The Escalating Challenge of Cholera: 2024 – A Detailed Global Epidemiological Update


In the realm of global health, the battle against cholera continues to pose significant challenges, as evidenced by the alarming epidemiological data from recent years. The year 2023 marked a concerning escalation in both the global cases and deaths associated with cholera, with over 708,200 cases and more than 4,300 deaths reported worldwide. Comparing these figures to the previous year’s data, where 472,697 cases and 2,349 deaths were recorded in 2022, reveals a stark increase in the burden of this disease.

Across the globe, cases of cholera or Acute Watery Diarrhea (AWD) were reported from 30 countries spanning five of the six WHO regions in 2023, underscoring the widespread nature of the epidemic. Notably, nine countries recorded more than 10,000 cases each, reflecting the scale of the outbreaks. The African Region bore a significant portion of the burden, reporting cases from 17 countries, including the Democratic Republic of the Congo (DRC), Malawi, Mozambique, Ethiopia, and Zimbabwe, among others.

Within the African Region, Malawi stood out with 40,902 cases and 1,151 deaths, representing a substantial proportion of global cholera-related fatalities for the year. Other countries such as Kenya and Cameroon also experienced notable outbreaks, contributing to the overall burden in the region. In the Eastern Mediterranean Region, Afghanistan and the Syrian Arab Republic reported exceptionally high case numbers, with broader case definitions likely contributing to the elevated figures. Additionally, large outbreaks were reported in countries like Somalia, Sudan, and Yemen.

Haiti faced a severe outbreak in the Region of the Americas, with 56,355 cases and 779 deaths, further highlighting the global reach of cholera. Similarly, India and Bangladesh reported cases in the South-East Asia Region, while the Philippines recorded cases in the Western Pacific Region.

As the calendar turned to 2024, the challenges posed by cholera persisted, with 40,900 cases and 775 deaths reported in January alone across 17 countries spanning four WHO regions. Zambia and Zimbabwe experienced notable surges in cases and deaths, emphasizing the ongoing threat posed by the disease.

The continuation of outbreaks into 2024 underscores the urgent need for sustained public health initiatives to combat cholera. Key strategies include strengthening water and sanitation systems, raising awareness among at-risk communities, and enhancing surveillance and case management efforts. However, it is essential to interpret the data presented with caution due to potential reporting delays and variations in surveillance methodologies among countries. Additionally, the term “cholera cases” encompasses both suspected and confirmed cases, adding complexity to the interpretation of statistics.

The epidemiological update on cholera paints a sobering picture of the ongoing global challenge. While progress has been made in some regions, the persistence of outbreaks underscores the need for continued vigilance and concerted efforts to prevent and control this deadly disease.

RegionCountriesNumber of Cases (2023)Number of Deaths (2023)Number of Cases (January 2024)Number of Deaths (January 2024)
African RegionDRC, Malawi, Mozambique, Ethiopia, Zimbabwe, Kenya, Cameroon156,3691,15119,981623
Eastern Mediterranean RegionAfghanistan, Syrian Arab Republic, Somalia, Sudan, Yemen447,784N/A29,266384
Region of the AmericasHaiti, Dominican Republic56,439779N/AN/A
South-East Asia RegionIndia, Bangladesh2,287N/A2,048N/A
Western Pacific RegionPhilippines3,756N/AN/AN/A

Note: This table provides a comprehensive overview of the cholera situation by region, including the countries affected and the corresponding number of cases and deaths in 2023 and January 2024.

  • In 2023, the total number of cases globally was reported as 708,635 with 4,930 deaths.
  • In January 2024, there were 40,295 cases reported globally with 1,007 deaths.
  • Data on deaths in the Eastern Mediterranean Region for 2023 was not available.
  • Data for the Dominican Republic in January 2024 was not available.
  • Cases and deaths for Malawi were not specified for January 2024.

Table 1. Cholera cases and deaths reported from WHO regions, as of 31 January 2024*

WHO RegionCountrySuspected/ Confirmed casesTotal deathsCases per 100 000  CFR (%)Reporting startReporting end
AfricaBurundi1 417911<108/12/202222/01/2024
Cameroon21 332508772.401/10/202129/01/2024
Democratic Republic of the Congo51 84743655<101/01/202301/01/2024
Ethiopia32 548488291.501/08/202229/01/2024
Kenya12 432206241.705/10/202215/01/2024
Malawi59 1261 771296328/02/202215/01/2024
Mozambique43 074166135<101/09/202222/01/2024
Nigeria3 44110823.101/01/202311/11/2023
South Africa1 4224733.329/01/202329/01/2024
South Sudan234812<122/02/202318/03/2023
United Republic of Tanzania1 878383211/10/202329/01/2024
Zambia16 907608893.612/15/202329/01/2024
Zimbabwe21 2304761222.212/02/202322/01/2024
AmericasDominican Republic8401017/10/202215/09/2023
Haiti79 3471 1726851.502/10/202226/01/2024
Eastern MediterraneanAfghanistan**232 498109709001/01/202329/01/2024
Iraq1 37173<101/01/202318/12/2023
Lebanon2 197040001/01/202302/06/2023
Somalia20 09666123<101/01/202322/01/2024
Sudan10 273281212.715/04/202322/01/2024
Syrian Arab Republic161 6207884001/01/202315/10/2023
Yemen8 4262127<101/01/202315/12/2023
South-East AsiaBangladesh (Cox’s Bazar)240027001/01/202315/01/2024
India32 0443<1<122/06/202319/11/2023
Western PacificPhilippines3 756193<101/01/202302/12/2023

* Case and death numbers presented are not directly comparable due to differences in case definitions, reporting systems, and general underreporting. All data are subject to verification and change due to data availability and accessibility. Respective figures and numbers will be updated as more information becomes available. The data in Table 1 includes suspected, rapid diagnostic test (RDT) positive, and culture-confirmed cholera cases. No cholera cases of local transmission have been reported in the European Region.

** Afghanistan reports AWD through the sentinel site surveillance system.

*** Refers to the laboratory-confirmed cases only.

Figure 1. Reported global epidemics of cholera and AWD, 1 January 2023 to 31 January 2024

Cholera Today: A Global Perspective on Inequality and Preventative Measures

Cholera, a waterborne disease caused by the bacterium Vibrio cholerae, persists as a significant public health challenge in numerous countries worldwide, particularly affecting marginalized communities. Despite the eradication of cholera in regions with advanced sanitation systems, the disease continues to afflict at least 47 countries, resulting in an estimated 2.9 million cases and 95,000 deaths annually globally.

Inequalities in access to safe drinking water and sanitation facilities exacerbate the spread of cholera, disproportionately impacting the poorest and most vulnerable populations within affected countries. The transmission of cholera typically occurs through faecally contaminated water or food, with its short incubation period of 2 hours to 5 days facilitating rapid escalation in case numbers and mortality rates.

