster superimposed on a chronic complex emergency. Virtually nothing is known about the stresses on the population resulting from this combination of events. WHO is preparing a vulnerability study is to sort out the effects on the population, and to design a medium to long-term response, including a recommendation on rebuilding/relocating outside of the immediate area of highest volcanic- seismic risk.