Algeria, sick with cholera

Early in August, several people from the same family came to the Ain Bessem hospital suffering from what appeared to be food poisoning. In that town with a population of 40,000, located 100 kilometres to the south of Algiers, cases of food poisoning are common during the summer months, as in the rest of the country, due to improper food storage and interruptions in the cold chain.

"Examining doctors suspected cases of cholera and sent the analyses to the Pasteur Institute in Algiers", according to a hospital employee who wishes to remain anonymous. Two elderly patients died after being hospitalised.

The epidemiological services ordered an investigation and took samples from the water supply system which the family was likely to have used. The media became alarmed and referred to a "mysterious illness". As for the local correspondent of the French language daily Le Soir, he pointed out that the members of that family seemed to have been infected one after the other, which caused a panic in the town.

Ten days later, the Bouira regional public health authority announced that several patients had been transferred to the El-Kettar Hospital, a specialised medical centre in the capital. The others were said to be suffering from acute gastroenteritis.

Conflicting statements

Meanwhile, in Blida, the region that lies just south of Algiers, five members of the same family were also hospitalised with violent vomiting and diarrhoea. Echourouk, the country's largest-selling daily in Arabic, spoke of "a mysterious epidemic".

On 20 August, the day before the beginning of the Eid holidays, the Algerian Institut Pasteur and the Ministry of Health held a press conference.

"Preliminary analyses have sufficed to show that this is absolutely not a cholera epidemic," declared Zoubir Harat, the director of the Institut Pasteur, and that food poisoning was the most likely cause.

'We were told to avoid spreading a panic', a journalist said

And yet only two days later, dozens of people were hospitalised in Boufarik in the Blida region. The following day, another press conference was held. The authorities announced 88 hospitalisations and 41 confirmed cases of cholera in the regions of Blida, Bouira, Algiers and Tipasa.

Zoubir Harat made a public statement: "It has to be said that this outbreak of cholera is not confined to Algeria. A number of countries recorded cholera cases at the beginning of the year, such as Yemen, Chad and Niger. Some countries have not declared a cholera outbreak at all. In Algeria, the law requires the disease to be declared. We had the courage to do so."

That Thursday evening, there was a violent outcry in the press and on social media networks. Algeria had not seen a cholera epidemic for 20 years. But above all the authorities were blamed for having concealed the epidemic during the two Eid holidays - a time when Algerians traditionally pay visits to their friends and relatives.

	Algerian Minister of Environment and Renewable Energies Fatma Zohra Zerouati (C) joins others in a cleaning operation after an outbreak of cholera in Algiers, Algeria, 30 August 2018. [Getty]

Despite the belated official recognition, official media had little to say. "We were told to avoid spreading a panic", a journalist said. 

The origins of the disease were not clear, even though the Institut Pasteur tended to think it was in the food supply, and specifically through the contamination of fruits and vegetables by waste water.

The next morning, in the Cheraga neighbourhood, Lamia bought a supply of bleach at the supermarket. "I'm going to put it in the children's bathwater. Yesterday I read on Facebook that the tap water was at fault. So we're going to drink mineral water." On social media networks, melons and watermelons were also thought to be potentially dangerous.

On Sunday, 26 August, at the specialised El-Kettar Hospital, overlooking Algiers, everything appeared calm.

And yet, inside the building men were wearing white boiler suits. "I'm not a doctor, I'm a plumber," one of them explained. "But we're afraid of the disease so we demanded some protective gear."

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The man who owns a shop by the hospital entrance had placed a bucket of water and bleach on ground. "After each customer, I dip my hands in it, you never know," he said. The hospital had sent several patients home, an employee told us.

'Everything will settle within a few days'

45 kilometres away, an emergency plan had been declared at the Boufarik hospital which dates from colonial days and consists of a pair of small two-story buildings.

The infectious diseases ward was too small to accommodate all the patients, so one whole wing had been isolated. In the courtyard, the families were waiting patiently on metal chairs.

"We're not allowed inside," said a woman wearing sunglasses and a beige headscarf. She had left her children at home in order to bring a pack of mineral water, some food and belonging to hospitalised relatives.

The infectious diseases ward was too small to accommodate all the patients, so one whole wing had been isolated

"My mother and her sister have been here for two days," she explained. "My sister is better but my mother has diabetes, her condition has worsened."

