In 2024, nobody needs to die because of cholera.
We have already eradicated it in many countries. After major outbreaks in the 19th century, Europe and North America have eliminated cholera by improving water and sanitation infrastructure.
We can easily treat cholera. Drinking an oral rehydration solution (water with added sugar and salts) helps most people recover quickly, while severe cases can be treated successfully with intravenous (IV) fluids and antibiotics.
We even have a vaccine. Delivered orally, the vaccine offers protection against cholera for multiple years.
Yet in recent years, there has been an alarming resurgence of cholera in countries around the world. Why is this infection continuing to cause deaths and suffering in 2024—and what can we do about it?
The current situation
The numbers of worldwide cholera cases and deaths have grown alarmingly in recent years. Last year, there were more than 667,000 cholera cases and 4,000 deaths, prompting the World Health Organization to declare a Grade 3 emergency—the highest emergency level. More than 30 countries—primarily in Africa, Asia and the Middle East—have been affected.
In the first four months of 2024, the highest numbers of cases have been reported in Afghanistan, Haiti, Ethiopia, Syria and Yemen, while the Democratic Republic of the Congo and Zimbabwe have reported the highest numbers of deaths.
Why is cholera so dangerous?
With proper treatment, almost everyone infected with cholera recovers quickly. Without treatment, severe cases can kill in just a few hours.
Common symptoms of cholera are acute watery diarrhea (AWD) and vomiting, which cause people to lose large amounts of fluid in a short space of time. The resulting severe dehydration can lead to kidney failure and death.
Children under the age of 5 are especially vulnerable, and account for a high proportion of cholera deaths. If they are malnourished, their weakened immune systems put them at increased risk.
Why is cholera spreading?
Cholera infection is caused by Vibrio cholerae bacteria, which are spread through contaminated water and food. Outbreaks are common in countries that have experienced natural disasters or conflicts that destroy water and sanitation infrastructure.
For example, cholera cases in Syria are linked to years of conflict that has destroyed vital infrastructure as well as the devastating earthquakes that hit neighboring Türkiye in February 2023. The destruction displaced people into crowded shelters and camps, where there’s a higher risk of contaminated water.
Similarly, much of Yemen’s infrastructure has been left in ruins after years of conflict, violence and economic collapse. Many people don’t have access to safe water and sanitation facilities. Because only about half of Yemen’s health facilities are fully functional, people who get infected from cholera often can’t get medical care.
Cholera outbreaks can also be driven by weather events and climate change. In Somalia, infections have increased due to flooding that destroyed and contaminated water sources in the wake of El Niño rains. Meanwhile, outbreaks in Zimbabwe have been linked to drought, which has forced people to rely on poor-quality water sources such as shallow wells and rivers that are easily contaminated.
Cholera infections are an international issue. Even if the disease can be controlled by efforts in one country, borders are porous and outbreaks in neighboring nations can easily reintroduce it. Therefore, efforts to fight cholera need to be coordinated.
How are humanitarian organizations fighting cholera?
International Medical Corps and other humanitarian agencies are fighting cholera around the world with a multi-pronged approach.
Improving water supplies and sanitation
One of the most important and effective ways to fight cholera is by improving access to modern water, sanitation and hygiene (WASH) facilities. This means improving access to clean water supplies, such as by trucking safe water into disaster zones, building solar-powered boreholes, and providing toilets and other sanitation infrastructure.
In the Tigray region of Ethiopia, at least half of the water supply points were destroyed when conflict broke out in 2020, forcing many of the residents to rely on unclean water sources or make long journeys to far-away sources. International Medical Corps is helping by rehabilitating boreholes and wells to give local people access to safe water. This means that they no longer have to drink contaminated water that could infect them with cholera.
We’ve also built new water supply systems—including solar-powered water purification plants—in Pakistan, where monsoon flooding left local communities reliant on unsafe water sources.
WASH infrastructure projects need to be sustainable long-term solutions. That’s why we build infrastructure that is powered by renewable energy and teach local people how to repair and maintain the facilities, to keep them functioning for many years in the future.
Strengthening healthcare facilities
While we improve people’s access to clean water and sanitation facilities, it’s important to also increase local healthcare facilities’ capacity to fight current cholera cases. This means rehabilitating facilities, delivering supplies and providing training to staff members.
For example, to help health facilities across Yemen, we have provided medical supplies such as antibiotics and intravenous fluids to help treat people suffering from severe cases of cholera and AWD. We established fully stocked oral rehydration points where people can receive fluids and have their recovery monitored, to reduce the risk of death from dehydration, and trained staff to treat cholera and AWD more effectively. We also provide mobile teams that are able to reach remote and underserved areas, to provide care to people who wouldn’t otherwise be able to reach a health facility.
Increasing the capacity of health facilities means they can better respond to current and future outbreaks and save lives.
Educating communities about hygiene and prevention
Education is essential to fighting cholera. Even simple demonstrations of effective handwashing techniques, or training on hygienic latrine use and solid-waste disposal can help reduce the risk of transmission.
Reaching communities with such WASH-related education is a vital part of our cholera-prevention strategy in countries around the world. For example, in Afghanistan, we train volunteers who visit homes in their local communities to teach best practices around hygiene and sanitation. With their enthusiasm and knowledge of local culture and customs, they make a real difference in their community.
Vaccinating vulnerable people
Oral cholera vaccines, taken in two doses as a drink, are a cheap and effective short-term tool for fighting cholera in hotspots. However, demand outpaces supply—about 36 million doses were produced in 2023, less than half the amount that was needed to address the surge in cases worldwide.
Vaccines are just part of the solution to cholera, alongside long-term solutions like improved infrastructure, healthcare facilities and WASH-related education. This is why we use vaccines tactically as a short-term measure in areas that are especially at risk of major outbreaks. For example, in Haiti, following the destruction caused by Hurricane Matthew in 2016, our team provided operational support to help deliver the largest emergency cholera vaccination campaign in history.
Addressing malnutrition
Malnutrition and cholera deaths are closely interlinked. Severely malnourished children are several times more likely to die after contracting cholera than well-nourished children, because their immune system is already weakened, and their lack of essential nutrients and fluids means that they become dehydrated faster.
Therefore, addressing childhood malnutrition is key to building resilience against cholera. Humanitarian agencies do this by providing nutrition and therapeutic feeding services for those already suffering from malnutrition, and by providing food and livelihoods support and education to prevent malnutrition in the first place.
For example, in Sudan—where conflict and mass displacement have left millions without reliable access to clean drinking water and food—we’re fighting cholera by improving WASH infrastructure and providing nutrition services to children under 5, as well as pregnant women and nursing mothers.
What can I do to help end cholera?
We know exactly how to eliminate cholera. But we need your help to do it.
To join the fight against cholera and to help us respond to other crises around the world, donate to International Medical Corps today.