I've often had to document Oxfam's hygiene promotion activities in communities, schools, markets and other public places. But never a prison. Until now.
In Bunia town, Ituri district, in Congo's Orientale Province, Oxfam's health and emergency response teams have been tackling a serious cholera outbreak. We've been working with a local water provider, Ngongo, to try improve water supply to sections of the town.
In Bunia, however, only half of all neighborhoods receive any treated water and the amount per person is only about a quarter of what humanitarian agencies normally say are acceptable levels.
According to a UN report last year, an estimated 51 million people, or three quarters of the population in Congo, have no access to safe drinking water.
During the current cholera outbreak in Ituri district, more than 2,000 cases have been reported and 56 cholera deaths have been confirmed. Oxfam has set up two large water treatment units, treating water from the city's Ngezi river with aluminium sulphate and then chlorinating it so that it's safe to use.
The water treatment means we can provide an extra 180 cubic metres of water a day, helping more than 40,000 people receive clean water.
Recently, reports surfaced of a possible cholera outbreak in Bunia's Central Prison, prompting Oxfam to begin work there too. We began providing water and installing hand-washing facilities at the request of the ICRC (the International Committee of the Red Cross), which had been working in the prison, while other arrangements were made for the water to be trucked twice a day from our water treatment centre. Oxfam staff are also carrying out hygiene promotion activities at the prison.
Health promotion in the prison
It was an eye-opening visit. The prison is severely overcrowded. Built for 200 inmates, it currently houses over a thousand, mostly men, although there are also separate compounds for minors and women. Before our intervention, the prison received just 1,000 liters of piped water a day, barely a liter per person for drinking, cooking and washing.
There are no beds and only a few dark, unlit and unfurnished bare-floor rooms that are crammed with people. Most inmates normally have to sleep outside in the prison courtyard because of lack of space. But heavy rain the night before my visit forced prisoners to get shelter where they could -- some even slept in the toilets to stay dry.
It's easy to see how disease could spread like wildfire here. People tightly packed together with poor sanitation facilities, including maggots in the toilets, while the number of toilets is woefully insufficient for the large number of people, and there was not enough water for drinking, washing or cooking. The scarcity of water meant most prisoners were only able to wash once a week.
I watched as public health promotion team leader Emilie Bhania spoke to a large group of male prisoners who'd gathered for our visit. She spoke about good hygiene and the importance of hand washing. The prisoners listened attentively and asked questions. Many raised problems that they were still facing due to overcrowding and sanitation.
Oxfam public health promoter, Emilie Bhania, talking to prisoners
Later, several told me disease was rampant. There had been cases of typhoid and many inmates had serious respiratory illnesses and skin diseases. I was told matter-of-factly that several prisoners had died and that cholera was not the cause. Inmates said they were very happy that Oxfam was now helping and that it had made their difficult conditions a bit better.
Overcrowding is a big problem
Cholera has become endemic in eastern Congo. Last year, an estimated 22,000 cases and 600 deaths were reported. Oxfam's work in areas like Bunia has made a difference. But it's clear that huge problems remain. People might understand and know what they need to do to prevent cholera, but unless they have access to the basics, things like clean water and soap, it's still going to be very difficult to keep cholera at bay in the future.