IRIN Africa

"Relief groups are considering resuming or expanding their operations in northern Mali after French and Malian troops took key towns from militant Islamists who controlled the region for nine months. Insecurity in the north during this period disrupted and restricted aid operations and also prevented free movement of the local population. 'The problem of access was double-edged. Many people who were being treated for malnutrition could not get to the health centres while health workers could not reach them.

"'Cholera is not just an emergency and humanitarian issue," said Jessica Dunoyer, an ACF cholera expert who worked in the two countries during the latest epidemic. 'It is an issue for the development community.' With respect to water access, she said that given the Millennium Development Goal (full report) of halving the number of people lacking access to safe water, there is often an emphasis on the number of people covered, while considerations such as an area being a cholera hotbed may not sufficiently guide selection."

"Many more northern Malians are likely to face severe food shortages in the coming days and weeks if markets remain blocked by border and road closures, and humanitarian access remains limited, warn food security agencies. Disruption to the Mopti-Douentza-Gao corridor has also led to severely diminished cereal supplies in Gao markets, says Action Against Hunger's head in the capital, Bamako, Franck Vannetelle. Gao residents are relying on cereal imports from Niger.

"Rains were decent across much of Mauritania in 2012 leading to hopes of a reasonable harvest. However, even in a good year farmers can produce a maximum five-month cereal supply - most small farmers produce much less - and most face 2013 with accumulated debts from previous years following decades of cyclical crises. One third of Mauritania’s population (700,000) was estimated to go hungry in 2012 (some studies put the figure higher at one million), while 12 percent of children assessed were severely malnourished.

"The cholera epidemic that struck Guinea and Sierra Leone in 2012 is winding down. What to do now? Start preparing - for cholera. That’s part of the message from donors, aid workers and health officials after the most serious cholera outbreak in years that infected some 30,000 people and killed 400 others in the two countries - mostly in Sierra Leone.

"Sparse rainfall in 2011 triggered food alerts for Mali which went out well before the start of the rebellion in the north in January, and the coup d'état in Bamako in March.

"Breastfeeding is almost universally practiced in Guinea. The problem, health experts say, is that it is rarely early or exclusive - both recommended for optimal health...Seeing positive experiences of other women and their babies is a powerful motivator for changing feeding practices, according to a study by aid group Action Against Hunger - Spain conducted in Conakry’s Matoto District.

"Aid agencies are scrambling to treat thousands of cholera patients in Sierra Leone’s capital, Freetown, where the number of infections is mounting by over 250 per day. Most patients are from the city’s various urban slums, where open defecation is rife, toilets are rare, sewage is improperly disposed of, and awareness of cholera is very low.

"...The UN World Food Programme (WFP) estimates that 1.7 million Malians are at risk of severe hunger this year due to drought, high food prices, poor terms of trade for animals, and conflict-driven insecurity. Malnutrition rates are sharpened by these factors, but they are always unacceptably high in Mali.

"The cyclical nature of cholera and the fact that immunity builds after large-scale epidemics are some of the reasons for this year’s lower caseload, said practitioners...All responding agencies, including MSF, stressed that the vaccine is not a standalone solution and should be seen as a supplementary activity. 'We put a lot of effort into all the strategies at once,' Ciglenecki told IRIN, referring to the need to raise awareness of public hygiene, targeting cholera hot spots, setting up early warning systems, and treating water.