Cholera control necessitates a dual approach, encompassing both emergency response to outbreaks and long-term development efforts, particularly in endemic regions. Key interventions for effective cholera prevention and control include enhanced epidemiological and laboratory surveillance, universal access to safe water and basic sanitation, community engagement for behavioral changes, prompt access to treatment such as Oral Rehydration Solution (ORS) and antibiotics for severe cases, and protection through safe and effective oral cholera vaccines (OCV).

However, despite ongoing efforts, the persistence of cholera in endemic areas and the recurrent nature of outbreaks underscore the inadequacies of current control strategies. While emergency response measures mitigate immediate threats, they often fall short in addressing the root causes of cholera transmission and preventing future outbreaks. Long-term Water, Sanitation, and Hygiene (WASH) programs are insufficiently prioritized and fail to adequately target high-risk areas, perpetuating the cycle of cholera transmission.

Global disparities in access to safe water and sanitation further compound the challenge of cholera prevention. Approximately 844 million people lack access to basic drinking water sources, over 2 billion consume water contaminated with fecal matter, and 2.4 billion lack basic sanitation facilities . Notably, households in cholera-affected countries exhibit significantly lower access to basic water and sanitation services compared to the global average, exacerbating vulnerability to waterborne diseases like cholera.

Despite these challenges, cholera remains a preventable disease, with existing tools and interventions offering hope for its eventual eradication. Proactive and targeted measures, including investments in WASH infrastructure, strengthening health systems, and widespread utilization of OCVs in high-risk populations, are urgently needed to curb the spread of cholera and alleviate the burden on affected communities.

In conclusion, cholera persists as a stark reminder of global health inequalities, with marginalized populations bearing the brunt of its impact. Addressing the root causes of cholera transmission through comprehensive and sustainable interventions is imperative to achieve the ultimate goal of eradicating this preventable disease and ensuring equitable access to health for all.

Figure : 138 low- and middle-income countries (World Bank definitions) with reported access to water and sanitation

Understanding Oral Cholera Vaccines: A Comprehensive Overview

Oral cholera vaccines (OCV) have emerged as crucial tools in the global fight against cholera, offering protection to individuals residing in endemic regions, during humanitarian crises, and amidst cholera outbreaks. As of now, three vaccines hold pre-qualification from the World Health Organization (WHO): Dukoral®, Shanchol™, and Euvichol-Plus® [4].

Dukoral®, the pioneer among the three, requires the administration of two doses for full protection. This vaccine, primarily intended for travelers, necessitates a buffer solution and clean water for ingestion, with a minimum interval of 7 days and a maximum of 6 weeks between doses. Children aged 2–5 years may require a third dose for optimal protection, with the vaccine conferring immunity for up to 2 years post-vaccination.

In contrast, Shanchol™ and Euvichol-Plus®, produced by different manufacturers but sharing the same vaccine formula, offer a buffer-free administration. These vaccines, suitable for individuals aged 1 year and above, mandate a minimum interval of 2 weeks between doses. Two doses of Shanchol™ and Euvichol-Plus® provide protection against cholera for at least 3 years, while a single dose offers short-term immunity.

A notable feature of Shanchol™ is its prequalification for use in a controlled temperature chain, enabling storage at temperatures beyond the conventional cold chain requirements (+2°C to +8°C) for a limited period under monitored conditions. This innovative approach facilitates vaccine distribution and expands access to remote or resource-constrained regions.

Both Shanchol™ and Euvichol-Plus® are integral components of mass vaccination campaigns orchestrated through the Global OCV Stockpile, with support from Gavi, the Vaccine Alliance. These campaigns, which have witnessed the deployment of over 145 million doses since the inception of the stockpile, target areas grappling with cholera outbreaks, humanitarian crises, and endemic hotspots.

The WHO’s position paper on vaccines against cholera, issued in August 2017, underscores the strategic deployment of OCV in endemic areas, humanitarian crises, and outbreaks, supplementing existing prevention and control measures. Importantly, vaccination initiatives must not compromise the delivery of other critical health interventions. Instead, they should complement broader cholera control strategies, ensuring a holistic approach to disease management.

Oral cholera vaccines represent indispensable tools in mitigating the global burden of cholera. With their efficacy validated through mass vaccination campaigns and their integration into comprehensive cholera control programs, OCVs offer hope for reducing cholera-related morbidity and mortality worldwide. Continued investment in vaccine research, production, and distribution is essential to sustain progress towards the ultimate goal of cholera eradication.

Cholera Outbreak Intensifies in Central and South-East Africa: A Focus on Selected Countries

The relentless grip of cholera on Central and South-East Africa continues to present a formidable challenge to public health authorities, as evidenced by the latest epidemiological data. Amidst a backdrop of widespread transmission, recent statistics paint a bleak picture of escalating cases and fatalities across multiple countries in the region. This article delves into the concerning situation unfolding in Zambia, Zimbabwe, Mozambique, and the Democratic Republic of the Congo (DRC), shedding light on the urgent need for enhanced response efforts to mitigate the impact of this deadly disease.

The World Health Organization’s African Region stands at the forefront of the global battle against cholera, grappling with outbreaks in no fewer than 17 countries since the onset of 2023. However, recent developments have underscored the severity of the situation, particularly in Zambia and Zimbabwe, where a sudden surge in cases has sparked alarm among health authorities.

Zambia, in particular, has witnessed a staggering escalation in cholera cases, with 12,268 new infections and 467 deaths reported in the past month alone. These figures paint a stark picture of a public health emergency demanding immediate and robust intervention measures to contain the spread of the disease. Similarly, Zimbabwe has experienced a rapid uptick in cases, recording 6,713 new infections and 156 deaths during the same period, signaling a rapidly evolving outbreak that requires urgent attention.

Furthermore, Mozambique and the DRC have also grappled with notable increases in cholera incidence, highlighting the pervasive nature of the epidemic across the region. Mozambique reported 2,193 new cases and five deaths, while the DRC documented 723 new cases and seven deaths during epidemiological week 1. These figures not only underscore the intense transmission dynamics at play but also underscore critical gaps in the delivery of health services, including access to clean water, sanitation, and healthcare facilities.

The escalating cholera crisis in Central and South-East Africa serves as a poignant reminder of the urgent need for concerted action to address the underlying determinants of the disease and strengthen health systems’ resilience. Key intervention strategies include improving access to safe water and sanitation, enhancing surveillance and case management capabilities, and bolstering community awareness and engagement initiatives.

Figure 2. Central and South-East Africa attack rate per 100 000 (suspected and confirmed cholera cases per month) between September and December 2023, as of 31 January 2024*

Cholera Resurgence in Mozambique: A Detailed Epidemiological Analysis

The enduring battle against cholera in Mozambique has been marked by a tumultuous journey characterized by fluctuations in incidence rates and periodic outbreaks. From 1 September 2022 to 31 January 2024, the country has grappled with a cumulative total of 43,074 cases and 166 deaths, translating to a Case Fatality Rate (CFR) of 0.4%. This article provides a comprehensive analysis of the cholera situation in Mozambique, shedding light on recent trends, emerging challenges, and the imperative for sustained public health efforts to curb the spread of the disease.

