Cholera, aid shortfalls plague desperate refugees of conflict

Starvation, conflict and displacement threaten millions of people in Yemen, South Sudan, Nigeria and Somalia, but there is another looming nightmare: rising waves of epidemic disease, especially cholera, made worse by the constant movement of refugees  seeking any kind of respite from chaos and mayhem.

Just how much more dire the situation can become may be known by the end of September, according to medical and relief experts, when seasonal rains in some of the afflicted nations make meager roads impassible, and further spread the water-born disease.

The same seasonal rains also bring rising incidences of other forms of watery diarrhea, as well as malaria, and there are reports of sporadic outbreaks of meningitis and measles.

The additional health hazards are placing further heavy strain on humanitarian resources that are already deeply inadequate to the massive challenge of aiding at least 30 million people suffering in and around the stricken countries with some 20 million—figures vary—in the direst need of assistance.

Moreover, the kind of money that the U.N. is asking international donors to provide is not rolling in. Of some $6.5 billion in humanitarian assistance, including funding for health emergencies, that the U.N. has asked for the four stricken countries, so far only about $3.45 billion  has materialized, or only about 53 percent of the funding appeal.

The U.S. share of the funding so far is about $1.1 billion, or nearly a third of the money so far on the table.

Another problem: dealing with the disease epidemics seems beyond the capacity available to the United Nations’ World Health Organization (WHO), which failed abysmally three years ago to deal rapidly with West Africa’s deadly Ebola crisis, in part because of its close ties with governments that sought to downplay the disaster.

There is no doubt that WHO is trying hard to stay in front of the disease crisis, and in some areas—Somalia and South Sudan—has claimed that the cholera epidemic is slowing down, as one of its websites puts it, “thanks to timely interventions by WHO, national health authorities and health partners.”

But other health workers in the stricken regions are less optimistic, and in some cases—South Sudan, for one—argue that the numbers of stricken are still badly underestimated.

Moreover, in regions that are wracked with internal conflict, and government health facilities are in an advanced state of collapse, WHO’s abilities are starkly limited, and even shrinking, due to its ties with stricken local governments.

“WHO is inherently unable to bring major outbreaks under control in places where there is violence, conflict and state instability and insecurity,” observes Lawrence Gostin, professor of medicine at Georgetown University and onetime member of the WHO Director-General’s Advisory Committee on Reforming the World Health Organization.

“WHO is highly dependent on national health authorities, and where there is a vacuum of power in local government, or when those governments are corrupt and even cause the health hazards, WHO simply doesn’t have the ability to end fast-moving epidemics. WHO also relies on strong national health systems, and these health systems are weak, fragmented or non existent in conflict zones and in places where refugees congregate.”

“It is probably unrealistic to believe that WHO has the political and economic power to be highly effective,” continued Gostin. “In the case of cholera, it has not been able to make a difference in war-torn countries.”

WHO, of course, argues otherwise. Nonetheless, a bad situation is fast becoming worse. The cholera crisis in Yemen, recognized as the world’s worst single-country outbreak, has some 630,000 cases so far, according to the United Nations’ World Health Organization (WHO), with about 2,000 dead as a result.

That is up from some 500,000 cases reported by WHO in mid-August, and despite the U.N. agency’s highlighting of small declines in new Yemeni cases in recent months, according to USAID those numbers started to rise again on a weekly basis later last month. In July, WHO figures were apparently showing that the epidemic was slowing down.

In a gloomy report to the U.N. Security Council, the U.N.’s top refugee official, Stephen O’Brien, declared that “we are seeing accelerating institutional collapse in Yemen, which is also putting considerable additional pressure on the response.” Only 45 per cent of national health facilities were fully functioning—a nebulous standard—he declared and “sanitation systems have mostly ground to a halt.”

Beyond those numbers is the much bigger disaster of some 2.9 million Yemeni refugees and 17 million people labeled as “food insecure” by the U.N., including 7 million at risk of famine. They are  bearing the overall brunt of a two-year civil war between Iran-backed Houthi forces and the forces of President Abdrabbuh Mansur Hadi, backed by a Saudi Arabia-led coalition that has had U.S. intelligence and logistical support.

“We are in a super-crisis,” said Caroline Seguin, deputy program manager for the medical group Doctors Without Borders/Medecins Sans Frontieres, a non-government organization that operates outside the U.N. health umbrella.

The Yemeni government Ministry of Health has “collapsed since the war,” she told Fox News. “There is bad management of treatment centers, problems of funds, people not getting paid.”

In some cases, she said, hospitals have been told to fend for themselves for supplies. “They came to us.”

“The response is not at all adequate, ” she summarized, and deemed the cholera crisis “catastrophic.”

Cholera totals have also been climbing in South Sudan, despite WHO claims of a recent slowdown. A tally of fewer than 600 cases in July 2016 had risen to more than 8,000 last May, according to U.N. figures, and 15 of 18 South Sudanese states were infected by last August.

Outbreaks are occurring “sporadically,” reports Deepmala Mahla, the South Sudan country director for U.S.-based Mercy Corps, one of the world’s biggest non-government  humanitarian aid organization. The full extent of the disease in South Sudan, she suggests, could already be “many fold times the number reported.”

Within South Sudan itself, an additional 1.8 million people have been displaced by ongoing violence, but as Mahla warned Fox News, many numbers are likely little more than guesses.

“We are not even sure what is the total population of South Sudan,” Mahla told Fox News. “There is no capacity to screen the larger populations and mobile groups like cattle raiders, nomads. Many times there is no access. Security concerns have also worsened the situation.”

Moreover, “most of the cholera affected counties in South Sudan in 2016 and 2017 are located along the Nile River,” she added. “I find this alarming.”

WHO downplays the significance of the Nile connection, especially when it comes to further transmission of cholera along one of Africa’s great inhabited waterways, arguing that the sheer volume of water in the Nile dilutes concentrations of cholera organisms to relatively safe levels.

Nonetheless, says Mahla, “This suggests vehicle-borne transmission from contaminated water in affected counties. There needs to more investigation to make conclusions.”

Cholera is now spreading in refugee camps in neighboring Uganda, where at least 600,000 South Sudanese have fled to escape a long-running civil war, despite faltering occasional signs of peace, and they aer only a fraction of those who have fled abroad.

In northeastern Nigeria, where the terrorism of Boko Haram is a  disruptive threat, WHO reports that they have now counted “more than 1,625 confirmed and/or suspected” cholera cases, including the first outbreak in two years in a camp for internally displaced persons. The agency added that “health workers fear those numbers could rise exponentially because of poor water and sanitation conditions in many [refugee] camps across the area.”

Nigeria currently has about 1.7 to 1.9 million internal refugees, and some 2 million people suffering from “severe and moderate acute”  malnutrition, according to the U.N.

The long-term solution to the cholera threat is well-known : investment in fresh water supplies and sanitation facilities, collectively known in relief-speak as WASH, to replace the unclean and untreated water supplies that are a major cholera vector.

But “when there is only emergency funding, you can’t be too long term,” observes Noah Gottschalk, senior policy advisor for humanitarian response at Oxfam America, who focuses on South Sudan, among other countries. Other issues, like education and self-sufficient livelihoods, are also falling behind, he noted.

And as long as conflicts continue, the kind of conditions that will really offer time and space to meet those longer term challenges are still receding.

In short, rather than stabilizing some of the world’s worst humanitarian disasters, the international relief community is struggling to even catch up. And the rising toll from disease among the beleaguered population is an alarming indicator that they may not be succeeding.

George Russell is editor-at-large of Fox News and can be found on Twitter: @GeorgeRussell or on