Photo: Manoocher Deghati/IRIN

Mothers in a waiting room at a clinic near Freetown.

On 18 July, the first reported case in Freetown came from Marbella, a slum area near the centre of town where a high volume of people constantly visit and trade in the busy 24-hour market. The Ministry of Health says they are seeing 40 new cases a day in this area.

In Freetown and the surrounding Western Area, 410 cases and 9 deaths have been reported. The fatality rate is at 2 percent.

"The fatality rate is very high," Sierra Leone's Minister of Health, Zainab Bangura, told a press conference on Monday. "It is pretty serious. At the moment our strategy is to contain it [the disease] and to clean the environment." Bangura said emergency measures were being put in place.

Dr Alemu Wondimagegnehu, Director of the World Health Organization (WHO) in Sierra Leone, told IRIN this is the biggest outbreak since 2007. "For a population of six million, 4,000 cases are significant - this is big."

Since January, Sierra Leone has seen 4,249 cases of cholera and 76 people have died from the waterborne disease. Wondimagegnehu said the epidemic has not yet reached its peak. Critics say the Ministry of Health in Sierra Leone was slow to respond to the outbreak, and prevention efforts in the country are weak.

The government has set up three emergency centres in hot spots around the city to handle new cases and all government clinics are providing free treatment for cholera.

But in Marbella, a high-density area that is not accessible by road and is packed with traders and dwellings, many residents do not have access to toilets and live close to each other.

"The situation in Marbella, with lack of sanitation and hygiene, lack of safe drinking water and the [poor] management of food in the market area - all these are risk factors for [the outbreak] to escalate," Wondimagegnehu said.

[This report does not necessarily reflect the views of the United Nations]