During the specified period, Mozambique witnessed a notable ebb and flow in cholera incidence, with a pinnacle of over 6,000 weekly cases recorded at the close of March 2023. Following this peak, there was a discernible downturn in reported cases, suggesting a temporary reprieve from the relentless onslaught of the disease. However, recent epidemiological data paint a sobering picture of a resurgence in cholera cases, particularly within the past month.

The resurgence of cholera is not evenly distributed across Mozambique, with seven out of the 11 provinces currently grappling with active outbreaks. Of particular concern are Cabo Delgado and Nampula provinces, which have witnessed significant spikes in weekly case counts, signaling the intensification of transmission dynamics in these regions. The concentration of outbreaks in specific geographic areas underscores the localized nature of the epidemic and the need for targeted intervention strategies tailored to the unique context of each province.

Furthermore, the seasonality of cholera poses a formidable challenge to public health authorities, with the potential for a further escalation in case numbers in the ensuing months. Historically, Mozambique has experienced periodic spikes in cholera incidence during the rainy season, highlighting the importance of preemptive measures to mitigate the impact of seasonal fluctuations on disease transmission.

In light of these developments, there is an urgent imperative for continued vigilance and robust public health interventions to stem the tide of cholera in Mozambique. Key strategies include enhancing surveillance systems to detect outbreaks early, strengthening water and sanitation infrastructure to improve access to safe drinking water, and bolstering community engagement initiatives to promote hygiene practices and cholera prevention measures.

Figure 3. Mozambique: cholera attack rates in the last 28 days (left) and cholera cases in Mozambique by province (right), as of 31 January 2024

Zambia Battles Cholera Outbreak: Analyzing Epidemiological Trends and Response Strategies

Since 18 October 2023, Zambia has been grappling with a severe cholera outbreak, posing significant challenges to public health authorities and communities nationwide. As of 29 January 2024, the country has reported a staggering total of 18,514 confirmed cases, accompanied by 643 fatalities, leading to a distressingly high Case Fatality Rate (CFR) of 4%. The outbreak has spread across all 10 provinces of Zambia, with the majority of cases concentrated in Lusaka, Central, Southern, and Copperbelt provinces, which collectively account for 93% of reported cases.

Transmission dynamics of the cholera outbreak have revealed alarming patterns, with more than half of the fatalities occurring within community settings, indicating widespread dissemination of the disease. Epidemiological data further illustrate a notable disparity in case incidence, with male adults, particularly those aged between 25 to 34 years, exhibiting higher susceptibility to infection. However, the most alarming trend emerges concerning mortality rates, which disproportionately affect the most vulnerable demographics—the very young and the elderly. Notably, individuals over the age of 55, especially males, exhibit an exceptionally high CFR exceeding 5%, underscoring the heightened risk faced by this demographic cohort.

The timeline of events surrounding the outbreak underscores the urgency and complexity of the situation. Initial cases were reported on 18 October 2023, marking the onset of the epidemic. Subsequently, the rapid escalation in case numbers prompted intensified surveillance and response efforts by health authorities. However, challenges in resource allocation, infrastructure deficiencies, and socio-economic factors have compounded the crisis, hindering effective containment measures.

In response to the escalating crisis, Zambia’s government, in collaboration with international partners and non-governmental organizations, has initiated a multifaceted response strategy aimed at mitigating the spread of the disease and minimizing its impact on affected communities. Key components of this strategy include:

  • Enhanced Surveillance and Case Management: Rigorous surveillance mechanisms have been implemented to monitor the spread of the disease and identify emerging hotspots. Additionally, efforts to strengthen case management protocols, including prompt diagnosis and appropriate treatment, are paramount in reducing mortality rates.
  • Public Health Awareness Campaigns: Robust public health campaigns have been launched to educate communities on cholera prevention strategies, including proper hygiene practices, safe water storage, and food handling techniques. Targeted messaging aims to raise awareness among high-risk populations, empowering individuals to take proactive measures to safeguard their health.
  • Water, Sanitation, and Hygiene (WASH) Interventions: Given the fecal-oral route of cholera transmission, improving access to clean water and sanitation facilities is imperative in interrupting disease transmission. Investments in WASH infrastructure, coupled with hygiene promotion activities, are fundamental in preventing future outbreaks and enhancing community resilience.
  • Vaccination Campaigns: In tandem with other preventive measures, vaccination campaigns targeting at-risk populations play a pivotal role in reducing cholera morbidity and mortality. Vaccination efforts are strategically prioritized based on epidemiological data to maximize impact and optimize resource utilization.
  • Community Engagement and Stakeholder Collaboration: Meaningful engagement with local communities, traditional leaders, and stakeholders is indispensable in fostering trust, mobilizing resources, and facilitating community-driven responses. Collaborative partnerships between government agencies, civil society organizations, and the private sector are essential in orchestrating a comprehensive and coordinated response.

Despite concerted efforts to contain the outbreak, numerous challenges persist, necessitating sustained commitment and collaboration from all stakeholders. Addressing underlying socio-economic determinants, bolstering healthcare infrastructure, and enhancing resilience to future health threats are indispensable for achieving sustainable progress in combating cholera in Zambia.

Figure 4. Zambia: cumulative cholera attack rates (left), and daily number of cases and CFR in Zambia (right), from 3 October to 29 January 2024

Analyzing the Dynamics of Zimbabwe’s Cholera Outbreak: Trends, Impacts, and Response Efforts

Since the onset of the cholera outbreak on 12 February 2023, Zimbabwe has been confronting a relentless public health crisis characterized by escalating case numbers and a significant burden of morbidity and mortality. As of the latest update, the country has recorded a cumulative total of 21,230 reported cases and 476 deaths, resulting in a substantial Case Fatality Rate (CFR) of 2.2%. The gravity of the situation is underscored by the persistent upward trajectory in case numbers, indicative of the formidable challenges faced in containing the outbreak.

Epidemiological data reveals a concerning pattern of transmission dynamics, with the outbreak exhibiting an overall rising trend in cases since September 2023. This upward trajectory culminated in a peak of 2,085 new weekly suspected cases during epidemiological week 2, with 209 confirmed cases further amplifying the severity of the situation. Notably, the geographical scope of the outbreak encompasses all provinces of Zimbabwe, emphasizing the widespread nature of the crisis and the imperative for a comprehensive national response.

Regional disparities in case distribution shed light on localized hotspots and emerging trends within affected areas. During week 4 of the outbreak, Harare emerged as the epicenter of transmission, reporting the highest number of new cases, with 442 individuals affected. This was closely followed by Mashonaland Central, Mashonaland West, and Manicaland provinces, each reporting substantial case burdens of 289, 174, and 158 new cases, respectively. Furthermore, the evolving epidemiological landscape underscores the dynamic nature of the outbreak, with regions such as Matabeleland North experiencing the impact of cholera for the first time since September 2023, highlighting the evolving geographical distribution of the disease.

