VZCZCXRO0776
PP RUEHDE RUEHROV RUEHTRO
DE RUEHNR #1130/01 0681011
ZNR UUUUU ZZH
P 091011Z MAR 07
FM AMEMBASSY NAIROBI
TO RUEHC/SECSTATE WASHDC PRIORITY 8125
INFO RUCNSOM/SOMALIA COLLECTIVE
RUEHRN/USMISSION UN ROME 0128
RHEHNSC/NSC WASHDC
RHMFIUU/CJTF HOA
RHMFIUU/CDR USCENTCOM MACDILL AFB FL
RUEKJCS/SECDEF WASHINGTON DC
RUEKJCS/JOINT STAFF WASHINGTON DC

UNCLAS SECTION 01 OF 03 NAIROBI 001130 
 
SIPDIS 
 
AIDAC 
 
USAID/DCHA FOR MHESS, WGARVELINK, LROGERS 
DCHA/OFDA FOR KLUU, GGOTTLIEB, AFERRARA, ACONVERY, 
KCHANNELL 
DCHA/FFP FOR WHAMMINK, JDWORKEN 
AFR/AFR/EA FOR JBORNS 
STATE FOR AF/E, AF/F AND PRM 
STATE/AF/E FOR NGARY 
STATE/F FOR ASISSON 
STATE/PRM FOR AWENDT, MMCKELVEY 
NSC FOR TSHORTLEY 
USUN FOR AMAHONEY 
BRUSSELS FOR PLERNER 
GENEVA FOR NKYLOH 
USMISSION UN ROME FOR RNEWBERG 
 
SIPDIS 
 
E.O. 12958:  N/A 
 
TAGS: EAID PHUM PREL SO
SUBJECT: SOMALIA DART SITUATION REPORT 19 ? CHOLERA 
UPDATE 
 
REFS:  A) NAIROBI 00255  B) NAIROBI 00720 
 
NAIROBI 00001130  001.2 OF 003 
 
 
SUMMARY 
 
¶1.  The rate of new cholera cases is declining in most 
areas of southern and central Somalia following repairs 
to water and sanitation facilities damaged from recent 
flooding.  However, repairs are needed in Lower 
Shabelle Region and Mogadishu, where insecurity has 
thus far obstructed response efforts, allowing the 
cholera outbreak to continue.  Despite adequate 
response efforts in most of southern and central 
Somalia, non-governmental organizations (NGOs) in 
northern regions have acknowledged that poor prevention 
and early detection capacity resulted in high case 
fatality rates in some areas, and are working to 
address the issue.  USAID's UN and NGO partners have 
provided medical supplies and assisted in water and 
sanitation repair activities, helping to prevent the 
further spread of cholera.  End summary. 
 
BACKGROUND 
 
¶2.  The current cholera outbreak in southern and 
central Somalia originated in Lower and Middle Juba 
regions in December 2006 as a direct result of recent 
flooding that had damaged water and sanitation 
facilities.  Health agencies acted quickly to contain 
the spread of cholera (REF A), which is endemic in 
Somalia.  However, deteriorating hygiene conditions led 
to new cases of suspected cholera in Hiran Region in 
mid January and it has since appeared in Lower and 
Middle Shabelle regions (REF B) and Mogadishu. 
 
¶3.  As of March 2, the UN World Health Organization 
(WHO) had received unconfirmed reports of 3,633 cases 
of acute watery diarrhea, including 143 deaths in 
southern and central regions.  Health organizations are 
also responding to a limited number of suspected cases 
in Mudug and Bari regions in northern Somalia. 
Although WHO continues to refer to the cases as acute 
watery diarrhea given insufficient sampling and 
confirmation of the cholera bacterium in all locations, 
many areas have confirmed the presence of the cholera 
bacterium and suspected cases are consistent with the 
case definition of cholera.  As such, the USG Disaster 
Assistance Response Team (DART) continues to refer to 
the current outbreak as cholera. 
 
GENERAL IMPROVEMENT IN SOUTHERN AND CENTRAL SOMALIA 
 
¶4.  Reports of new cases are declining overall in 
southern and central Somalia, and WHO reports that 
adequate medical supplies have been mobilized to Hiran, 
Middle Shabelle, and Lower and Middle Juba regions. 
WHO staff lead regular task force meetings in Hiran and 
Middle Shabelle regions and in Kismayo and Mogadishu to 
discuss and improve upon cholera response activities. 
WHO has provided medical supplies to affected areas, 
and humanitarian organizations are coordinating 
surveillance, treatment, and water and sanitation 
activities. 
 
