MSF, Doctors Without Borders, cholera outbreaks in Southern Africa
Cholera

If we can’t avoid people getting sick from cholera, we must at least avoid them dying from it

Latest News22 June 2023

What is cholera?

Cholera is a disease caused by eating or drinking something that is contaminated with cholera bacteria. People with cholera develop profuse diarrhoea and (sometimes also vomiting), which leads to dehydration. They can die very quickly, sometimes within 24 hours. Because the cholera bacteria live in water, epidemics can spread very fast if people have no access to clean water.
 

MSF, Doctors Without Borders, Southern Africa cholera response
An area of Hammanskraal called Kanana is the epicentre of a cholera outbreak in South Africa’s Gauteng Province, which has thus far resulted in more than a dozen confirmed deaths from cholera. The community’s tap water is not safe to drink, and residents are reliant on tanked water. MSF is assisting with the chlorination of water supplies, and by providing Aquatabs to residents to kill microorganisms in water.
Bafana Ngwenya/MSF

What is happening in Southern Africa?

All countries where MSF is working in Southern Africa have been affected by cholera in 2023. Since the beginning of this year, MSF has done cholera interventions in Zimbabwe (Harare, Beitbridge, Chegutu), Mozambique (Quelimane, Macomia), Malawi (Mangochi, Lilongwe, Blantyre) and South Africa (Hammanskraal). 

Cholera is not a new disease in Southern Africa. In countries like Malawi, Zimbabwe and Mozambique, cholera is endemic. This means that a certain number of cholera cases is to be expected, because cholera bacteria are present and the environmental conditions facilitate their spread.


In 2022 there was already a worldwide surge in the number of cholera cases, so the situation is not unique to Southern Africa. This trend from 2022 has extended to 2023. But cholera outbreaks have occurred not only in the endemic countries (Malawi, Mozambique, Zimbabwe) but also in South Africa, which was unexpected and worrying. And the large-scale outbreaks in Malawi and Mozambique are not part of the usual endemic pattern.
 

MSF, Doctors Without Borders, Southern Africa cholera response
A four-bed cholera treatment unit that MSF helped to set up in Kanana, Hammanskraal is making a difference by giving community members access to immediate care, and by taking some of the pressure off the referral hospital.
Bafana Ngwenya/MSF

The lack of access to safe drinking water and sewage treatment in several places in the affected countries certainly plays a role. Also important are extreme weather events. Cyclone Freddy, which hit (among other countries) Mozambique and Malawi, contributed to a peak in cholera cases. The cyclone destroyed infrastructure and caused severe flooding, which destroyed access to safe drinking water and made the cholera bacteria spread very fast.

On top of this, there is a chronic lack of cholera vaccines since 2022. Cholera vaccines are not only used to stop cholera epidemics but also to prevent them. However, because of the shortage of vaccines, authorities are reluctant to vaccinate preventively to make sure there are enough doses left to vaccinate in case of an outbreak. The shortage not only hampers ending cholera epidemics but also allows more outbreaks to start in the first place.
 

Video

Cholera crisis in Southern Africa

"Most of Southern African countries where MSF operates - namely Malawi, Zimbabwe, Mozambique and South Africa, experienced worrying cholera outbreaks in 2023. With climate change increasing, the risk of cyclones and floods and an ongoing shortage of cholera vaccines, the outlooks aren't very good for a disease that is easy to prevent and easy to treat," - Strategic Medical Advisor for Southern Africa, Dr Mounia Amrani, explains what needs to be done to stop cholera in Southern Africa.
MSF
Cholera isn't going to go away anytime soon. Areas with a lot of poverty and a lack of good water infrastructure are always vulnerable to the disease. Global warming means more cyclones and flooding for this part of the world, and we know that further increases the risk of cholera outbreaks.

What can be done about it?

Unfortunately, it doesn’t look like cholera is going to go away any time soon. Areas with a lot of poverty and a lack of good water infrastructure are always vulnerable to the disease. Global warming means more cyclones and flooding for this part of the world, and we know that further increases the risk of cholera outbreaks.
The first thing that needs to happen is an increased availability of vaccines. The current scarcity is a problem, and because we expect more outbreaks, the problem will only become bigger. More vaccines are an absolute must.

Given the importance of clean water, governments and other organisations will also have to invest in solid infrastructure for drinking water and waste management. This is the only long-term solution for cholera, and given the increased risk of climate change, investments need to be sped up.

In the meanwhile, as outbreaks keep occurring, it’s important to organise health promotion campaigns and to train medical staff to treat cholera. Cholera can kill quickly, so fast and adequate medical interventions are crucial. If we can’t avoid people getting sick from cholera, we must at least avoid them dying from it.