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Viewing cable 09ADDISABABA2164, CHOLERA SPREADS THROUGHOUT ETHIOPIA

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Reference ID Created Released Classification Origin
09ADDISABABA2164 2009-09-04 09:14 2011-08-25 00:00 UNCLASSIFIED Embassy Addis Ababa
O 040914Z SEP 09
FM AMEMBASSY ADDIS ABABA
TO SECSTATE WASHDC IMMEDIATE 6120
INFO IGAD COLLECTIVE
USEU BRUSSELS
USMISSION GENEVA 
AMEMBASSY LONDON 
AMEMBASSY ROME 
AMEMBASSY PARIS 
USMISSION GENEVA 
USMISSION USUN NEW YORK 
CDC ATLANTA
DEPT OF HHS WASHINGTON DC
DEPT OF AGRICULTURE WASHDC
CIA WASHINGTON DC
DIA WASHINGTON DC
HQ USAFRICOM STUTTGART GE
CJTF HOA
NSC WASHDC
UNCLAS ADDIS ABABA 002164 
 
 
STATE DEPARTMENT AF/E, AF/PDPA, OES, AND PRM/AFR 
USAID FOR AFR EGAST, CTHOMPSON 
DCHA/AA SCROMER 
DCHA/OFDA CCHAN, ACONVERY, JFLEMMING, PMORRIS, KCHANNELL, CCHRISTIE 
DCHA/FFP JDWORKEN, PMOHAN 
LONDON, PARIS, ROME FOR AFRICA WATCHER 
CJTF-HOA AND USCENTCOM FOR POLAD 
USDA/FAS FOR U/S PENN, RTILSWORTH, AND LPANASUK 
NAIROBI FOR OFDA/ECARO GPLATT, JKIMBROUGH, RFFPO NCOX 
USMISSION UN ROME FOR RNEWBERG 
NEW YORK FOR DMERCADO 
USEU FOR PBROWN 
GENEVA FOR NKYLOH, RMA 
NSC FOR CPRATT 
 
E.O. 12958: N/A 
TAGS: EAID PHUM SENV EAGR PGOV ET
SUBJECT: CHOLERA SPREADS THROUGHOUT ETHIOPIA 
 
REF:  Addis Ababa 2096 
 
SUMMARY 
-------- 
 
1. (SBU) To date, seven of 10 regions of Ethiopia have been affected 
by cholera or acute watery diarrhea (AWD).  The percentage of 
cholera cases is not known but it is expected to be significant. 
While cholera is an endemic disease in Ethiopia, it is rarely seen 
in Addis Ababa.  However, a recent outbreak in the capital (reftel) 
has resulted in the activation of a command center at the Government 
of Ethiopia's (GoE) Ministry of Health (MoH). 
 
2. (SBU) Thus far in 2009, the World Health Organization (WHO) and 
UNICEF are reporting more than 18,000 cases of cholera/AWD and the 
MoH expects up to an additional 114,000 before the end of the year. 
USAID's Office of U.S. Foreign Disaster Assistance (USAID/OFDA) has 
provided $1 million to the International Rescue Committee (IRC) and 
$2 million to UNICEF for water and cholera interventions 
countrywide. 
 
THE NUMBERS GAME 
----------------- 
 
3. (SBU) WHO and UNICEF reported in a meeting on September 1 more 
than 4,000 cases of cholera/AWD in Addis Ababa, and an additional 
14,000 cases countrywide.  The overall Case Fatality Ratio (CFR) for 
the country is 1.3 percent - just over the emergency threshold of 
one percent.  The CFR in each region is highly variable.  UNICEF and 
WHO report that Afar region currently has a CFR of 3.5 percent. 
(Comment: Humanitarian actors in country are concerned that the CFR 
is actually higher than reported due to aggravating factors 
including significant distances between houses and cholera treatment 
centers, as well as malnutrition.  End Comment.) 
 
4. (SBU) The international non-governmental organization (NGO) 
Medicine Sans Frontiers/Belgium is operating six cholera treatment 
centers in Addis Ababa and reports that the majority of people 
arriving for treatment are moderate cases requiring only rehydration 
on an outpatient basis while 25 percent are severe and requiring 
inpatient care. 
 
WHAT'S IN A NAME? 
----------------- 
 
5. (SBU) At a joint WHO/UNICEF meeting on August 25, significant 
discussion took place as to whether or not the current outbreak can 
be called "cholera" or whether it must still be referred to as 
"AWD."  The WHO representative working with the MoH Command Center 
stated that while at a technical level the term "cholera" is 
permissible, the GoE is still requiring that all reports use the 
phrase "Acute Watery Diarrhea."  (Comment: This remains a very 
sensitive issue and using "cholera" publically in any reports, by 
USG or others, could hinder actions being taken by the humanitarian 
community.  End comment.) 
 
6. (SBU) Meeting participants expressed concern that affected 
populations and their families may be confused as to whether the 
disease is cholera or AWD.  Additionally, participants expressed 
concern that the media will refer to all cases as cholera which 
could lead to a hostile GoE response and possible closure of NGO 
activities.  Participants wondered if the MoH reluctance to use the 
term "cholera" will result in a situation similar to the recent 
outbreak of cholera in Zimbabwe where containment, resources and 
education materials were not quickly and adequately mobilized 
resulting in a large scale, preventable outbreak. 
 
