Today marks International World Water Day, a way of focusing global attention on the importance of water and the need for the sustainable management of freshwater resources. It's estimated that by 2025, 1.8 billion people will be living in countries or regions with absolute water scarcity, and two thirds of the world's population could be living under water stressed conditions, making it especially hard to produce crops. But in the Democratic Republic of Congo, which is currently facing a serious cholera epidemic which has spread to nine out of 11 provinces, the problem is a result of excess water and the failure to ensure water sources are kept clean. Oxfam's public health advisor in the country, Tom Skitt, reports.
In the middle of the day it is hot and humid next to Lake Albert, one of the Great Lakes that separates Uganda from the Democratic Republic of Congo (DRC). The smell of drying fish is strong, and all along the shore, boats have been drawn up in readiness for the evening fishing.
Just behind the shore is a densely populated area where Christine lives with her husband, a fisherman, and her three young children in a wattle and daub hut with a low roof of grass thatch. She, like many others, is resting during the heat of the day.
It does not take long to find out what is concerning her and her neighbour, with whom she is chatting. "People are getting sick," they say, "and we are worried." Christine regularly collects water from the lake because the nearest protected water source, a well with a hand pump, is 2km away and often during dry periods does not yield enough for the needs of the local population.
Their views however differ about what is causing the sickness. Christine believes it is contaminated lake water but her friend is more convinced by sorcery. Our conversation turns to other problems. "No, we don't have latrines, the landlord won't provide them, and anyway there is no space. We use 'flying toilets'" (plastic bags for defecation which are then thrown away). She shows us a small gully a few metres away full of rubbish.
Tchomia, the small town where she lives, is in the midst of a cholera epidemic. Since the beginning of the year more than 1,500 people have been affected and nearly 40 have died. The disease is a permanent feature of DRC, and a powerful indicator of the risk of exposure to other water related diseases. In 2011 an estimated 22,000 cholera cases, and 600 fatalities, were recorded. The majority were in the east along the Great Lakes, but cases were widely spread. The epidemic in Tchomia and the surrounding area is one of eight that Oxfam has responded to during the past 12 months.
Cholera epidemics can be prevented very simply by providing clean water. However, the dilapidated water supply infrastructure in many towns was designed for populations much smaller than are now present. In addition, widespread displacement because of violence has caused these towns (particularly in eastern DRC) to become overwhelmed. The amount of investment needed to ensure clean water for all is enormous, and the country is in no position to manage development on this scale.
There is an enormous irony here as the abundance of water resources in DRC contributes to the problem. DRC has more than half of the freshwater resources for Africa. Indeed nearly 25% of all renewable water resources (i.e. those resources recharged by rainfall) are in DRC. At present less than 0.05% of freshwater is exploited, and future projects are only likely to bring this up to 0.15% by 2025. Many other African countries whose water supplies are "stressed" (i.e. the water resources recharged by rainfall are similar to the amount that is being exploited) provide much greater quantities of clean water per person.
Oxfam, as one of the bigger agencies in the water sector, is making an important contribution to more permanent water supplies, but is also ready to respond to cholera epidemics when needed. In such emergencies the focus is on the speed of response, by setting up simple water treatment systems linked with intensive hygiene promotion, to allow people at risk to protect themselves immediately. This is normally sufficient to stop the epidemic, but does not tackle the underlying causes.
In the centre of town next to the hospital an area with large tents fenced in by plastic sheeting and a lingering odour of chlorine marks the presence of the cholera treatment centre. Most of those who are treated there recover quickly. The number of sufferers is now diminishing and there are no more fatalities. In a few weeks the epidemic cycle will have been broken by ensuring clean water and improved basic hygiene, and the number of cases greatly reduced. Christine's worries will recede, and she will have learnt how to better protect her and her family in the future, but she will be aware that until the water supply in Tchomia is improved there is a strong risk that cholera will come again.