CONCERNING TRENDS IN LOWER SHABELLE AND MOGADISHU 
 
¶5.  WHO is particularly concerned over recent cholera 
cases in Lower Shabelle Region and Mogadishu, where 
 
NAIROBI 00001130  002.2 OF 003 
 
 
insecurity presents significant challenges to relief 
agencies.  The number of suspected cases is increasing 
in Lower Shabelle, due to an influx of internally 
displaced persons from Mogadishu, who lack access to 
clean water and sanitary facilities.  By March 2, WHO 
had received unconfirmed reports of 235 cases in Merka, 
including 15 deaths, representing the highest incidence 
in the region.  Between early February and March 2, 
health officials reported 151 cases with 15 deaths in 
Afgoye, 112 cases with 7 deaths in Kattunwery, and 111 
cases with 7 deaths in Qoryoley.  From February 10 to 
March 2, Sablale and Awdegle reported 61 cases, 
including 12 deaths, and 17 cases have been noted in 
Brava town since February 24. 
 
¶6.  In Mogadishu, WHO has reported 391 cases with nine 
deaths between February 24 and March 2.  Out of ten 
samples collected from Banadir hospital, nine tested 
positive for the cholera bacterium.  WHO notes a need 
for additional water and sanitation activities to 
improve hygiene conditions, however, the limited 
presence of international humanitarian organizations in 
Mogadishu combined with ongoing insecurity 
significantly limits the potential response. 
 
¶7.  Regular water and sanitation activities had been 
temporarily suspended due to insecurity, however WHO 
has requested that partners resume efforts in order to 
improve sanitation and curb the spread of cholera in 
Lower Shabelle.   Mobile health teams are providing 
treatment and WHO dispatched a diarrhea disease kit 
with sufficient supplies for 100 severe and 400 
moderate cases to both Lower Shabelle and Mogadishu. 
USAID partner the UN Children's Fund (UNICEF) is 
scheduled to distribute additional supplies within the 
following week and is also pre-positioning supplies in 
Baidoa and Mogadishu for future response efforts. 
 
¶8.  In addition to regular health cluster coordination 
meetings in Nairobi, and cholera task force meetings in 
Mogadishu, the Somalia Support Secretariat (SSS) health 
cluster meeting chair may call ad hoc meetings in March 
to further coordinate cholera response efforts between 
local, international and UN agencies. 
 
CHOLERA IN NORTHERN REGIONS 
 
¶9.  Although the overall number of cholera cases is 
declining in Galkayo and Bossaso towns, health agencies 
have expressed marked concern over the high case 
fatality rates, particularly in Galkayo.  With some new 
cases in the past two weeks, health officials in 
Galkayo have reported 66 cases, including 13 deaths, 
resulting in a case fatality rate (CFR) of 19.6 percent 
for the February 18 to March 5 reporting period.  In 
Bossaso, local officials reported 202 cases, including 
10 deaths between February 16 and March 6, yielding a 
CFR of 4.95 percent.  Health experts noted that while 
the outbreak has already been contained in Galkayo and 
Bossaso, the unacceptably high CFRs were due in part to 
poor application of institutional knowledge and 
insufficient preparation and prevention activities. 
 
¶10.  The SSS chairperson for the health cluster said 
that cholera prevention and early detection efforts, 
particularly in these two areas, had been insufficient, 
and indicated that health agencies were not adequately 
 
NAIROBI 00001130  003.2 OF 003 
 
 
prepared despite cholera being endemic in Somalia.  The 
NGO Merlin has drafted a lessons learned document 
regarding the cholera situation in Galkayo and Bossaso 
for review by the health cluster to enhance 
preparedness for future outbreaks. 
 
USAID PRIORITIZES HEALTH AND WASH INTERVENTIONS 
 
¶11.  USAID's Office of US Foreign Disaster Assistance 
(OFDA) has long prioritized health and water, 
sanitation, and hygiene (WASH) interventions throughout 
Somalia with the aim of improving sanitation and 
hygiene and reducing vulnerability to water-borne 
diseases such as cholera.  OFDA committed more than 
$4.5 million for health and WASH activities throughout 
Somalia in FY 2006, and has provided $2 million to date 
in FY 2007 for additional WASH programming through 
UNICEF in response to recent flooding and conflict. 
 
COMMENTS 
 
¶12.  While Puntland has been more secure than southern 
and central Somalia and has a functioning Ministry of 
Health (MOH), it appears that a degree of complacency 
has set in amongst the MOH, UN and NGOs.  While most 
recently international focus has been on southern and 
central Somalia, the UN and aid agencies must maintain 
vigilance and garner the same level of response for 
cholera in the northeast and northwest regions of the 
country. 
 
¶13.  In spite of years of NGO experience and decent 
preparation efforts in most of Somalia, cholera is 
again claiming lives.  Until security improves and 
health resources increase, Somalis will continue to be 
vulnerable to this preventable disease. 
 
RANNEBERGER