Africa is caught in a vortex of poverty, water and disease
The novel coronavirus pandemic has disrupted the hard-won years of progress against another pandemic — cholera, an acute diarrhoeal illness caused by Vibrio cholerae. The bacteria is shed through faeces and infects through contaminated water and food.
Since 1817, the infection has emerged from endemic areas in Asia in seven pandemic waves that have involved much of the world. The seventh and current cholera pandemic, which began in 1961, has lasted longer, spread further, and infected more people than any of its predecessors, and remains entrenched in sub-Saharan Africa where it causes intermittent outbreaks in communities already burdened with conflict, lack of infrastructure, poor health systems and malnutrition.
The illness is easily preventable by ensuring access to safe drinking water and sanitation and is curable through simple treatments like oral medicine, or in severe cases, intravenous rehydration. But as per the World Health Organization, 83 per cent of deaths in sub-Saharan Africa between 2000 and 2015 were due to cholera.
Though cases were on the wane since 2017, several countries including Nigeria, Ethiopia, Sudan, Niger, Somalia, Cameroon, Mozambique have reported outbreaks of cholera since the onset of COVID-19. In Nigeria, which faces one of the largest outbreaks, cholera had spread to 32 of its 36 states, sickened 90,000 people and caused more than 3,000 deaths by the end of 2021.
In Zambia, the Disease Intelligence Agency, the water utility companies and the local authorities, heightened active surveillance-reporting of diarrhoea cases every morning just like for COVID-19, after they found faecal contamination of water in seven townships of capital city Lusaka in October 2021.
To contain the spread, authorities in Nigeria have supplied tanker water in high-risk areas, while those in Lusaka have secured bottles of liquid chlorine to disinfect water.
Some analysts blame COVID-19 for the cholera outbreaks. As priority shifted towards COVID-19 containment, it resulted in a lapse in contact-tracing and the diagnosis and treatment of cholera patients in high-risk areas, they say.
Bioye Ogunjobi, a UNICEF official in Nigeria, however, blames it on the governments’ lackadaisical attitude towards ensuring access to safe water and sanitation:
The countries have not understood the concept of water quality. It does not involve chlorinating water at one point. Combating water-borne diseases rather requires ensuring that water is safe in the entire value chain — from the source till consumption.
Quality takes a hit
But this is a difficult proposition for most living in rural and peri-urban areas or informal settlements of Africa. Williams Ngwakwe, who coordinates a non-profit Golden Change that works on water and sanitation projects in northern Nigeria, says a community called Chida in Kwali area council of Federal Capital Territory (FCT) grows a lot of cassava, but rarely cleans it with water before eating it.
Such is the water shortage that they just peel it, grind it and consume. Hand hygiene before meals is also poor. One can imagine what a girl child goes through in such places during menstrual period and the kind of disease outbreaks such personal and environmental hygiene can result in, Ngwakwe adds.
In South Africa’s Mthatha city, a majority of well-to-do population also struggles daily to get water and resorts to using water from drains for bathing and washing.
The Joint Monitoring Program the World Health Organization (WHO) and UNICEF, which is responsible for global monitoring of the progress on sustainable development goals, in its latest report states that the rural poor are more prone to contaminated water. They usually depend on shallow borewells that have been found to be bacteriologically contaminated due to lack of proper sanitation facilities.
This lack of access leads to diseases like cholera, dysentery and typhoid. Poor sanitation facilities also lead to stagnated waters which lead to breeding of mosquitoes and malaria outbreaks in sub-Saharan Africa.
A 2020 study by Delhi-based Centre for Science and Environment (CSE) on groundwater resources of Uganda also finds that inadequate sanitation facilities are a major cause for the deterioration of the quality of the country’s water bodies.
In the Kingdom of Eswatini, Ndumiso Cyprian Magagula, an environmental inspector for waste management at Eswatini Environment Authority, admits that faulty sanitation systems end up contaminating the surface and groundwater bodies.
“A system should be developed which ensures that the potable water shall be provided only to those households which have properly designed containment systems and ensure timely emptying of systems,” Magagula says.
No space for sanitation
Although Africa is the least urbanised continent, the sub-Saharan region, which has 46 countries and several developing cities, has seen rapid urbanisation. It has consequently spurred challenges in terms of basic services and sanitation.