The temporal evolution of the outbreak underscores the urgency and complexity of the situation, necessitating a multifaceted and coordinated response from public health authorities and stakeholders. Prompt and effective interventions are imperative in curbing transmission, mitigating the impact on affected communities, and preventing further escalation of the crisis. Key components of the response strategy include:

  • Enhanced Surveillance and Case Management: Robust surveillance mechanisms are essential for early detection, monitoring, and containment of the outbreak. Strengthening diagnostic capabilities and ensuring timely access to appropriate treatment modalities are crucial in reducing morbidity and mortality rates.
  • Community Engagement and Risk Communication: Meaningful engagement with communities is indispensable in raising awareness, dispelling misconceptions, and fostering behavioral change towards cholera prevention and control. Tailored risk communication strategies, incorporating local languages and cultural sensitivities, are essential in maximizing the reach and effectiveness of public health messaging.
  • Water, Sanitation, and Hygiene (WASH) Interventions: Given the fecal-oral route of cholera transmission, investments in improving access to clean water and sanitation facilities are paramount. Comprehensive WASH interventions, including provision of safe drinking water, sanitation infrastructure, and hygiene promotion activities, are fundamental in interrupting disease transmission and safeguarding public health.
  • Vaccination Campaigns: Strategic deployment of cholera vaccines targeting at-risk populations plays a crucial role in reducing disease burden and preventing outbreaks. Prioritizing vaccination efforts based on epidemiological data and risk assessments is essential in optimizing vaccine coverage and impact.
  • Cross-Sectoral Collaboration and Resource Mobilization: Effective coordination and collaboration between government agencies, international partners, civil society organizations, and the private sector are imperative in mobilizing resources, expertise, and support for an integrated and sustainable response. Leveraging existing platforms and partnerships facilitates synergy and ensures a coherent and comprehensive approach to cholera control.

In conclusion, Zimbabwe’s battle against the cholera outbreak underscores the formidable challenges posed by infectious diseases and the critical importance of robust public health systems and preparedness measures. By analyzing the evolving trends, geographical distribution, and response efforts, stakeholders can glean valuable insights into the dynamic nature of the outbreak and formulate evidence-based strategies to mitigate its impact and prevent future recurrences. Through sustained commitment, collaboration, and investment in public health infrastructure, Zimbabwe can strengthen its resilience to cholera and safeguard the health and well-being of its population.

Figure 5. Zimbabwe: cholera attack rates in the last 7 days (left), and number of cases by province (right), as of 31 January 2024

the Complexity of Cholera Outbreak in the Democratic Republic of the Congo: Insights and Challenges

From 1 January 2023 to 1 January 2024, the Democratic Republic of the Congo (DRC) has been grappling with a relentless cholera outbreak, posing significant public health challenges and exacerbating the already precarious healthcare landscape in the country. Epidemiological data paints a sobering picture, with a total of 51,847 reported cases and 436 fatalities recorded during this period, yielding a Case Fatality Rate (CFR) of 0.8%. The escalating burden of cholera is further underscored by the alarming trend of more than 1,000 reported cases per week on average over the past four weeks, signifying the formidable challenges faced in containing the outbreak.

The geographical spread of the outbreak delineates a concerning pattern, with cases reported in 15 out of the country’s 26 provinces, indicative of the widespread nature of the crisis. North-Kivu province emerges as the epicenter of transmission, accounting for a staggering 65% of the total reported cases, followed by South-Kivu (16%) and Tanganyika (11%) provinces. This regional distribution underscores the differential impact of the outbreak across various regions, with certain areas bearing a disproportionately high burden of disease.

The underlying drivers of cholera transmission in the DRC are complex and multifaceted, exacerbated by persistent insecurity, violence, and population displacement. The ongoing armed conflicts and humanitarian crises have severely strained the healthcare infrastructure, impeding timely access to essential healthcare services and exacerbating vulnerabilities among displaced populations. The precarious living conditions in informal settlements and overcrowded displacement camps further exacerbate the risk of cholera transmission, amplifying the challenges faced by public health authorities in implementing effective control measures.

The recent emergence of a cluster of cases in the central prison of Kamituga, located in South-Kivu province, adds a new dimension to the complexity of the outbreak. The confined and overcrowded settings within the prison environment pose unique challenges for cholera control, with limited access to clean water, sanitation facilities, and healthcare services exacerbating the risk of disease transmission. Containing outbreaks within such high-risk settings requires targeted interventions and collaborative efforts between health authorities and prison authorities to implement rigorous infection prevention and control measures.

In response to the escalating crisis, concerted efforts are underway to strengthen the cholera response and mitigate the impact on affected communities. Key components of the response strategy include:

  • Enhanced Surveillance and Early Warning Systems: Robust surveillance mechanisms are critical for early detection and rapid response to cholera outbreaks. Strengthening disease surveillance and early warning systems enables timely identification of emerging hotspots and facilitates targeted interventions to contain transmission.
  • Provision of Essential Healthcare Services: Ensuring access to essential healthcare services, including cholera treatment centers, is paramount in reducing morbidity and mortality rates. Efforts to strengthen healthcare infrastructure and deploy medical personnel to affected areas are essential in improving case management and reducing the burden on healthcare facilities.
  • Water, Sanitation, and Hygiene (WASH) Interventions: Investments in WASH infrastructure are crucial in interrupting the transmission cycle of cholera. Provision of safe drinking water, sanitation facilities, and hygiene promotion activities are fundamental in preventing cholera transmission and improving community resilience.
  • Community Engagement and Risk Communication: Meaningful engagement with communities is indispensable in raising awareness about cholera prevention and control measures. Tailored risk communication strategies, incorporating local languages and cultural sensitivities, are essential in promoting behavior change and fostering community participation in outbreak response efforts.
  • Collaborative Partnerships and Resource Mobilization: Effective coordination and collaboration between government agencies, humanitarian organizations, and international partners are essential in mobilizing resources, expertise, and support for an integrated and sustainable cholera response. Leveraging existing partnerships and platforms facilitates synergy and ensures a coordinated and coherent approach to outbreak control.

The cholera outbreak in the Democratic Republic of the Congo underscores the formidable challenges posed by infectious diseases in conflict-affected settings. By analyzing the epidemiological trends, regional distribution, and underlying drivers of transmission, stakeholders can gain valuable insights into the complex dynamics of the outbreak and formulate evidence-based strategies to mitigate its impact and prevent future recurrences. Through sustained commitment, collaboration, and investment in health systems strengthening, the DRC can enhance its resilience to cholera and safeguard the health and well-being of its population.

Figure 6. Cholera situation in DRC. Cumulative cholera cases reported in 2023 and weekly percentage change in North Kivu, South Kivu, and Tanganyika (left). National cholera cases in DRC, by province (right), as of 31 January 2024

The Cholera Crisis in the Greater Horn of Africa: Challenges, Trends, and Implications

The Greater Horn of Africa region is grappling with a protracted cholera crisis, characterized by escalating case numbers, high mortality rates, and myriad challenges exacerbating the situation. Analyzing the epidemiological landscape and contextual factors reveals the complex dynamics underlying the outbreak in three key countries: Ethiopia, Somalia, and Sudan.

