Every evening at about 10pm, dozens of sleeping forms appear outside Luanda's Josina Machel hospital.

Angolans visiting relatives or seeking treatment at one of its rudimentary wards stretch out on the pavements and use a nearby lot as a toilet. The neighbouring paediatric hospital has a similar overflow crowd of mothers and children, also sleeping rough.

The scene would be alarming enough were Angola not struggling with an outbreak of the highly virulent Marburg haemorrhagic fever. The little-understood and incurable disease, which is spread through contact with blood, faeces and other bodily fluids, has caught the war-damaged African country unprepared and exposed gaping holes in its health and other infrastructure.

As of yesterday, 215 people were reported dead out of 235 confirmed and suspected cases, according to the United Nations and Angola's ministry of health. While past outbreaks of Marburg or the similar Ebola virus have been contained within three months, health officials will not hazard a guess when they might bring Angola's current one under control.

"We're not sure where we are in this current outbreak," said Dave Daigle of the World Health Organisation. "Our guys won't say whether we're at the beginning, in the middle or at the end."

Nearby countries, including Namibia, South Africa and the Democratic Republic of Congo (DRC), have taken precautions at points of entry to prevent the disease from spreading. While eight cases have been reported in Luanda, the Angolan capital, the epidemic is centred in the northern province of Uige.

International and health officials seeking to prevent the disease's spread have struggled with bad roads and minimal mobile phone reception in the region, which is larger than Switzerland.

Angola's civil war, which lasted with brief interruptions from 1975 until 2002, devastated the country's health and other infrastructure. Sebastiao Veloso, the country's health minister, has said his budget accounts for only 3.8 per cent of government spending, a fraction of the 12-15 per cent of its budget the UN says Angola should spend on health.

Whereas the DRC has emergency protocols in place for epidemics after outbreaks of Marburg and Ebola, Angola lacks everything from disinfectant to properly trained medical personnel. Several dozen officials from the UN, the US Centres for Disease Control, and Médecins sans Frontières now in Uige are trying to fill the gap.

An MSF team sent to Uige in late March found the hospital where most of the cases were treated without water or electricity, and its morgue packed. The medical charity set about establishing an isolation unit and training staff in bio-security measures.

Angolan authorities have carved a path through the country's customs and immigration bureaucracy to allow foreign medical equipment and staff to enter quickly. The government quickly established an inter-ministerial working group, and began broadcasting radio and television messages warning people to report illnesses or sightings of bodies. "We've been pretty impressed by what they've accomplished with grossly limited resources," a western diplomat said.

Although the epidemic was not officially declared until March, health officials now believe the outbreak began in October, when Angola's rainy season begins. The damp weather normally brings a surge in deaths of children from malaria and other diseases, so officials did not raise the alarm for months.

Health workers screening children for measles and polio routinely saw symptoms typical of haemorrhagic diseases and sent blood samples to Atlanta for testing. Several tested positive for Marburg, and the epidemic was declared on March 21.

Health officials had as of yesterday identified 468 people in contact with Marburg cases.

http://news.ft.com/cms/s/679dfab8-ac83-11d9-bb67-00000e2511c8.html




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