[Cholera in Goma, July 1994. Bioforce].

In 1994, between July 14 and July 20, around one million of Rwandan refugees fled to the North Kivu region of Zaire. In spite of the existence of favorable conditions for cholera, it was necessary to wait until the laboratories isolated the first strain of cholera, on July 20 and 21, before the international community took action in one of the most important outbreaks of cholera known. The total number of cases of cholera was 36 471, of which half occurred between July 21 and July 27, reaching a peak on July 26. The average overall mortality was 28 per 10,000 in the second half of July, and 5 per 10,000 in the first half of August. 85 percent of the deaths are associated with diarrhea and 60 percent of these deaths with diarrhea are caused by cholera, the other being caused by dysentery. From July 24 to September 17, the Bioforce laboratory (French army) carried out 396 coprocultures : it isolated 78 strains of cholera (Vibrio cholerae 01, biotype El Tor, serotype Ogawa, resisting at O129, without indole), and 77 strains of shigella (Shigella dysenteriae type 1). There were several causes of this outbreak, among which the most important was the lack of water : during the first week, the average available of water was been evaluated at 200 ml per day per person ; the other causes of this outbreak were the impossibility to dig latrines, the lack of hygiene, the level of health and the promiscuity among the refugees. One of the modalities to limit this outbreak of cholera would probably have been to anticipate the subsequent cases and deaths by a massive international response adapted to this risk, as soon the Rwandan refugees began to flood in Goma.