It’s a disease we thought we were free of. Buried, with the filth of past societies and open-air gutters. And yet, in the space of thirty days, 10 cases of cholera were detected on the national territory, in Mayotte. A record, whereas usually, cases oscillate between 0 and two per year. We have to go back to 1986 to find so many of these infernal diarrheas, which drain the most fragile to death, on average 5% of patients.
For the moment, no “native” cases have been reported. All caught the disease abroad. But a race against time is underway. Because, unlike other years, cholera, still very active in certain areas of the world, is now swarming in the nearby Comoros archipelago. And also spreads on the African coast, in Zambia, Zimbabwe, Mozambique, the Democratic Republic of Congo or Ethiopia. Countries in a “critical” situation, according to the WHO. 60,000 infections have been discovered there since January.
The threat is all the more serious as many people from these areas try to reach French territory almost every day. At least eight of the 10 patients treated in France by the regional health agency (ARS) and the Mayotte Hospital Center (CHM), had illegally entered France from the Union of the Comoros, where the Vibrio cholerae in their intestines. Seven shared the same makeshift boat, one of those that roam the French beaches of Mayotte in search of a new life.
The risk of a cluster in administrative detention
The contaminated illegal boat was first intercepted by the French border police. There are more and more patrols there, because of the health risk but above all to respond to migratory pressure on the archipelago. The passengers, who did not know they were ill at the time, were then placed at the administrative detention center (CRA) of Pamandzi, in Petite-Terre, one of the two islands which form the department. It is here, where more than 60 migrants fail every day, that the first symptoms, intense abdominal pain, were triggered.
Once the cases were transferred to the hospital, health authorities disinfected the rooms and distributed antibiotics for prevention. Analyzes were carried out, ruling out on-site contamination. But the arrival of cholera in the largest CRA in France, where 32,000 foreigners arrive each year, all from exposed countries, is worrying. The place is at risk, due to its promiscuity and its precarious hygienic conditions: “There is only one toilet for 10 people, and you often have to ask for soap or hygienic protection”, testifies a internal source.
The associations on site (Solidarité Internationale, Unicef) therefore fear seeing the CRA become a source of contamination, the first on French soil in around twenty years – in 2022, 4 indigenous cases were recorded, but they were due to imported products. These organizations recommend that gloves and hydroalcoholic gel be systematically distributed. This is still not the case, according to our information. “We should also demonstrate total transparency, even in the event of suspicion. We are talking about cholera, all the same. Have the administrators understood the danger?”, worries this source.
The hospital is reorganizing
At the CHM of Mamoudzou, the only hospital in Mayotte, a special unit was created at the beginning of the year. 70% of beds are already occupied. There are 14 in total. The emergency services, headed by Dr Alimata Gravaillac, have put in place a procedure to isolate patients and prevent the bacteria from proliferating. “The patients are rehydrated, using infusions. Antibiotics are given to them. They are effective against the strains currently circulating,” explains the doctor, contacted by telephone, between two interventions.
In the event of an influx, the ARS plans to double the size of the service. Additional units could also open in other cities. This would make 40 beds in total, reserved for people affected by vibrio. Tarpaulins and stakes have also been ordered. Enough to support possible field hospitals, if they had to be built. “We must be as responsive as possible,” comments Olivier Brahic, president of ARS Mayotte. At its premises, five trucks full of care kits are ready to start.
In the Comoros, on the opposite islands, 366 cases have been detected over the last four days. 1,700, since February 2. 43 people died. The epidemic is concentrated on the island of Anjouan, a few dozen kilometers from Mayotte. This is where candidates for departure take to the sea. The panic generated by what is considered “the other plague” reinforces the temptation to leave. In April, 130 Mozambicans began to flee their country at full speed, simply because rumors were spreading. Their boat overturned, killing 96 people.
Trucks ready to go
To limit the risk of dissemination, the ARS has also set up mobile teams. Agents, ready to put on their full suits at the slightest suspicion. They disinfect homes, test the surrounding water, trace possible contact cases, to give them preventive treatment. 60 people have already received them. Prevention messages are also disseminated, particularly at the borders. The state sends text messages to all travelers coming from risk areas. If necessary, they can be found and isolated.
That cholera is resuming in France is a fiction as it stands, experts say. Dirty water and contaminated food are the main vectors of the disease. However, France has had highly controlled networks for a long time. And its health resources remain extensive. “A contaminated meal taken just before taking off for Roissy is always possible. But sick people everywhere, that would go against what we know,” says Renaud Piarroux, biologist and historian of cholera. He participated in drafting the current defense plans.
The fact remains that in Mayotte, the territory of all crises – social, environmental, security, migratory – the situation is far removed from metropolitan standards. A “special case”, explained Covars, the government’s scientific council, in a report published in early April. This combines “major epidemic risks including almost all of the diseases analyzed, including some including cholera, plague or polio, almost forgotten in the national territory”. With, also, “food, infectious and toxicological risks linked to climate change, in particular drought”.
Mayotte, this powder keg
Its geography, its tropical climate and the abandonment of the State make Mayotte a health powder keg. With, as a deminer, a care service “at the end of its rope”, to use the words of the Senate Social Affairs Commission which qualified it thus in a report published in 2022. The least endowed in the territory: only 1, 56 hospital beds per 1,000 inhabitants. Around two times less than the French average. In 2023, 242 million euros were injected to urgently renovate the CHM and build a second hospital.
Some 29% of Mahorais are not connected to running water, or around 93,000 people. Among them, 21% hydrate at a well or stream, according to INSEE. A figure, an anomaly in France, which swells during droughts. The taps are still cut off two days a week, reminiscent of the water crisis that has been raging since this summer. The worst-case scenario? Let these untreated sources become contaminated. Cases would spike suddenly. Cholera is treatable, but requires emergency care in a fifth of cases.
The probability of a Mahoran epidemic outbreak is real, but moderate, according to specialists: “the agents are on alert. We have sufficient response capacities”, estimates Brigitte Autran, immunologist and president of Covars. The threat does not seem any less great. “In neighborhoods that resemble shantytowns, the promiscuity of housing, the absence of appropriate hygiene services and the lack of drinking water favor the rapid spread of bacteria. Such an epidemic would be a disaster,” ruled theUnicefin a press release published in March.
Vaccines exist, but they are currently in short supply on the global market. Demand has exploded, as cases worldwide have more than doubled since the Covid-19 crisis. ARS Mayotte has a stock of 4,000 doses. Enough for the current situation, she said. But the syringes empty quickly. 441 contact cases have already received an injection this month. The Ministry of Health, on the phone twice a week with the ARS, had to place new orders. Front-line staff, caregivers, firefighters, and agents who fight against illegal immigration, are waiting.
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