There are many ways to steal water. Close a tap. Block access to a river. Drain a well. Or, more viciously: steal life out of it.

This is what cholera does. It secretly poisons even a pure looking stream. It creeps into its victims when they drink or eat food that they thought they had cleaned.

And once inside their bodies, it keeps on looting: it siphons off water, making it gush out, from vomit and from diarrhoea, continuously and without relent.

In the most extreme cholera cases, an adult can lose up to twenty litres of water in just one day. Death is quick to follow.

According to official statistics, 55 people have died and over 7,400 have been infected in the current outbreak sweeping through Mozambique since early February.

Patients at the cholera treatment centre in Tete district, Mozambique. Photo: Luca Sola
Patients at the cholera treatment centre in Tete district, Mozambique. Photo: Luca Sola

A third of the cases have passed through Tete city's cholera treatment centre (CTC), one of three such centres set up by Doctors Without Borders (MSF), that is co-managed with Mozambican authorities.

While the number of cases is now quickly decreasing in Tete, cholera is flaring up especially in the coastal Zambezia province to the east, which has recorded 1.100 cases in the past three weeks according to official figures.

A CTC is a place that smells just like a municipal swimming pool early in the morning; a place where the water thief comes to die at the hands of a legion of cleaners, masks on their faces to avoid the splitting headaches from the chlorine continuously scrubbed on the floors, beds, clothes, hands.

Cholera can kill 50% of the severe cases; but with proper treatment, where the dirty water that cholera sucks out of the patients is replaced by clean rehydration liquid, mortality drops to below 1%.

Entrance to the cholera treatment centre managed by MSF in Tete district in Mozambique. Photo: Luca Sola
Entrance to the cholera treatment centre managed by MSF in Tete district in Mozambique. Photo: Luca Sola

By early March, in the first two months of MSF's operations, over 3.000 people had been treated and cured in this CTC. For the people in Tete, life or death partly depended on how quickly they could get there once the symptoms start.

This is their story.

It's 8:00 AM and David Domingos anxiously wait in front of the CTC, along with about forty people. He's been sleeping outside of the centre for the past two weeks.

At first, his two oldest children were being treated there. The day they were discharged, his toddler was admitted. Now it's his wife.

Suddenly, the crowd parts to make way for a battered pickup truck carrying cholera's fresh batch of victims. Two moms climb out holding their children, little-ragged dolls knocked almost unconscious by the vicious attack.

They came as quickly as they could, they say; but it is not much you can do when your little one starts showing symptoms in the middle of the night.

Quick, quick, hold them tight, walk and run for the hour or so that it takes to go to the nearby health centre, sandals batting desperately on the muddy streets.

And there you wait, you wait, you wait until a car is sent, until the car drives out toward Tete city, as fast as it can go through the broken streets. They came as quickly as they could, they say.

Floods aftermath: cholera emergency in Mozambique. Photo: Luca Sola
Floods aftermath: cholera emergency in Mozambique. Photo: Luca Sola

Three-year-old Mauro is in a critical condition. The veins in his limbs have collapsed – the body knows that when it is so much under attack, it has to ration the little life that still flows to only feed the vital organs.

The nurse gently taps his skull, where blood is still pumping weakly, looking for a way to insert an IV line that will replace the water that cholera drained out of Mauro's body during the night.

Serita, his mother, came as quickly as she could, she says. But she came too late. An hour after her arrival, she is a childless mother.

There was still time for 18 month-old Midio. An IV line on his ankle replenishes the fluids lost to dehydration, stabilizing him, and six hours later, he is sitting on his mother's lap, eating porridge. He's back home after a few days – but back to a home where he got the disease in the first place. 

Little Mauro lived in Samora Machel Bairro, one of the settlements half way between little town and big village that recently sprung into existence along with the local mining boom.

Tens of thousands of people from the rest of Mozambique or neighbouring Malawi and Zimbabwe streamed in, looking for work, but basic services were much slower to follow.

As most houses here don't have latrines we spot a couple of little kids squatting in the bush near the river. “Fecalismo”, is what they call it here Mozambique, or open defecation - the perfect way for cholera to spread.

There are public toilets on top of a small hill, but the large pipe connecting it to the septic tank has a hole as big as a fist. It will just take some rain for waste to be washed down 30 meters downhill and for cholera to creep into the water pouring out of the communal tap through a leaky water pipe.

In Mozambique only 37% of the rural population has access to safe water sources.

Mozambican women wash clouds using one of the public water pomps in Dégué village, Chiringa area, approximately 30km (18 miles) from Tete city. Photo: Luca Sola
Mozambican women wash clouds using one of the public water pomps in Dégué village, Chiringa area, approximately 30km (18 miles) from Tete city. Photo: Luca Sola

Cholera is seen as a shameful disease because it's spread through faeces. It thrives in places where too little has been done to protect the purity of water sources, and it can spread almost undetected: while the number cases are starting to decrease in Tete city, the epidemic is now spreading deeper into the countryside, along the tranquil Zambeze river and its tributaries where many villagers get their drinking water from.

“But is the river the guilty one?”, asks Renato Souza, MSF's emergency coordinator on the cholera response.

The large village of Dégué, 45 minutes away from the urban boom of Tete city, wouldn't strike anyone as a dirty place. Its mix of brick, mud and wood houses are neatly swept, not a bit of trash around.

At midday, most men are working on their maize fields, but a crowd of women and children quickly gather in the shade of a thick baobab tree in response to MSF counsellor Gabriela Fernando on the megaphone, one of 150 workers from MSF and the ministry of health charged with explaining how to avoid the disease. “People of Dégué! Protect yourself from cholera!”

People attentively listen to Gabrielan and ask questions. They know all too well that the invisible water thief is among them: within the last week, five people, all of them children, have been hit by the disease. One died, an eight-year-old.

Gabriela starts explaining how to use Certeza, the chlorine solution she's about to distribute to clean the water when the meeting is suddenly interrupted by a stampede. “Black mamba! Black mamba!”.

A woman jumps on the small stone wall where people where sitting, tries to coax the snake out of its hole, then the crowd settles back. “Did the snake come because we forgot to do a traditional ceremony before starting this meeting?” ask Gabriela. “No, no”, say the villagers, “he lives there. Go on”.

 Daniel Bila, 71 year old, from Samoa Machel area, being treated in the Cholera Treatment Center set up by MSF (Médecins Sans Frontières) and co-managed with the Mozambican ministry of Health in Tete district which is the most affected area in the country. Photo: Luca Sola
 Daniel Bila, 71 year old, from Samoa Machel area, being treated in the Cholera Treatment Center set up by MSF (Médecins Sans Frontières) and co-managed with the Mozambican Ministry of Health in Tete district which is the most affected area in the country. Photo: Luca Sola

Life can be tough in Degué, and cholera doesn't make it easier.

77-year-old Francisco Saene ambles out of his house. He's weak, finishing a bout of malaria, but is eager to talk. Two of cholera's victims lived only a few paces away: a mud house 30 meters north, a little brick one 50 meters south. Does it frighten him?

“I can't afford to be frightened”, he says. “If I get sick, there would be no one to take care of me. I can't lose my head”. Is it the first time he's heard of cholera? “Oh no”, he says.

“Cholera is like the wind: sometimes it blows this way, sometimes it blows another way. You just never know when it will come.”

The source of the cholera outbreak here seems obvious though: everybody drinks from the same water pump, 200 meters from where the black mamba lives.

A few days later MSF sends a water specialist to kill cholera with chlorine, and to put life back into the neighbourhood's water source. It cost about $100 to abate the wind that frightens Francisco.

Find out more about MSF's work in Mozambique