Gripped by its worst cholera outbreak in nearly 15 years, which has already left 229 dead, Sierra Leone is likely to see cases triple in the next month as the rainy season hits its peak, estimates show.
In Freetown, the densely populated seaside capital, makeshift houses without toilets or running water crowd the muddy green hills surrounding the city. Slums cluster on the seafront, where rubbish chokes streams and children play in dirty water.
With the heavy rains - which one NGO worker described as “turning a bucket upside down” - and poor hygiene and living conditions, cholera has spread rapidly, leaving thousands stricken with vomiting, diarrhoea and stomach cramps.
The outbreak has prompted the government to declare a national emergency.
Across the country about 13 300 people have so far been infected by the water-borne disease, and with September typically bringing the heaviest rains, cases are expected to hit 32 000, according to the government and the World Health Organisation (WHO).
At 34 Military Hospital in the west of the city, Doctors Without Borders is manning one of several dedicated cholera treatment centres set up around the capital.
One doctor there reported “a streaming procession of patients”.
Relatives mill around the treatment centre, their faces drawn as they wait for news of their loved ones, while nurses hook new patients up to drips and porters scrub the floor to get rid of the stench.
“I was brought here rather dehydrated and I had given up hope that I would live,” murmured Alimatu Turay, lying listlessly on a stretcher, her eyes half-open.
“I had eaten two pieces of roast meat for breakfast and after about an hour, I could hardly control my vomiting and bowel movements. Now I am feeling better, although still delirious, but I think I have passed the danger point,” she said.
Unclean street food is a vector for the disease, and health inspectors are moving around the capital ordering food vendors to cover their wares - but this has not prevented a drop in business, an AFP correspondent reported.
People have stopped shaking hands, while others move around with their faces covered in a bid to avoid catching the disease, not realising that cholera is not airborne.
“We are now teaching patients best hygiene practices to wash hands before having meals, to cover all meals and ensure their children avoid drinking water from streams,” said nurse Matron Abibatu Sesay at the Mabela treatment centre in one of the biggest waterfront slums.
Claire Seaward of Oxfam Sierra Leone told AFP the increase in cases was due to cholera emerging in January, whereas it usually only breaks out in the middle of the year.
“The rains began earlier as well, we had a few cases and then it just exploded. It is expected to get a lot worse before it gets better,” she said.
Sierra Leone is struggling to rebuild water and sanitation systems a decade after a devastating civil war.
Seward said only about 40 percent of people have access to a private or shared latrine, and that up to seven families would often share one toilet.
An already-struggling health system has also been overwhelmed by the outbreak in a nation where only one in four children lives to see the age of five, according to UN figures.
Amara Jambai, the health ministry's director of disease prevention and control, hailed a rapid response to the outbreak since it was declared a national emergency in mid-August.
Over the weekend the Finnish Red Cross flew in a special cargo of medication and doctors.
Britain's Department for International Development has pledged $3 million (2.3 million euros) to help the country fight the crisis and also plans to bring in a humanitarian expert and anti-cholera drugs.
Cholera patients can grow dehydrated quickly and die in less than a day if they do not know to seek help.
Salimatu Turay's 20-year-old son Alusine Vandi is one of those.
“He was taking his terminal exams when he collapsed and had to be rushed to the hospital. He died two hours after he was admitted. It all happened so suddenly,” she told AFP.
Only two of the country's 12 districts remain untouched by the epidemic, which has also left 82 dead in neighbouring Guinea.
According to the WHO, about 2 500 people died and 85 000 were affected by cholera in Africa in 2011. - Sapa-AFP