Volume 14, Number 6—June 2008
Conflict and Emerging Infectious Diseases
In the November 2007 issue of Emerging Infectious Diseases, Gayer et al. (1) describe how conflict leaves populations in dire poverty, internally displaced or seeking asylum, having poor access to essential services, and consequentially vulnerable to infectious diseases.
Cholera, caused by the bacterium Vibrio cholerae, is a disease that seems particularly sensitive to conflict and deserves more consideration. Major risk factors for cholera—poverty, overcrowding, poor hygiene, contaminated food, and lack of safe drinking water (2,3)—largely resemble the consequences of war and civil fighting. Yet little is known about the relationship between cholera and conflict. This lack of information may be because cholera tends to be epidemic, affecting hundreds to thousands of people across vast, war-torn regions, making it impossible for local governments, nongovernment organizations, and aid workers to control, let alone collect and analyze data.
Examination of data sources listed by Gayer et al. (1) and recent reviews (2,3) indicate that cholera occurs 1) in countries during war and civil unrest, as exemplified by the latest outbreaks among displaced populations across northern Iraq; 2) in neighboring countries, where temporary camps accommodate masses of political refugees under poor conditions, such as those in eastern Chad near Darfur, Sudan; and 3) during the postwar period when large numbers of repatriated persons return home and consequently place undue pressure on an eroded and fragile national infrastructure, as evident in Angola in recent years.
Moreover, all the countries affected by conflict shown in the Appendix Figure by Gayer et al. (1) have reported cholera outbreaks (2–4). They are also among the poorest countries in the world; the latest statistics on human development (5) indicate that compared with all developing countries, on average they have higher rates of undernourishment, refugees, child deaths, and less adequate water and sanitation facilities. Thus, more information is needed about conflict and cholera, especially in Africa.
- Gayer M, Legros D, Formenty P, Connolly MA. Conflict and emerging infectious diseases. Emerg Infect Dis. 2007;13:1625–31.
- Gaffga NH, Tauxe RV, Mintz ED. Cholera: a new homeland in Africa? Am J Trop Med Hyg. 2007;77:705–13.
- Griffith DC, Kelly-Hope LA, Miller MA. Review of reported cholera outbreaks worldwide, 1995–2005. Am J Trop Med Hyg. 2006;75:973–7.
- World Health Organization. Cholera surveillance and number of cases. 2007 [cited 2007 Dec 10]. Available from http://www.who.int/topics/cholera/surveillance/en/index.html
- United Nations Development Programme. Human development report 2007/2008. Fighting climate change: human solidarity in a divided world. 2007 [cited 2007 Dec 12]. Available from http://hdr.undp.org/en/reports/global/hdr2007-2008