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Armed with heavy-duty black rubber gloves, a face mask and a bucket of liquid, Maleyamungu Rukamata, 34, stands guard against a menace that lurks beneath the waters of Lake Kivu. “I am the chlorinator,” he says as he syringes a dose of chlorine solution into the jerry can that a girl from a nearby village has filled with lake-water. The shot of chlorine makes it safe to drink.

The latest outbreak of the cholera in Minova, a lakeside region of the Democratic Republic of Congo’s war-torn east, has struck 794 people, killing 14. Across the world last year there were 5,000 deaths among cholera’s reported 220,000 victims, according to the World Health Organisation.

The materials for Minova’s lakeside chlorine stations, as well as bulk deliveries of clean water, latrine kits and supplies to help sanitise the local hospital, come from Action Against Hunger/ACF International, the charity the Financial Times is supporting in this year’s seasonal appeal.

Combating cholera and other waterborne diseases might seem a step too far for a charity devoted to preventing the malnutrition that claims 3.5m children’s lives worldwide annually. Yet such diseases do their work in deadly counterpoint with malnutrition. Conditions such as diarrhoea leave children unable to retain nutrients; their immune systems, weakened by hunger, leave them prone to further infection from bad water.

The world’s 1bn hungry people tend to live in the same areas as the 2.6bn who lack “improved sanitation” – polite code for having to share festering pits for toilets. Potable water has become more widely available in recent years but more than one-third of Africans have none. Only one of every 50 rural Congolese receives water through a pipe, according to United Nations figures.

Such is the critical role that clean water and sanitation play in fighting malnutrition – from the shores of Lake Kivu to slums of Haiti – that of the 4.3m people ACF assisted last year, 1.5m, or more than one-third, benefited from such projects, as opposed to its nutrition programmes and long-term initiatives to foster livelihoods and improve farming techniques.

Water programmes also highlight a central tenet of ACF’s philosophy. When it comes to protecting water sources or installing hygienic latrines, the charity seeks to mobilise villagers and slum-dwellers to lead the effort.

Rukamata was appointed as chlorinator-in-chief following a village poll for a community health representative. ACF pays the $60 a month that allows him to be at his post for 12½ hours a day during the cholera outbreak – but he answers to his neighbours. He takes pride in his work but knows he could be subject to a recall vote if it is not deemed up to scratch.

“It’s absolutely fundamental for us,” says Jean Lapegue, a hydrological engineer at ACF’s Paris office, and its senior water and sanitation adviser. “If the community has been involved from the start, they will sustain it.”

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