Cholera risks are also a function of public health policy choices, especially those involving water and sanitation. The case studies in this chapter include Senegal, South Africa, and Angola.

SENEGAL

On the South Atlantic coast of West Africa, Senegal, together with the region of Senegambia of which it forms a central part, has been vulnerable to extreme weather and thus to high risks from cholera. Several times in the past two decades, extensive flooding following heavy rains has wreaked havoc from Mauritania through to Guinea-Bissau. In Senegal, cholera outbreaks have troubled districts of the capital city of Dakar and the national Muslim pilgrimage site of Touba in the Diourbel region. In Dakar, seasonal flooding exacerbated by climate change has created a cholera danger, and resulted in internally displaced persons who run risks similar to refugees elsewhere in Africa.

Dakar was the capital of the French Colonial Federation of West Africa from 1905 to independence in 1960. Its core urban area, known as the “Plateau,” received modern sanitary infrastructure from the colonial government to make it attractive and healthful for French citizens and their families in the public and private sectors. As Assane Seck details, privileged Africans working as colonial intermediaries also benefited from these facilities. Unlike the vast majority of Africans, they could afford housing in the European Plateau, which was also inhabited by Lebanese traders and Portuguese-speaking immigrants from the Cape Verde islands. In short, colonial Dakar was a city where economic, not political, segregation prevailed.