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Hepatitis Outbreak Hits Camps

Scores reportedly killed and thousands hospitalised as virus grips northern Uganda.
By Caroline Ayugi
An outbreak of Hepatitis E, which first hit the Kitgum district in northern Uganda last October, has claimed some 90 lives and left 5,339 bedridden and battling the disease, say health officials.

The number of cases in northern Uganda continues to rise, officials say, with 505 cases having been registered in the past two weeks in the Kitgum district, with little relief in sight.

Kitgum local council chairman John Komakech told IWPR that two internal refugee camps, Padibe and Agoro, have the highest concentration of cases and deaths from the disease.

According to a top Pader district official, Charles Kurwa, 13 new cases of the disease were reported in the nearby communities of Atanga and Pader, and four cases have been confirmed.

"[Refugees] should leave the camps and go back home to have a spacious environment, … one that doesn't favour the breeding of the virus,” said Kurwa.

"NGOs should [hasten] the process of return by drilling many water sources in villages and putting up health facilities,” he said, because most villagers lack access to clean water or health care once they leave the camps.

District disease surveillance officer Michael Chankara told IWPR that Hepatitis E has been confirmed in the Gulu district and is suspected to have also hit the adjacent Amuru district.

Four suspected cases – all from the same family in Dino refugee camp in Gulu – were reported and three were confirmed last month.

Three other cases were again reported in Lalogi Health Centre IV in the Acet camp and in the Lacor hospital, which is just north of Gulu town, in the past ten days.

Chankara said although Gulu had few cases, the rapid spread of the disease is cause for alarm.

"A two-year-old child from Parabongo camp in Amuru district was diagnosed with signs of the disease,” he said, raising fears of a possible epidemic among the young.

"Our office has linked with the district health office of Amuru, and taken the blood sample of the child to the virus research institute in Entebbe, to confirm if the child has the disease.”

For the past decade, the vast majority of the north's nearly two million residents have been settled in 200 camps across the north. Most have several thousand inhabitants – some up to 60,000 – living in extremely close quarters.

These densely populated camps have been criticised by health officials as breeding grounds for disease. Of major concern has been sanitation, as latrines and water sources have not been properly maintained.

Although most of the camps across the north are in the process of being dismantled, many residents, especially those in the Kitgum, Pader and Gulu regions, continue to live in the temporary settlements while farming land in their villages.

The Gulu District Director of Health Services, Dr Paul Onek, said the numbers of Hepatitis E cases is likely to rise rapidly because it can spread easily.

"[The disease]takes one to two months before it shows signs of an infected person. That is why we don't know exactly how many people are already infected in Gulu," said Onek.

Hepatitis E is a virus transmitted through consumption of water and food contaminated with fecal matter in which the virus lives. It causes inflammation of the liver, jaundice, loss of appetite, and fatigue, but is generally not fatal.

"If the sanitation in the camps is not improved, the disease will live on. The abandoned huts in the camps which have been turned into 'lodges' for illicit sex, and fecal and condom disposal grounds, will increase the problem," he said.

Onek was critical of local leaders where the earliest cases were registered, saying they were uncooperative in alerting their communities to the dangers of improper hygiene. These representatives refused to attend community meetings on the crisis, said Onek.

Hepatitis E has no specific treatment, he said, but patients are treated by helping them feel comfortable and treating the symptoms.

Experts from the World Health Organisation, WHO, have confirmed that the disease came from contaminated water at the internal refugee camps.

Solomon Fisseha, of WHO in Gulu, said, [Refugees] are drinking contaminated water because the [wells] and other water points are very close to the latrines."

An evaluation of water quality conducted between August 2007 to January 2008 at a number of camps in Gulu district found that wells and protected springs were contaminated.

Patrick Macek, Gulu’s assistant water officer, said, "Thirty-eight out of 82 water samples from households in the camps in Gulu were found [to be] contaminated, and 37 [wells] out of 265 examined, had contaminants."

The water study showed that 34 out of 59 shallow wells, and 21 out of 41 protected springs, contained fecal coliform bacteria.

At the Acet camp, one motorised water system was supplying contaminated water to thousands of people.

"The water used by the [refugees] is contaminated because of poor management of water sources and surroundings," said Macek.

"The contamination of these water points is caused by latrines dug close to water sources, poor drainage, and ditches carved by animals, such as pigs, with dirty still water."

Unfortunately, Macek said people continue to drink the contaminated water because they have no other choice.

Caroline Auygi is an IWPR-trained journalist.

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