Nairobi — Conflict in eastern Democratic Republic of Congo (DRC), where M23 rebels and other armed groups are fighting government forces, is dangerously undermining efforts to combat a cholera outbreak.
There has been "a sharp increase in the number of cholera cases in the armed conflict area of North Kivu" Province, the World Health Organization (WHO) said in a statement.
Between 11 June and 1 July some 368 new cases were reported in the province, WHO said, naming the most affected areas as Birambizo, Goma, Karisimbi, Kiroshe, Mutwanga, Mweso and Rwanguba.
According to the International Medical Corps (IMC), there have been some 15,000 new cases of cholera in eastern DRC over recent months.
"There is concern that the security situation may increase difficulty in accessing the healthcare facilities and could increase the number of severe and fatal cases. The current armed conflict in North Kivu also poses a risk of international spread of the disease to neighbouring countries such as Burundi, Rwanda, South Sudan and Uganda," WHO warned, adding that cholera is endemic to North Kivu and five other provinces in eastern DRC.
"Insufficient access to safe water supply remains the main cause of the epidemic," the statement said.
World Vision, some of whose staff were among 60 aid workers who evacuated the North Kivu town of Walikale after clashes there between government forces and the Raia Mutomboki armed group, said fighting in the town "forced the suspension of efforts to combat a deadly cholera outbreak".
As a result of the evacuation, which World Vision said could last several weeks, "projects to counter cholera have been temporarily halted, including the rehabilitation of water points, hygiene training, water purification, and latrine construction."
A representative of Médecins Sans Frontières (MSF) who asked not to be named said of the fighting, which began on 17 July: "People were trying to run to the bush/forest during the fighting itself but some were caught up in it. It was three days of on-and-off, open fighting in the streets."
A few days later Walikale was said to be calm but very tense. "People don't know what will happen," said the MSF source.
The evacuation meant MSF had to suspend its activities in Walikale, where the medical charity was treating more than 1,000 people per week for malaria in a programme that started only the previous month.
Many of those benefiting from the programme had sought refuge in the dense forest around the town having fled previous bouts of fighting, MSF said.
"Any further displacement caused by this violence will only exacerbate their vulnerability to this deadly disease," said Andrew Mews, MSF's head of mission in Goma, the provincial capital.
IMC's departure from Walikale has led to the suspension there of its primary health care services, clinical management of the rape cases that are a frequent characteristic of the conflict in eastern DRC, as well as interventions designed to prevent malaria, diarrhoea and respiratory illnesses.
A local source told IRIN that the fighting is now happening in so many different places in North Kivu that people are struggling to find safe refuge - they feel relentlessly pursued by the sense that fighting might be about to start.
A resident of Rutshuru, a town that was briefly held by M23 rebels when they took it without force earlier in the month, said the sense of confusion is being compounded by the fact that it is increasingly hard to distinguish FARDC from M23 because they are in the same uniform.
At-risk groups such as children and the elderly are of growing concern to humanitarians unable to gain access to them. Many are becoming separated from families, which adds to their vulnerability.
HelpAge International, an NGO working to raise awareness of their invisibility in emergencies, is one of the organizations forced to cease operations in Walikale. A representative of the charity said they had noticed an increase in violence against old people as thieves see them as easy targets. HelpAge has recorded incidents including the theft of food rations and the beating of one elderly displaced person.
The latest situation report from the UN Office for the Coordination of Humanitarian Affairs (OCHA) describes a deteriorating security situation that has led to more than 220,000 displaced within North Kivu, and 54,000 others having crossed into Rwanda and Uganda to escape the violence.
The report also cites numerous protection incidents including sexual violence, child soldier recruitment, and community violence.
[This report does not necessarily reflect the views of the United Nations]