7. (SBU) The Acting UN Humanitarian Coordinator (HC) has talked to 
senior level government officials about this issue and while the MoH 
is selectively supportive of using the term "cholera," it remains a 
political issue at other levels of the GoE.  USAID has offered to 
provide advocacy support with other government ministries should WHO 
and UNICEF feel that it would be of benefit. 
 
SPREADING RAPIDLY 
----------------- 
 
8. (SBU) MOH and WHO officials report that part of the reason for 
the rapid spread of cholera is due to contamination of "holy water" 
in several locations.  Pilgrims who have traveled to holy cites 
around Addis Ababa and in Amhara region often stay in extremely 
crowded conditions with little or no sanitation facilities allowing 
any communicable disease to quickly spread among the population. 
USAID's public health specialist reports that if a person gets ill 
after drinking holy water they believe that the water is working to 
remove the illness from their system. 
 
9. (SBU) As a result of contamination at two holy water locations 
near Addis Ababa, all pilgrims were evacuated and the sites were 
closed for two days.  The sites have been re-opened and WHO reports 
that significant public health messaging is taking place in both 
locations.  With additional religious and national holidays 
approaching, as well as the beginning of the school year, quick 
action and significant public health messages are required.  The 
Patriarch of the Ethiopian Orthodox Church recently met with the 
MoH, UN OCHA and NGO representatives to devise an appropriate 
intervention strategy. 
 
FUNDING REQUIREMENTS 
--------------------- 
 
10. (SBU) WHO recently stated that the 2009 GoE Humanitarian 
Requirements Document will soon be revised to reflect an increase of 
$2.3 million for the health sector and at least $5 million for the 
water and sanitation sector for AWD/cholera.  WHO and the MoH are 
anticipating 132,000 AWD/cholera cases between now and the end of 
December assuming an attack rate of 1 percent.  For comparison, 
UNICEF reports that the worst recorded outbreaks since the year 2000 
occurred in 2006 and 2007 (approximately 50,000 cases each). 
 
11. (SBU) For Addis Ababa, WHO has pledged $30,000 for surveillance, 
training of health workers and case management.  UNICEF has pledged 
$100,000 for training, containment, communication and operational 
costs.  UNICEF reports that it has about half of the funds needed to 
meet the anticipated country-wide case load for the year (UNICEF 
estimates 65,000).  UNICEF has recently received requests from 
various regional governments for an additional $800,000 for response 
interventions. 
 
COORDINATION 
------------ 
 
12. (SBU) Coordination among the GoE, WHO, UNICEF, donor and NGO 
agencies needs improvement.  WHO is unable to implement activities 
or report without MoH concurrence and is addressing the situation 
only from the health standpoint.  UNICEF and the Ministry of Water 
Resources are looking principally at water resource, containment and 
contamination issues.  WHO has announced several different meetings, 
but cancellations have inhibited transparent communication among 
stakeholders. 
 
13. (SBU) With support from OCHA and USAID/OFDA, the Acting HC 
recently called a joint meeting with UNICEF, WHO, donors and 
implementing agencies to discuss a strategy for addressing 
coordination, containment, prevention, treatment and control.  The 
Acting HC continues to encourage government officials to call a 
similar meeting of all stakeholders.  (Comment: USAID/OFDA is 
encouraged by the progress of the Acting HC in talks with GoE 
officials.  The Acting HC is now requesting that donors also 
encourage transparency and coordination when talking with government 
officials.  End comment.) 
 
USAID RESPONSE 
-------------- 
 
14. (U) PEPFAR's Supply Chain Management Systems project (SCMS), 
supported through USAID, is coordinating with the Federal MOH and 
Regional Health Bureaus to provide 2,640 bottles of disinfectant 
solution and 900,000 sachets of oral rehydration salts.  These 
commodities, from supplies on hand procured for HIV-positive 
individuals can be spared for this emergency situation without 
affecting supplies needed for people living with HIV/AIDS (Reftel). 
 
 
USAID/OFDA RESPONSE 
------------------- 
 
15. (U) USAID/OFDA has provided $1 million in Fiscal Year 2009 to 
the international NGO IRC for emergency rapid response programming 
including AWD/cholera response.  IRC is currently responding to the 
outbreaks with USAID/OFDA funding in four woredas in the Somali, 
Afar, Oromiya and SNNP regions and is investigating additional 
response activities in Afar and Amhara regions.  Activities include 
distribution of water treatment chemicals and hygiene and sanitation 
education.  USAID/OFDA partners are also looking at potential 
interventions in Addis Ababa and other nearby urban centers. 
 
CONCLUSION 
---------- 
 
16. (SBU) The cholera situation in Addis Ababa and the country will 
be long-term with periodic spikes.  Large gatherings of religious 
pilgrims, the start of the school season, and traditional movement 
of migrant workers are of particular concern in coming months. 
USAID is working with UNICEF, WHO and other partners to address 
coordination, containment, treatment and prevention activities 
countrywide. 
 
MEECE