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Cholera

Cholera outbreaks

 Multiple countries are dealing with cholera outbreaks today

 Although easy to prevent and treat, cholera affects up to 4 million people worldwide per year, resulting in up to 140,000 deaths.

Putting cholera into context

Cholera is a disease, caused by bacteria that infect the intestines after people have ingested contaminated water (or food). The bacteria cause very severe diarrhoea, and sometimes vomiting. The diarrhoea is so severe that a sick person quickly gets dehydrated and this can lead to death within hours.

The diarrhoea of cholera patients contains a lot of cholera bacteria. If wastewater with cholera bacteria somehow contaminates drinking water, which can happen surprisingly easily, cholera outbreaks can spread extremely fast.

Why are there so many cholera outbreaks today?

In 2022, at least 30 countries have seen outbreaks of cholera or cholera-like diseases. But this is not one big outbreak. For most countries, the current surge of cholera is due to specific, local conditions. The risk factors for cholera outbreaks are well known and always linked to access to clean drinking water and proper wastewater disposal.

Protracted political and/or military crises

This type of crises can lead to a lack of maintenance of drinking water and/or sewage infrastructure. This is the case today in countries like Haiti, Somalia and Syria

Natural disasters

Heat and drought can reduce the amount of safe drinking water, forcing people to use unsafe sources. Floods on the other hand, can facilitate the bacteria’s spread to previously safe water sources. In 2022, countries like Somalia, Kenya and Ethiopia suffered from severe droughts. Others, like South Sudan and Nigeria, faced floods. 

People on the move

Refugees often have to stay in places where there’s not enough access to clean water, and authorities often don’t invest in proper water and waste infrastructure in refugee camps. This year, there were cholera outbreaks in refugee camps in Lebanon, Somalia and Nigeria.

What are the challenges today?

Cholera is easy to treat, with oral rehydration for most patients, and intravenous rehydration for more severe cases. If treated in time, more than 99% of patients will survive the disease. Providing clean drinking water and correctly processing wastewater protects people from getting infected in the first place. There is also a good vaccine against cholera. 

But treatment and prevention of cholera come with considerable logistic challenges. Setting up cholera treatment centres requires a lot of supplies, and so do water and sanitation projects. In places that are unsafe or otherwise difficult to access, that is a huge constraint. And just the number of outbreaks this year makes it very challenging. There’s already a shortage of cholera vaccines and the supply of other essential materials, like the fluid for intravenous rehydration, is also under pressure.

Additionally, sometimes governments don’t want to officially declare cholera outbreaks, often for political reasons. This makes it very difficult to adequately inform the population how they can protect themselves, and impossible to do cholera vaccination.

What is MSF doing today?

MSF is today running cholera programs in 10 countries (Kenya, Ethiopia, Somalia, Cameroon, Nigeria, Haiti, Lebanon, Syria, Malawi). Our teams are involved in cholera prevention: they do health promotion, water and sanitation works, and cholera vaccination. We’re also running cholera units to treat patients in medical facilities, and have set up bigger, separate cholera centres where hundreds of cholera patients can be admitted simultaneously.

Haiti

Since the arrival of the first suspected cases in MSF facilities on 28 September 2022, approximately 8,500 patients have been admitted to the five CTCs, however an effective response to this resurgence is currently very difficult.

We are calling for an immediate intensification of the response to the outbreak as an effective response to this resurgence is currently very difficult: 

  • Few medical and humanitarian actors are present on the scene - MSF is one of the few, if not the only, actor to provide a meaningful response to the cholera outbreak through the installation of CTCs and the implementation of community-based activities in the most affected neighbourhoods. 
  • The population is very vulnerable to cholera - This is due to problems with access to drinking water, unsanitary living conditions in many parts of Port-au-Prince and the difficulty for people to move around due to fuel shortages and insecurity. Access to water is very complicated, with water trucks not circulating in certain neighbourhoods and the temporary closure in early October of the largest water distribution company. 
  • The health system is heavily affected by the situation - Haiti is going through a severe fuel shortage which has had a direct impact on the functioning of hospitals still in operation, preventing the treatment and referral of patients. Fighting between armed groups, recurrent demonstrations and piles of waste are also among the factors that complicate the transfer of patients to treatment centres. 

To respond more effectively to this emergency, MSF is calling for a much greater presence of medical-humanitarian actors and cholera vaccination. The few hundred thousand doses of cholera vaccine that have been allocated to the country by the International Coordinating Group, the international mechanism for vaccine response to epidemics, are far from sufficient.

However, MSF stands ready to begin implementing a vaccination campaign, in support of the health authorities and in addition to other activities. 

Lebanon

On the 6th of October 2022, a cholera outbreak was declared in Lebanon signaling the return of the bacteria for the first time in nearly three decades. Since declaring it an outbreak on October 6, the highly contagious disease 19 people have died as a result of the disease, with the number of confirmed and suspected rising to 3,671 as of 16th of November 2022.

The cholera situation is unfolding on top of the ongoing economic and fuel crisis that has further exacerbated the limited access to safe drinking water and properly functioning waste management networks in the country, threatening a full-blown spread of the disease.

On Saturday 5th of November, MSF started vaccinating people in the north and northeast of Lebanon, where most cases are recorded, as part of the national vaccination campaign launched by the Lebanese Ministry of Public Health.  Our teams are going from door to door in all neighbourhoods, visiting homes, shops, and camps actively seeking out people to get vaccinated and to raise awareness on the importance of vaccination of a rapidly spread disease.  

Syria

After 15 years, a Cholera outbreak has been declared again in Syria in September 2022, including northeast and northwest Syria. 

As of November 22, more than 37,000 suspected cases of Cholera have been recorded in northern Syria including 43 deaths (according to Assistance Coordination Unit-ACU). First linked to the contaminated water near the Euphrates River and the severe water shortage in the north of Syria, the outbreak is currently spread across the country.

MSF is responding to the outbreak since September 2022 by conducting community-based health promotion activities as well as preparatory training of relevant healthcare workers, and we are closely monitoring the situation in coordination with the authorities and other medical and humanitarian organizations and adapting our operations based on the needs. 

What happens in an MSF cholera treatment centre?

MSF often responds to outbreaks of cholera in the countries we work. But how do we set up our cholera treatment centres to ensure our patients get the best care possible - and that the disease doesn't spread? Learn more about the layout and activities of an MSF cholera treatment centre in this interactive guide.

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