As the number of cholera cases in Senegal this year tops 2,000, Red Cross and UN officials say not enough has changed since a huge epidemic two years ago that affected more than 30,000 people and killed 450.

According to the International Federation of the Red Cross (IFRC), 12 deaths and 2,231 cases of cholera have been registered since the beginning of August in six regions of the country.

“Every day, we’re getting new cases. Before, it was one or two cases a day. Now, it’s 60 or 70. It’s alarming,” said Mamadou Sonko, head of operations for the Senegalese Red Cross.

Cholera is a highly contagious intestinal infection that is transmitted through contaminated water or food. It leads to acute diarrhoea and often vomiting; if untreated it can kill within days.

Last week, the IFRC launched an appeal for 40,000 Swiss francs (US$34,000) to support the emergency operations of the Senegalese Red Cross. The appeal has been completely funded, and operations will begin within days, Sonko said.

The Red Cross will train 240 volunteers who will lead awareness activities in different communities. It will also distribute disinfectant, anti-microbial soap, bowls, buckets and measuring cups to families in Diourbel, Dakar, Louga, Saint Louis, Fatick and Kaolack, where cases have emerged.

Floods and movement

According to Aissa Fall Gueye, IFRC’s regional health manager for Sahel countries, cholera cases appeared only sporadically and were easily contained until the rainy season began in July and flood waters began pouring down on Senegal and other West African nations.

“It’s during that period that we saw a big peak,” Gueye said. “The rainy season certainly had an impact.”

The movement of people across cities and regions was another important factor. Sonko said the first cases of cholera appeared in Touba, the religious centre of the country.

One week after it rained in Touba, and sewer waters overflowed onto the streets, a large religious gathering took place in Saint Louis, on the north-eastern coast hundreds of kilometres away. “Within three days, the first cases appeared in Saint Louis.”

Lessons learned?

Water and sanitation experts say progress in good hygiene and sanitation – the basis of preventing water-borne diseases like cholera – has been too slow.

The behaviour that leads to cholera – irregular hand washing, improper preparation of food, bad hygiene – has not significantly improved, Claire-Lise Chaignat, head of the Global Task Force on Cholera Control at the World Health Organization (WHO), told IRIN in August, when flooding had begun in various parts of West Africa.

“All the ingredients for an epidemic still exist,” she said. “Vulnerable populations are in fact increasing over time,” as rural people move to the cities in search of a better life but end up in shanty towns where hygienic conditions are poor.

“If we want to eliminate cholera, we need to improve the prevention approach.”

The Red Cross’ Sonko said Senegal has made some improvements. In a country where people used to regularly defecate in the outdoors, latrines are now available even in the smallest villages.

Still, he agreed it is time to place focus on prevention, and the Red Cross has drafted a regional cholera prevention strategy for 2008.

“It’s important to learn lessons,” the IFRC’s Gueye said. “We are convinced that we can’t wait for an epidemic to begin in order to react. It’s only through awareness and changing behaviours that we can prevent the recurrence of these cases in such a cyclical manner.”

In 2005, a cholera epidemic killed 1,295 people of 76,881 cases in West Africa, according to the WHO, more than a third of them in Senegal. This year, cholera has already killed 262 people in Guinea and 30 in Sierra Leone. Cases have also been recorded in Ghana.