The gate opened and a nurse motioned to her. She stood up and handed her carrier bags to the nurse who went back inside. Sid Ali was also there to bring food to his wife, who had been in hospital for several days:

"They don't know what she's got yet, the tests haven't come back. The health services came to the house to investigate, they took photos. They said the house was clean and the children were in good health. I don't know where that disease came from."

New patients were dropped off in front of the infectious diseases wing. A clinical officer wearing a surgical mask and a blue apron checked to see if the man had been examined by a doctor: "We've declared a state of emergency, we accept only patients suspected of cholera."

That very morning, the minister of health Mokhtar Hasbellaoui made his first public appearance since the official admission of the appearance of the bacteria. He toured the hospital, gave a press conference and assured his listeners that everything would be settled within three days. The hospital personnel, on the other hand, denounced the lack of personnel and equipment to deal with the epidemic.

The hospital personnel denounced the lack of personnel and equipment to deal with the epidemic

The authorities were hard pressed to explain where the disease had spread from. At first they laid the blame on a spring in the Tipaza, then on crop irrigation and announced a reinforcement of inspections.

But a problem arose when the Ministry of Agriculture retorted that "the water used for irrigation and absorbed by plants is not dangerous for agricultural products. Fruits and vegetables do not provide a favourable environment for the development of the vibrio cholera."

In a press release, the ministry emphasised that irrigation using waste waters was rare: "The relevant local authorities have always sanctioned such practices and taken appropriate action which in this case means legal proceedings, confiscation of irrigation equipment and systematic destruction of crops." As for the services in charge of the hydraulic sector, they insisted that piped water was not the culprit.

Conspiracy theories dominate

While the authorities were passing the buck among themselves, people in the streets passed around various conspiracy theories.

Amine, a taxi driver, was convinced the disease was imaginary: "I think the mineral water producers have contrived to raise the price of their bottles." Saliha, a city hospital worker, went even further: "In my opinion, the cholera [epidemic] is an invention. They're trying to get us to accept the idea of a fifth term of office [for President Bouteflika]."

In the wilaya of Tipaza where a spring was held responsible for the contamination of some of the hospitalised patients, people in the district were shown on television drinking the water directly and declaring it was harmless. There was a general feeling of disbelief.

At the same time, Algerians were accusing each other of not respecting the rules of elementary hygiene. Pictures of rubbish bins emptied into the streets circulated on the social networks.

Journalist Adlene Meddi pointed to the public authorities' inability to organise city life: "After 60 years of squandering human resources, with incompetence and corruption reaching new heights, the powers that be have no right to tell anyone what to do and how to do it."

In the capital, despite the cholera epidemic, some neighbourhoods had to wait several days before their rubbish was collected.

On 4 September, the minister of health assured the public that the epidemic was under control and that the prevention system would be kept in place.

In Boufarik Hospital, a few patients were still hospitalised "as a precaution" the hospital director assured us. Mostly these were food-poisoning cases. Hospital personnel had been supplied with a rapid test which can indicate in 30 minutes whether a patient should be hospitalised or sent to some other service.

"Everything is much calmer now," said one assistant. The next day, a month after the first case, the authorities announced they had identified the origin of the cholera epidemic: Beni Azza oued, a river which flows from the mountains of Blida to the beaches west of Algiers through a part of the Tipaza region.

The banks of this water course are lined with slum areas and according to the press are regularly polluted by domestic and industrial waste. Hence, the oued is going to be decontaminated.

For the new school year, the government has said that awareness sessions will be organised so that pupils will learn to wash their hands more frequently.

The chairman of the National Medical Board, Mohamed Bekkat Berkani, interviewed on public radio, denounced the inadequacy of preventive measures: "There is a lack of surveillance and preventive measures, especially as regards the inventory of water courses and water points to determine their degree of contamination and avoid propagation of the disease," he declared.

On 10 September, according to the head of the Institut Pasteur, there were still three patients hospitalised. "The cycle of the epidemic is practically ended. All indicators tell us it is over," he told the AFP.



Leila Beratto is a journalist based in Algiers. She launched the project 'Terminus Algérie' in collaboration with the photographer Bachir, which documents migration in Algeria.

This article was republished with permission from our friends at Orient XXI.

Follow her on Twitter: @LeilaBeratto

Opinions expressed in this article remain those of the author and do not necessarily represent those of The New Arab.