Outbreaks can rapidly spread in over-crowded communities and in dense living conditions when there is inadequate access to clean water, waste collection, and proper toilets. Because of population displacement, destruction of infrastructure, or a lack of public services, cholera is a serious risk in the aftermath of a natural disaster or during a conflict. The situation can be especially problematic in rainy seasons when houses and latrines flood and contaminated water collects in stagnant pools.
Caused by a water-borne bacterial infection, cholera is transmitted through contaminated food or water, or through contact with fecal matter or vomit from infected people. A patient can lose up to 25 litres of fluid per day. Cholera can cause severe diarrhoea and vomiting, and rapidly prove fatal, within hours, if not treated. But cholera is very simple to treat – most patients respond well to oral rehydration salts, which are easy to administer. In more serious cases, intravenous fluids are required. Ultimately, no-one should die of cholera - yet well over 100,000 do each year.
Quick facts about cholera
Cholera is relatively simple to treat in most cases, with people with mild to moderate forms usually able to recover through treatment with fluids and oral rehydration salts, which are easy to administer. People who are severely dehydrated may need intravenous fluids and hospitalisation. In these cases, they should be admitted to a Cholera Treatment Centre (CTC). Without treatment, the mortality rate can reach 50 per cent; with adequate care, it's less than 2 per cent.
Cholera occurs in areas with poor access to sanitation and unsafe drinking water - so providing people with clean drinking water and proper sanitation facilities is vital to preventing and curbing any outbreaks. Our WATSAN (water and sanitation) teams provide people with sachets to purify water, truck clean water in, and install, fix and clean out sanitation facilities such as toilets in affected areas. Informing people about good hygiene practices such as washing hands, using clean toilets, and using only clean water to drink and wash food, can also curb outbreaks of the disease.
While oral vaccines have proven effective in preventing cholera during outbreaks, current two-dose strategies are logistically challenging to implement during emergencies. But we know from previous experience and scientific evidence that a one-dose oral cholera vaccine strategy is not only safe and easy to implement, but can also prevent or reduce the transmission of the disease during an epidemic.
A rapid response is vital to containing the spread of a cholera outbreak. Quickly putting in place health promotion activities - educating people about how to help to limit the spread - plus water and sanitation activities, establishing treatment centres and vaccinating in an emergency response can help limit how far an epidemic spreads and reduce the number of people who fall sick or die.
The design of the Cholera Treatment Centre (CTC) by MSF was a significant contribution to cholera epidemic response. A CTC is set up outside of the main hospital to prevent the spread of the disease and is fully autonomous. In open settings, with spread-out populations, treatment needs to be as close as possible to affected populations. Care can be decentralised to smaller-scale CTCs known as cholera treatment units and oral rehydration solution (ORS) points, supported by mobile teams.
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.
In 2022 at least 30 countries have seen cholera or cholera-like diseases outbreaks. 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,, however, 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.
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 many supplies, as 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.
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.
What happens in an MSF cholera treatment centre?msf.org
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.LEARN MORE ABOUT MSF'S CHOLERA TREAMENT CENTRES