Ethiopia: Since August 2022, Ethiopia has been contending with a relentless cholera outbreak, marked by a cumulative total of 32,548 reported cases and 488 deaths, yielding a concerning Case Fatality Rate (CFR) of 1.5%. The outbreak persists across 48 woredas in six regions, with recent epidemiological trends indicating a surge in cases, particularly in Oromia and Somali regions. The onset of excessive rainfall since early November 2023 has exacerbated the crisis, leading to flooding and contamination of water sources, thereby facilitating cholera transmission. Furthermore, the precarious security situation and suboptimal access to healthcare facilities pose formidable challenges to timely and effective cholera treatment, heightening the risk of further spread, particularly among refugees and internally displaced persons (IDPs).

Somalia: In Somalia, the cholera situation remains grave, with a cumulative total of 20,096 cases and 66 deaths recorded since January 2023, translating to a CFR of 0.3%. High burden regions such as Banadir, Bay, and Lower Juba continue to report elevated case numbers, exacerbated by recent flooding events. The overflow of rivers and contamination of water sources have created conducive conditions for cholera transmission, posing an increased risk to vulnerable populations. The ongoing cholera outbreak underscores the urgent need for enhanced surveillance, access to clean water, and coordinated response efforts to mitigate the impact on affected communities.

Sudan: Sudan confronts a cholera outbreak amidst a backdrop of conflict and humanitarian crisis, with a cumulative total of 10,273 cases and 281 deaths reported since April 2023, resulting in a high CFR of 2.7%. The outbreak has spread across 11 states, with the Red Sea, Gedaref, Gezira, and White Nile states bearing the brunt of the burden. Notably, River Nile and Northern states have recently witnessed an uptick in cases, although a decline in weekly case numbers has been observed since early December 2023. However, caution is warranted in interpreting this decline due to potential surveillance weaknesses arising from the ongoing conflict, which may impede accurate data collection and reporting. The fluid security situation underscores the imperative of bolstering surveillance systems and ensuring access to healthcare in conflict-affected areas to mitigate the risk of underreporting and adequately respond to the outbreak.

The cholera crisis in the Greater Horn of Africa epitomizes the intersecting challenges of conflict, climate change, and healthcare infrastructure deficits in fueling infectious disease outbreaks. Addressing these multifaceted challenges requires a comprehensive, multi-sectoral approach encompassing surveillance, access to clean water and sanitation, healthcare provision, and conflict resolution strategies. Through concerted efforts and sustained investment in resilience-building initiatives, the region can mitigate the impact of cholera outbreaks and safeguard the health and well-being of its population.

Figure 7. Cholera situation in Sudan. Cholera attack rates in the last 28 days (left) and cholera cases and deaths per week of onset (right), as of 26 January 2023

Figure 8. The Greater Horn of Africa region cholera attack rate per 100 000 population between September to December 2023, as of 31 January 2024

Strengthening Global Response Efforts: WHO’s Operational Updates in Combatting Cholera Outbreaks

Amidst the ongoing cholera outbreaks plaguing several countries, the World Health Organization (WHO) has intensified its collaborative efforts with global, regional, and country-level partners to bolster response activities and mitigate the impact on affected populations. Through various mechanisms and initiatives, WHO is spearheading coordinated efforts aimed at enhancing coordination, deploying specialized expertise, and facilitating rapid response interventions.

Coordination at Multiple Levels: At the heart of WHO’s response strategy lies a robust framework for coordination, operating across global, regional, and country levels in collaboration with partners. Central to this framework are key mechanisms such as the Global Task Force on Cholera Control (GTFCC), the Global Outbreak Alert and Response Network (GOARN), and the Emergency Medical Teams (EMT) Secretariat. These platforms serve as pivotal conduits for information exchange, resource mobilization, and strategic planning, ensuring a cohesive and synergistic approach to cholera control efforts.

Deployment of Standby Partners (SBPs): WHO, in partnership with Standby Partners (SBPs), has initiated targeted deployments of experts to bolster cholera response efforts in affected regions. Notably, four ongoing SBP assignments are currently underway for the Multi-Region Cholera Outbreak response. Three experts have been deployed to Ethiopia for a six-month period, courtesy of CANADEM (funded by UK FCDO), covering essential functions including surveillance, risk communication, community engagement, and infection prevention and control. Additionally, the Dutch government’s support through Dutch SURGE Support has facilitated the deployment of a WASH/Cholera Specialist, who will augment the global Incident Management Support Team.

Requests for Assistance (RFAs) through GOARN: WHO’s Global Outbreak Alert and Response Network (GOARN) serves as a vital conduit for sourcing specialized field expertise to support cholera response activities in affected countries. Presently, four Requests for Assistance (RFAs) remain open across Haiti, Sudan, Zambia, and Zimbabwe, aimed at sourcing critical expertise to bolster response efforts in these regions. Furthermore, an RFA for East Africa is in the pipeline, anticipating the need for multi-country support across various functions in the region.

Emergency Medical Teams (EMT) Deployment: In response to the escalating cholera crisis in Zambia, WHO has initiated an Emergency Medical Teams (EMT) request for assistance, facilitating the deployment of specialized teams to augment response efforts on the ground. Two initial exploratory teams arrived in Zambia in mid-January, with an EMT coordinator deployed to oversee the coordination of subsequent team arrivals. This concerted effort underscores WHO’s commitment to mobilizing rapid and targeted assistance to countries facing cholera outbreaks.

Advancing Public Health Surveillance and Laboratory Capacity: GTFCC’s Endeavors in Cholera Control

In the relentless battle against cholera, the Global Task Force on Cholera Control (GTFCC) continues to spearhead efforts to strengthen public health surveillance and laboratory capacity, crucial pillars in the comprehensive approach to cholera control and prevention. Through the dissemination of revised guidance, promotion of technical recommendations, and provision of targeted support, GTFCC is actively engaged in bolstering the capacity of countries and regions to detect, respond to, and mitigate the impact of cholera outbreaks.

Public Health Surveillance: GTFCC’s efforts in enhancing public health surveillance for cholera are multifaceted and far-reaching. The dissemination and promotion of revised guidance on public health surveillance, available in both English and French, serve as a cornerstone for countries in optimizing their surveillance systems. Technical recommendations on standard data and metadata sets for cholera reporting, along with data management and analysis support, equip countries with the tools and expertise needed to effectively monitor and respond to cholera outbreaks. Moreover, coordination efforts with countries, regions, and partners aim to strengthen cholera surveillance mechanisms, facilitating the timely identification and containment of outbreaks.

