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Knowledge Systems for Sustainable Development

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    • Education must play a central role to meet the challenges of sustainable development.
      • Four concrete concrete examples of a connection between water resources and epidemics in developing countries - Renaud PIARROUX

Four concrete concrete examples of a connection between water resources and epidemics in developing countries - Renaud PIARROUX

In developing countries, the scarcity of drinking water and insufficient hygiene create the conditions in which diarrhoea and cholera epidemics thrive. Local experience demonstrates that access to safe drinking water is an effective weapon to combat these epidemics.

There is a very clear connection between drinking water resources and the risk of outbreaks of diarrhoea (epidemic or endemic). This relationship can be illustrated with four concrete examples.

In 1994, after the Rwandan genocide and the defeat of the Hutus, there was an exodus of a million people. In just a few days, refugee camps sprang up in Goma and Zaire containing as many as 200,000 people. Hygiene was precarious or totally lacking. Immediately after their creation, the camps were the scene of epidemics of exceptional amplitude, partly due to a shortage of drinking water: in July 1994, refugees could only get an average of 0.2 litres of drinking water (the equivalent of a single glass of water) a day per person. A minimum of five, or even twenty litres would have been necessary. Of course people continued to drink but from water sources which were used for everything (cleaning, washing, defecation) thus multiplying the risk of epidemic disease. In all, more than 10,000 people died of cholera, out of a reported (but not exhaustive) number of cases amounting to 60,000. The cholera problem was only solved once an increased supply of drinking water became available.

The second example was situated in the Grande Comore. The island is in an intertropical area, and judging by the landscape, would not seem to suffer from any shortage of water. However, there are neither rivers nor springs, and the main water resources are provided by rainwater and pools of brackish water, referred to as "swimming pools", near the ocean. Most of the villages are therefore along the coastline, in close proximity to these sources of brackish water. Remaining resources are supplied by rainwater collected on housetops and stored in cisterns (30,000 cisterns for 300,000 inhabitants). In 1998, cholera was introduced by a visitor and spread very quickly through various vectors, such as transmission in hospitals or funeral rites. However, the main cause was above all faulty personal and food hygiene because of a water shortage. The fight against cholera focused on conservation of the sparse drinking water resources, in particular by chlorinating the cisterns. At the close of the epidemic, the hardest hit villages were those along the coastline close to the "swimming pools", whereas in the mountain villages situated further away where the only water came from the cisterns, there were a great deal fewer cases of cholera (2% of the population hospitalised as compared to 10% in coastal villages).

In the poorer parts of Côte d'Ivoire, water is usually drawn from wells, where the lip is a drum or a tyre and the dipper is an old inner tube. No particular hygiene precautions are observed when the water is consumed. A programme was launched to improve access to drinking water, using a network of supply lines and individual or collective branch lines (street fountains). In parallel, a community information scheme was launched on the subject of using water and desirable hygiene precautions. However, in 2001, when the programme was evaluated, it was found that the street fountains had remained largely unused, in particular because they were not profitable for the suppliers. Childhood outbreaks of diarrhoea and epidemics had fallen sharply where the fountains were used, but there was no improvement in places where they were little used or not at all.

The last example is again situated in Goma, where in 2002, the Nyiragongo erupted and sent voluminous flows of lava into the heart of the town; 100,000 people were homeless as a result.

The water supply network was destroyed and so were some of the hospitals and outpatient facilities.

A Médecins du Monde mission was sent to support the healthcare system.

Their task was to ensure continuity of healthcare and to watch out for the possible appearance of epidemics. Since 1994, there had been several cholera epidemics in Goma, even in the absence of any natural disaster or of any connection with armed conflict. Before the volcanic eruption, visits to healthcare centres were infrequent because they were not free of charge. However, because of the precarious situation brought about by the disaster, the health authorities decided that for a period of six weeks, care would be provided free, after which it would be provided at a lower cost than before. Epidemiological supervision evidenced some outbreaks of diarrhoea in certain parts of the town, but there was no cholera epidemic. In fact, as soon as a case was suspected, the organisations in charge of water supplies were alerted and took immediate action. One of these organisations was Water Force, an association within Veolia Environnement, which was working in cooperation with the International Red Cross Federation. In this way, diarrhoea problems were dealt with before the event, so that there was no epidemic of cholera in Goma in 2002.

These four examples show that water is an effective weapon in the fight against outbreaks of diarrhoea and a useful instrument to curb epidemics, of cholera in particular. Alas, this instrument is still too rarely used in emergency situations.

Emergencies that are kept too quiet...

As regards water and sanitation, more often than not the situation is typically a "silent emergency". Mortality in developing countries, particularly where there is no access to water, is still extremely high. Various studies have shown that 2.5 million people die every year because of lack of clean water. This is a deep-rooted problem. Its first victims are among the poorest: as of now, three billion people do not have access to water. Future development can only aggravate these deficiencies. Two thirds of the population will be living in an urban environment within the next fifty years. Unfortunately, this is not a very fashionable subject, and the media are not very interested. The problem is to raise sufficient and appropriate political commitment to confront it as it should be confronted. In fact, this is not a subject which seems to attract the greatest expertise.
Darren SAYWELL, Programme Manager, Water Supply and Sanitation Collaborative Council