The United Nations refugee agency has launched extensive health measures to combat an outbreak of jaundice in the world's largest refugee camp, located in northern Kenya.
Four people have died among 223 confirmed cases of acute jaundice at the five camps of the Dadaab complex, where more than 473,000 people are living in overcrowded conditions.
The outbreak comes as Kenyan authorities report some 80 cases of cholera in Kenya's North Eastern Province, with a settlement close to the border with Somalia the most affected. Twelve deaths have been reported on the Somalia side. While 18 cholera cases have been diagnosed in Dadaab, no deaths are reported in the complex.
"Bad hygiene is the major cause of infection for both diseases and our public health efforts in Dadaab camps are addressing this issue in particular," Andrej Mahecic, spokesperson for the UN High Commission for Refugees (UNHCR), told reporters in Geneva.
"In addition to raising the health, water and sanitation standards and awareness about the importance of hand-washing, use of latrines, and food and water hygiene, refugee health workers are also being trained in surveillance and to look for new cases."
Health officials discovered the first case of jaundice, which is largely caused by the hepatitis E virus, in Dadaab's Ifo 2 refugee camp six weeks ago. Most hepatitis E cases have been found in camps lacking an adequate number of latrines and among new arrivals with poor hygiene habits, Mr. Mahecic explained.
While there is currently no vaccine for hepatitis E, Mr. Mahecic said UNHCR officials are improving sanitation facilities and promoting good hygiene practices. Construction of an additional 6,000 latrines is also under way. Still, he warned that the number of jaundice cases could increase since the incubation period for the condition is one month.
Those affected by cholera are believed to have been in contact with affected communities near the Somali border.
"We are concerned that water-borne diseases could spread with the arrival of the rainy season in October and November," Mr. Mahecic said. "Forecasts for the region are for heavier than average rainfall. This could adversely affect the situation in Dadaab as parts of the camp complex are prone to flooding."
To respond to any cholera spread, UNHCR has established a response team that coordinates at the camp level daily, and includes health, water and sanitation experts with partner agencies. A cholera isolation ward has also been opened at Hagadera camp hospital, and additional staff have been trained to handle cases. Cholera treatment centres have also been established at other camp hospitals.
"At present, there are adequate resources to manage 100 cholera patients," Mr. Mahecic said.
The health campaign is unfolding despite poor security conditions that have sometimes restricted staff movements in Dadaab.
"All essential services and provision of aid to refugees continue uninterrupted," he said.