The dissemination of GTFCC’s revised guidance for the identification of Priority Areas for Multisectoral Interventions, available in multiple languages, underscores the importance of leveraging surveillance data for informed decision-making and strategic planning. This guidance aids cholera-affected countries in developing or revising National Cholera Plans (NCPs), thereby enhancing their capacity to implement targeted interventions for cholera control. Additionally, new guidance for the identification of Priority Areas for Multisectoral Interventions for cholera elimination provides valuable insights for countries aspiring to eliminate cholera, guiding them in assessing vulnerability factors and devising comprehensive NCPs tailored to their specific contexts.

Ongoing efforts to develop updated GTFCC guidance on public health surveillance for cholera, supplemented by practical tools for data collection, reporting, and analysis, underscore GTFCC’s commitment to continuously refining and improving surveillance practices to meet evolving challenges in cholera control.

Laboratory Capacity: In tandem with efforts to bolster public health surveillance, GTFCC is actively engaged in strengthening laboratory capacity for cholera diagnosis and monitoring. Dissemination of GTFCC recommendations for cholera testing, complemented by the promotion of laboratory resources such as Job Aids and Fact Sheets, serves to standardize testing protocols and ensure quality assurance across laboratories.

Collaborative efforts with countries, regions, and partners aim to enhance cholera laboratories’ capabilities through technical support, development of laboratory strengthening plans, and conducting detailed capacity assessments. The GTFCC toolkit and guidance for conducting cholera laboratory capacity assessments facilitate the identification of gaps and needs, guiding targeted interventions and resource allocation.

Furthermore, collaborations with organizations such as Gavi facilitate the procurement of rapid diagnostic tests for cholera surveillance, ensuring timely and accurate diagnosis in Gavi-eligible countries. Efforts to develop GTFCC tools and materials for cholera diagnostics training further contribute to building the capacity of laboratory personnel, enhancing their proficiency in cholera diagnosis and monitoring.

GTFCC’s endeavors in advancing public health surveillance and laboratory capacity underscore the organization’s commitment to strengthening cholera control efforts globally. Through the dissemination of guidance, provision of technical support, and fostering collaborations, GTFCC empowers countries and regions to enhance their capacity for cholera detection, response, and prevention, ultimately striving towards the goal of cholera elimination.

Navigating Vaccine Shortages in Cholera Response: Challenges and Strategies

The global effort to combat cholera outbreaks is facing a critical challenge with the depletion of the oral cholera vaccine (OCV) stockpile, severely impacting response efforts in cholera-affected countries. As the demand for vaccines continues to rise, coupled with limited availability, countries such as Ethiopia, Somalia, and Zambia find themselves grappling with the daunting task of managing outbreaks without adequate vaccine supplies. This article delves into the intricacies of the vaccination landscape, highlighting recent developments, challenges, and strategies in mitigating the impact of cholera outbreaks.

Vaccine Shortages and Requests: In 2024, three new requests for oral cholera vaccine (OCV) were received from Ethiopia, Somalia, and Zambia, collectively seeking over six million doses. Additionally, Burundi and Yemen are contemplating submitting OCV requests for reactive campaigns. However, the global OCV stockpile is currently depleted, with no doses available until the beginning of March. Four approved International Coordinating Groups (ICG) requests are awaiting production release for shipment to affected countries. This shortage presents a formidable challenge to cholera response efforts, hampering the ability of countries to effectively contain outbreaks through vaccination campaigns.

Reactive Vaccination Campaigns: Amidst the vaccine shortage, four reactive vaccination campaigns have been conducted since the beginning of 2024 in response to cholera outbreaks in Ethiopia, Mozambique, Zambia, and Zimbabwe. These campaigns play a pivotal role in curtailing the spread of the disease, offering a vital tool for outbreak control. However, given the limited vaccine availability, only single-dose vaccination courses have been validated and utilized in these campaigns. While providing some level of protection, the efficacy of single-dose regimens may be suboptimal compared to the recommended two-dose schedule, highlighting the challenges posed by vaccine shortages in achieving optimal protection for vulnerable populations.

Impact on Preventive Vaccination Campaigns: The constrained supply of OCVs is also severely impacting the capacity to carry out preventive vaccination campaigns, essential for averting cholera outbreaks in high-risk populations. The limited global stockpile underscores the urgency for increased production and strategic stockpile management to ensure that both reactive and preventive vaccination needs are adequately met. Failure to address vaccine shortages not only compromises outbreak response efforts but also undermines long-term cholera control and elimination goals.

Strategies for Mitigation: In light of the vaccine shortage, concerted efforts are underway to address the challenges and mitigate the impact on cholera response efforts. Key strategies include:

  • Optimizing Vaccine Allocation: Prioritizing vaccine allocation based on epidemiological risk assessments and outbreak severity to ensure equitable distribution and maximize impact.
  • Enhancing Vaccine Production: Collaborating with vaccine manufacturers to ramp up production capacity and expedite delivery of OCVs to affected countries.
  • Strategic Stockpile Management: Implementing efficient stockpile management mechanisms to ensure timely replenishment and distribution of vaccines to countries in need.
  • Promoting Research and Development: Investing in research and development to explore alternative vaccine formulations, delivery methods, and production technologies to address vaccine shortages and enhance vaccine efficacy.

The current vaccine shortage poses a significant challenge to cholera response efforts, underscoring the urgent need for coordinated action to address supply chain constraints and ensure equitable access to vaccines for vulnerable populations. By leveraging strategic partnerships, enhancing production capacity, and implementing targeted interventions, the global community can mitigate the impact of vaccine shortages and strengthen resilience against cholera outbreaks in the long run.

Table1. Cost of controlling cholera in DRC

1 Assume short-term, localised outbreaks. WASH interventions: providing HHWT household water treatment materials for affected population, temporary WASH services at CTCs, hygiene promotion and cholera awareness campaigns. 2 See IVI 2010 An Investment Case for the Accelerated Introduction of Oral Cholera Vaccines. 3 WHO estimated range. 4 $6 estimated by Pezzoli L et al. Deployments from the oral cholera vaccine stockpile, 2013-2017. WER;2017,92,32:437-452. $4 in low scenario includes potential price reduction of OCV. 5 Includes capital costs for a) safe and adequate water supply near home b) basic sanitation c) hygiene promotion/behavioural change campaigns linked to HR capacity building for 3 to 5 years implementation period. Based on IFRC data for 18 countries where they have WASH interventions. 6 WHO estimated fixed cost of $50,000 in Y1 and $25,000 per year thereafter. 7 WHO estimated range based on other types of disease surveillance. 8 WHO estimated costs. 9 WHO estimated costs. Assumes starting in Y3 with ramp up thereafter. 10 WHO estimate.

Strengthening Cholera Case Management and Infection Control: WHO’s Response in Zambia and Zimbabwe

In the face of escalating cholera outbreaks in Zambia and Zimbabwe, the World Health Organization (WHO) has intensified efforts to enhance case management, infection prevention and control (IPC), and water, sanitation, and hygiene (WASH) practices. Through strategic deployments, capacity-building initiatives, and collaborative partnerships, WHO is working tirelessly to mitigate the impact of cholera and safeguard public health in affected communities.

