In response to the influx of refugees from the Democratic Republic of Congo (DRC) into Luapula province, the WHO Country Office is working in collaboration with the Ministry of Health to strengthen disease surveillance in order to reduce the risk of spread of communicable diseases. The WHO Representative, Dr. Nathan Bakyaita undertook a familiarisation tour of the refugee camps at Mantampala and Kenani in Nchelenge district from 23 February - 1 March 2018 in order to assess the health situation, the health services available for the refugee population and to identify areas which needed WHO’s immediate and long term support. Dr. Bakyaita  paid a courtesy call on the Provincial Permanent Secretary, Dr. Buleti Nsemukila and also held meetings with the Provincial Health Director and District Director of Health to gain an insight into the situation. Dr. Buleti Nsemukila informed Dr. Bakyaita that the border between Zambia and DRC was long and that 8 out of the 11 districts in the province shared boundaries with the DRC while illegal and uncontrolled border crossing points were common. He also said that the Zambian health facilities located near the border were constrained by unplanned population movement. Moreover, the districts of Nchelenge and Chiengi were prone to cholera outbreaks due to existence of illegal fishing camps with inadequate water supply and sanitation facilities.
 
The refugees at the border site in Chiengi are being screened following the disease surveillance guidelines and they are then moved from Kenani transit centre to Mantampala on a weekly basis. However, caution is being taken to ensure that the chronically ill, children under two years, pregnant women and those with mental disorders are not moved as the health services in Mantampala are not yet well established. A public health specialist has been deployed by UNHCR while MSF is to construct 2 treatment centres in case of any outbreak of diseases of public health concern. Although the Mantampala settlement reception area has adequate water supply and sanitation facilities, the residential area to be allocated for permanent settlement has not yet been covered.
 
The refugee camps face a number of challenges which include: the slow development of the camp at Mantampala due to heavy rains, lack of access roads in the camp to allow demarcation of plots and construction of houses for the refugees because the forest has not yet been cleared. Some cases of diarrhoea and malnutrition as well as community deaths have occurred as a result of poor health care seeking behaviours, limited transport and ambulance services, compromising for the quality of health services. There are inadequate human resources to provide health services in the refugee camps since no staff have been deployed by government due to lack of accommodation. In the meantime, staff from Nchelenge and Chiengi districts health facilities are temporarily deployed to serve the refugee population, stretching the capacity of the existing health facilities. The UN agencies using CERF resources are procuring an inter-agency kit, will construct a temporary health facility and improve the provision of sexual and reproductive health services.
 
The WHO Representative emphasised the importance of strengthening disease surveillance to prevent disease outbreaks. He said that WHO provided technical and financial support for disease surveillance and stationed a Surveillance Officer at the Provincial Health Office in Kasama to support IDSR activities in Luapula, Muchinga and Northern provinces. Dr. Bakyaita said that using CERF resources, WHO would support training of community agents in disease surveillance. Furthermore, through support from DFID, WHO was in the process of delivering boats to enhance service delivery to areas where water transport was the only means of reaching the needy populations.
 
The government has placed priority and effort in responding to the refugee situation working with a number of partners including MSF, the UN family and NGOs . An inter-ministerial Steering Committee has been set up to oversee the response to the influx of refugees comprising 8 Ministries, Permanent Secretaries and the UN Resident Coordinator.
 
The WHO Representative also visited Mansa General Hospital and School of Nursing, the Tropical Diseases Research Centre (TDRC) in Ndola, the Provincial Health Office for Copperbelt Province in Ndola, and the Ndola Teaching Hospital and Copperbelt Medical University.