Magagula points out that in commercial hubs of Eswatini that receive a large number of migrant workers, people build cheap housing without any sanitary services. Over the years, these cramped up spaces have left little to provide facilities to manage faecal sludge.
Dumping of solid waste, household waste water and effluent from industries end up in water bodies. The part of population that depend on borewells also face water quality issues due to faulty sewage and onsite systems.
Magagula says the only possible solution to this is some people are relocated and space is made to develop proper facilities along with developing proper solid waste and waste water management systems. For now the Eswatini government is training the police to monitor any violation activities and educating communities.
In Nigeria, says Ngwakwe, the government has introduced a national action plan to stop defecation in the open. To begin with, the clean Nigeria campaign was launched in the north-western part of the country, where the aim was to declare 100 local government areas open-defecation-free (ODF) by the end of 2021.
However, scarcity of water in addition to the activities of bandits in the Northwestern part has slowed the campaign work and less than 30 areas could be declared ODF.
“Now we hear that some people in those communities are moving to internally displaced persons’ camps. So when that eventually happened we were sure that people will continue defecating outside again as they may not even have access to the basic amenities, including water and sanitation,” says Magagula.
Some 600,000 people in Cabo Delgado in Mozambique’s Northern Province have been facing shortage of safe water, sanitation and health following a massive migration due to frequent cyclones and armed attacks. Pandemic has added to the woes. A WHO report in March 2021 states cholera cases had surpassed the 2020 levels despite reduction in testing capacity owing to destruction of health facilities.
While a majority of the economy is dependent on groundwater in sub-Saharan Africa, little attention is paid to its quality. Due to geological formations several African countries have higher concentrations of fluorides, arsenic and chlorides.
These also make groundwater unfit for drinking without treatment. A 2020 study by CSE has found high concentration of iron, magnesium and chlorides due to natural mineralisation in groundwater of Uganda. Fluoride levels were also higher than the drinking water guidelines by WHO due to volcanic deposits.
These results in various diseases such as fluorosis, while iron results in unpleasant odour and taste and manganese damages the plumbing fixtures and laundries.
In Tanzania, the CSE study had identified that the groundwater was polluted with nitrates and sulphates. Mining of these resources and hazardous dumping of waste in the open, results in the waste ending up in waterbodies and this increases their salts and mineral contents, affecting their pH value (acidity or basicity).
However, the need for the same is hardly addressed barring a few research studies. Problems such as groundwater contaminated with nitrate and fluoride should also be catered to on a war footing.
The community should either have a community-level water supply systems which treat the groundwater before supply to households or their should be mechanisms where the groundwater supplies are treated before supply to households, which again can be a costly affair for the rural households.
Water resources are unevenly distributed in Africa, points out Puneet Srivastava, senior international expert on water who currently works with WaterAid UK. Water is abundant in the Congo basin while there is physical water scarcity in southern Africa and economic water scarcity elsewhere.
Weak rainwater harvesting, limited renewal of groundwater and little conservation exacerbates water scarcity. This scarcity, coupled with poor sanitation practices, has resulted in an abundance of illnesses, diseases and deaths.
Water scarcity is responsible for a variety of waterborne tropical diseases, such as typhoid fever, cholera, dysentery and diarrheal illnesses in Africa. Where people have access to water, activities such as mining, farming and deforestation, combined with weak infrastructure, lack of improved public policy and public accountability and weak regulation have significantly contributed to the pollution of those sources.
To solve some of these challenges, Srivastava highlights the need for involvement of all people in water related democratic dialogues at all the levels to identify some of these challenges and their solutions by the local stakeholders, a concept that he has successfully applied in shape of Jal Choupalor Water Democratic Platforms in northern Indian states.
Democratising water helps in bringing all stakeholders such as governments, local governments, communities, private sector and non-profits towards a common understanding of challenges to water quality and working on locally relevant solutions together and in convergence.
Reporting by Rivonala Razafison, Bennett Oghifo, Mekonnen Teshome , Maina Waruru, Engela Duvenage, Kiran Pandey, Swati Bhatia, Nivit Kumar Yadav
This was first published in Down To Earth’s print edition (dated 16-31 January, 2022)
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