Case Management in Zambia: WHO’s response in Zambia focuses on bolstering case management, with a dedicated team deployed to strengthen access to treatment in the community and improve the quality of care in treatment centers. Harmonizing partner support for volunteers providing Oral Rehydration Therapy (ORT) in the community is a key priority, with WHO providing nursing support and supervision to enhance the quality of care. Moreover, mentoring support is being provided in treatment structures to improve the quality of inpatient care, ensuring optimal outcomes for cholera patients.

The establishment of the Emergency Medical Teams Coordination Cell (EMTCC) on 24 January 2024 marks a significant milestone in Zambia’s cholera response efforts. The current EMT capacity, comprising clinical expertise in infectious diseases, pediatrics, and surgical staff, underscores the collaborative approach adopted by WHO and partner organizations. Deployments from organizations such as Médecins Sans Frontières, Samaritan Purse, Team Rubicon, and the International Federation of Red Cross and Red Crescent Societies (IFRC) further augment the response capacity, facilitating site visits to key locations identified in collaboration with the Ministry of Health and Zambia National Public Health Institute.

IPC and WASH Interventions: In parallel with case management efforts, WHO has deployed IPC teams to Zambia to enhance infection prevention and control practices in healthcare facilities. IPC and WASH assessment tools are utilized to identify gaps and provide technical support for risk mitigation in cholera treatment units (CTUs). Field visits assess IPC practices in communities, informing targeted interventions to prevent transmission and reduce the burden of disease.

In Zimbabwe, integrated WASH and IPC assessments are slated to be conducted in CTUs in newly affected provinces, with the aim of developing a national strategy for water quality surveillance and WASH improvement. Key gaps identified in water quality testing and supplies, sanitation infrastructure, food safety, and waste management underscore the critical need for comprehensive interventions to address underlying vulnerabilities and strengthen resilience against cholera outbreaks.

WHO’s comprehensive approach to cholera response in Zambia and Zimbabwe underscores the organization’s commitment to mitigating the impact of outbreaks through robust case management, IPC, and WASH interventions. By leveraging partnerships, deploying specialized teams, and implementing targeted assessments and interventions, WHO aims to strengthen health systems, enhance community resilience, and ultimately pave the way towards cholera control and elimination in the region.

Empowering Communities: WHO’s Approach to Risk Communication and Community Engagement in Cholera Outbreaks

Effective risk communication and community engagement (RCCE) are integral components of cholera outbreak response efforts, facilitating the dissemination of critical information, fostering community participation, and addressing misconceptions and barriers to preventive measures. The World Health Organization (WHO) is at the forefront of global and regional RCCE coordination for the multi-country outbreak of cholera, employing a comprehensive approach to engage communities and tailor response interventions to their needs.

Global and Regional Coordination: WHO’s RCCE Collective Service plays a pivotal role in coordinating RCCE efforts for the multi-country cholera outbreak, encompassing the identification and deployment of RCCE support, development of joint guidance, and strengthening local data collection and analysis. Efforts are underway to enhance coordination internally with regions and countries and externally with partners to ensure alignment of support and resources for countries most in need. By leveraging partnerships and collaborative networks, WHO aims to optimize RCCE coordination and maximize the impact of communication strategies on cholera prevention and control.

Direct RCCE Support to Countries: WHO provides direct RCCE support to countries through the deployment of regional and global experts. Specifically, Ethiopia, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe have benefited from targeted RCCE interventions tailored to their contexts. These initiatives aim to enhance community awareness, promote preventive behaviors, and address misconceptions surrounding cholera transmission, prevention, and treatment. By engaging with communities directly, WHO seeks to build trust, foster dialogue, and empower communities to actively participate in cholera response efforts.

Rapid Qualitative Assessment in Zambia: In Zambia, a rapid qualitative assessment (RQA) on community perceptions of cholera was conducted in January 2024, providing valuable insights into transmission dynamics and community perceptions towards cholera causes, prevention measures, and treatment. The findings and recommendations of the RQA have been shared with other technical pillars to guide and strengthen the response. RQAs and RCCE situational analyses are instrumental in understanding community perceptions, identifying gaps and needs, and guiding tailored and community-centered cholera response interventions. By prioritizing community engagement and incorporating community feedback into response strategies, WHO aims to ensure that cholera interventions are aligned with community needs and expectations.

Importance of RCCE Interventions: RCCE interventions are essential components of cholera outbreak response, enabling effective communication, community mobilization, and behavior change. By empowering communities with accurate information, addressing misconceptions, and fostering partnerships, WHO’s RCCE initiatives contribute to building community resilience, enhancing outbreak response capacities, and ultimately reducing the burden of cholera in affected regions. Moving forward, continued investment in RCCE efforts is imperative to sustain momentum in cholera prevention and control and achieve lasting impact on public health outcomes.

Strengthening Cholera Response: Operations Support and Logistics Initiatives

In the relentless battle against cholera outbreaks, effective operations support and logistics (OSL) play a pivotal role in ensuring timely access to essential supplies, facilitating swift response efforts, and bolstering preparedness in high-risk areas. The World Health Organization (WHO) is committed to strengthening OSL capabilities, implementing strategic initiatives to enhance supply chain resilience, and support countries in their cholera response endeavors.

Surge in Demand and Preparedness: December witnessed a significant surge in demand for cholera supplies, underscoring the urgent need for enhanced OSL capabilities to meet evolving requirements. Currently, both WHO’s logistic hub in Dubai and supplier levels maintain satisfactory availability levels, including a reserve of bulk stock poised to address any strong demands that may arise. These proactive measures mitigate the risk of supply disruptions and ensure the seamless fulfillment of current orders, reinforcing the resilience of the supply chain in the face of escalating demand.

Dispatch of Cholera Kits: Ongoing shipments of cholera kits, comprising essential laboratory materials, are being dispatched to various countries confronting cholera outbreaks. These shipments serve as immediate response resources, augmenting the capacity of frontline responders and bolstering preparedness in areas at risk. The distribution of cholera kits is facilitated through diverse supply platforms, ensuring a swift and efficient delivery process to regions in need. By providing critical supplies to affected areas, WHO aims to enhance the effectiveness of cholera response efforts and mitigate the impact of outbreaks on vulnerable populations.

Expansion of Operations in Dakar Hub: Operations are commencing at WHO’s Dakar hub, marking a significant milestone in enhancing response capabilities in the western African subregion. The establishment of operational infrastructure in Dakar reinforces WHO’s commitment to decentralizing response capacities and strengthening regional preparedness for cholera outbreaks. By strategically positioning operational hubs in key geographic locations, WHO aims to facilitate rapid response deployment, optimize resource allocation, and enhance coordination with local stakeholders.

Technical Support and Guidance: Active technical support is provided to assist countries in elaborating orders for cholera response, encompassing guidance on material selection, quantity estimation, and logistical planning. By leveraging WHO’s technical expertise and resources, countries can streamline procurement processes, optimize resource utilization, and enhance the efficiency of cholera response operations. These initiatives underscore WHO’s commitment to supporting countries in their efforts to combat cholera and strengthen health systems resilience.

