International aid workers say West and Central Africa are in the grips of a regional cholera epidemic that has been aggravated by heavy rains and flooding.
According to the U.N. Office for the Coordination of Humanitarian Affairs, nearly 40,000 cases of cholera have been reported in Cameroon, Chad, Niger and Nigeria this year. The U.N. says the disease has killed nearly 1,200 people in those countries surrounding the Lake Chad Basin.
Chad and Cameroon are among the hardest hit. In both countries, the current actually epidemic began last year and recently flared up with the onset of another rainy season.
Cameroon has reported more than 14,000 cases this year across all of the country's major regions.
Moustapha Diallo, Regional spokesman for the International Federation of the Red Cross, says the reasons for the epidemic in Cameroon are similar to those around the region.
"The population does not have access to clean drinking water or adequate sanitation facilities," he said. "Villagers do not build latrines but prefer to go in nature [and] rains then wash up solid waste and spread the disease."
Cholera, a highly contagious diarrheal disease that causes severe dehydration and can lead to death if not treated quickly, is transmitted by ingesting food or water contaminated by bacteria.
Relief workers blame cross-border transmission for persistent outbreaks in the Lake Chad Basin, which serves as a bustling trading center for farmers, fishermen and merchants.
"Fishing around Lake Chad has been a problem because people move across borders," said Lillian Okwirry, chief of the Water, Environment and Sanitation division for the U.N. Children's Fund in Chad. "You go to a funeral on the other side and you are bringing back the cholera."
Okwirry says free treatment clinics in Chad attract infected Cameroonians who lack similar services at home, exacerbating the problem.
"People come to this side to be treated and that in itself is a mode of transmission," she said.
Although the problem is regional in scope, Okwirry says countries comprising the Lake Chad Basin typically do not coordinate public health strategies, and that outbreaks often happen in far-flung villages where medical care is limited.
Chad has reported more than 11,000 cases of cholera this year, more than two-thirds of them since the rains began in June.
A looming crisis?
As the rainy season peaks in September and October, Red Cross officials warn if rapid action is not taken caseloads in Chad could double to as many as 25,000 and possibly spread to refugee camps along the Sudanese border.
Nigeria has reported more than 13,000 cases of cholera this year where cases were seen in 23 of the country's 36 states. Niger and Mali have also each reported approximately 1,000 cases this year.
Further south, the World Health Organization says cholera has spread in the Democratic Republic of Congo along the Congo River, causing more than 5,000 cases since March.
Cholera is treatable and preventable, and the WHO says a death rate of higher than one percent indicates problems in the health system. Affected countries in the Lake Chad Basin, such as Cameroon and Chad, are reporting death rates of more than 3 percent.