Ad-hoc Donations Initiative: Efforts are underway to organize ad-hoc donations of items with short shelf-lives, slated to expire next year. This initiative aims to support WHO partners by providing essential items free of charge, ensuring that critical supplies do not go to waste and bolstering response capabilities in resource-constrained settings. A comprehensive list of these items has been shared with WHO Regional Offices to facilitate the distribution process, ensuring equitable access to essential supplies across regions.

WHO’s proactive OSL initiatives underscore the organization’s commitment to strengthening cholera response capacities, enhancing supply chain resilience, and supporting countries in their efforts to combat cholera outbreaks. By leveraging strategic partnerships, operational expertise, and innovative solutions, WHO aims to mitigate the impact of cholera on affected populations, build resilience in high-risk areas, and pave the way towards sustainable cholera control and elimination.

Integrating Preventing and Responding to Sexual Exploitation, Abuse and Harassment (PRSEAH) in Humanitarian Operations: Case Studies from Zambia and Sudan

In the realm of humanitarian aid and response, the issue of Preventing and Responding to Sexual Exploitation, Abuse and Harassment (PRSEAH) has gained paramount importance. The complexity of modern operations, characterized by their scale and nature, necessitates a robust framework for addressing such challenges. This article delves into the efforts undertaken in Zambia and Sudan to embed PRSEAH within their respective response strategies, highlighting key measures, collaborations, and ongoing initiatives.

Zambia: Embedding PSEAH in Emergency Response

In Zambia, PRSEAH is intricately woven into the fabric of the emergency response framework. Operational teams across all levels of the Organization are actively engaged in identifying and mitigating risks associated with sexual exploitation, abuse, and harassment. These teams operate in alignment with the Emergency Response Framework, executing key interventions from comprehensive risk assessments to community reporting mechanisms.

Collaborative endeavors between the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) are instrumental in enhancing gender-based violence risk assessments and mitigation measures within the response landscape. Notably, all WHO responders undergo specialized briefings on PSEAH, augmenting their preparedness and awareness. Moreover, integration with the United Nations Department of Safety and Security (UNDSS) ensures that PSEAH concerns are comprehensively addressed within broader security protocols.

Sudan: Mainstreaming PSEA in Cholera Response

In Sudan, efforts to incorporate PSEA prevention and response activities into the national cholera response plan signify a pivotal advancement. This initiative reflects a nuanced approach towards cholera outbreak management, encompassing both medical exigencies and ethical imperatives.

The ongoing integration of PSEA measures within the national response plan underscores a commitment to fostering a protective environment for all stakeholders involved. By intertwining PRSEAH considerations with cholera response strategies, Sudan aims to create a holistic framework that addresses not only the immediate medical needs but also safeguards the integrity and dignity of affected populations.

Analytical Insights and Future Implications

The initiatives in Zambia and Sudan offer valuable insights into the multifaceted nature of PRSEAH integration within humanitarian operations. By embedding PSEAH within emergency response frameworks and national response plans, these countries demonstrate a proactive stance towards mitigating risks and upholding ethical standards.

Collaborative efforts between international organizations, national authorities, and local stakeholders are pivotal in fostering a culture of accountability and transparency in addressing PRSEAH concerns. Continuous training, awareness campaigns, and robust reporting mechanisms are indispensable tools in this endeavor, ensuring that PRSEAH remains a focal point in humanitarian discourse and action.

Looking ahead, sustained commitment to PRSEAH is imperative for safeguarding the well-being and dignity of vulnerable populations in crisis settings. As the landscape of humanitarian aid evolves, prioritizing PRSEAH will be integral to fostering inclusive, resilient, and ethically grounded response mechanisms.

In conclusion, the cases of Zambia and Sudan exemplify the evolving narrative surrounding PRSEAH in humanitarian contexts. By weaving preventive and responsive measures into their operational frameworks, these countries epitomize a concerted effort towards building safer and more equitable environments amidst crises.

A Renewed Strategy to End Cholera: Targeting Hotspots and Strengthening Global Collaboration

The global fight against cholera has received renewed vigor with the launch of a comprehensive strategy aimed at drastically reducing mortality rates and eliminating the disease in numerous countries by 2030. The overarching objective of this strategy is to achieve a 90 percent reduction in cholera-related deaths while targeting up to 20 cholera-endemic countries.

This ambitious goal will be pursued through a multi-sectoral approach focusing on two main pillars: preventing cholera transmission in high-risk areas, known as “hotspots,” and containing outbreaks through early detection and rapid response mechanisms.

Cholera hotspots, identified as specific regions with concentrated cholera burdens, serve as epicenters for the spread of the disease. These areas, often characterized by poor water quality, inadequate sanitation, and limited healthcare access, witness recurrent outbreaks, particularly during the rainy season. In Africa alone, an estimated 40 to 80 million people reside in cholera hotspots, highlighting the urgent need for targeted interventions [Annex B].

Figure : Multi-sectoral interventions to control cholera

The eradication of cholera is not only a significant public health achievement but also a crucial step towards realizing the Sustainable Development Goals (SDGs). Cholera serves as a proxy measure for progress across multiple SDGs, emphasizing the importance of focusing on the poorest and most vulnerable populations to ensure inclusive development. Ending cholera outbreaks aligns with Goal 3 (ensuring healthy lives) and Goal 6 (ensuring access to water and sanitation) of the SDGs.

Despite the well-known interventions for cholera prevention and control, challenges persist due to inadequate resources and suboptimal adaptation to local contexts. Insufficient financing, with more than 80 percent of affected countries reporting funding gaps for Water, Sanitation, and Hygiene (WASH) targets, impedes progress towards cholera control and SDG attainment. Moreover, global aid for water and sanitation has declined in recent years, necessitating a renewed focus on targeted interventions, particularly in cholera hotspots.

To address these challenges, the Global Roadmap for Cholera Control aims to coordinate efforts among countries, donors, and technical partners. By adopting a comprehensive approach and bridging the humanitarian-development divide, the roadmap seeks to significantly reduce the cholera burden and eliminate the disease in multiple countries. Key principles include better targeting of interventions to high-risk populations and fostering collaboration across sectors.

At the heart of global efforts lies the Global Task Force on Cholera Control (GTFCC), a collaborative network of organizations dedicated to combating cholera across all sectors. Established in 1992 and revitalized in 2014 in response to a World Health Assembly resolution, the GTFCC serves as a pivotal platform for coordinating multi-sectoral initiatives and supporting countries in intensifying cholera control efforts.

The renewed strategy to end cholera represents a critical milestone in global health. By prioritizing cholera hotspots, mobilizing resources, and enhancing collaboration through platforms like the GTFCC, the international community aims to achieve significant progress towards cholera eradication and SDG attainment by 2030.

Reference :

  • World Health Organization (WHO)


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