A child recovers from cholera at a UNICEF treatment center in Ethiopia's Oromia Region.

UNICEF Fights Fast-Spreading Cholera Outbreaks in Africa

Cholera cases are on the rise in eastern and southern Africa, leaving 28.4 million people in need across 11 countries. UNICEF is working with partners to improve critical health, water, sanitation and hygiene services.

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The cholera treatment tents at Area 25 clinic near Chikanda, Malawi, are filled with patients of all ages — mothers, fathers, children — at various stages of sickness. Some are hooked up to IVs; others take oral rehydration salts. Others are asleep, too weak to stay awake.

Despite the overwhelming number of patients, the tents are well organized, each bed equipped with plastic basins and pails to treat patients recovering from the virulent intestinal disease.

Cholera is caused by eating food or drinking water contaminated by the bacterium Vibrio cholerae. Symptoms — violent cramps, vomiting, acute diarrhea — lead to severe and rapid dehydration. If caught in time, cholera is easily treatable. If not, it can kill within hours. 

Weak, malnourished children are most at risk. 

Cholera patients are treated at a UNICEF-supported treatment center near Chikanda, Malawi.
Cholera patients receive treatment at a UNICEF-supported health facility near Chikanda, Malawi. One pregnant patient said that after the community borehole that once provided safe water broke down some time ago, she and her neighbors have been digging wells in their compounds and drinking water wherever they can find it.  © UNICEF Homeline Media 2023

Floods, droughts and tropical cyclones fueling a rapid rise in cholera cases

Across eastern and southern Africa, the devastating effects of floods, droughts and tropical storms are pushing already weakened community health, water, sanitation and hygiene (WASH) systems to the breaking point, fueling one of the worst cholera outbreaks in decades. 

By the third week of March, 93,681 cholera cases had been reported in Malawi, Mozambique, Somalia, Kenya, Ethiopia, Zambia, South Sudan, Burundi, Tanzania, Zimbabwe and South Africa. 

map showing 11 countries battling cholera outbreak across eastern and southern Africa

UNICEF-supported cholera treatment centers save lives

Ahmed Aleyi sits on the end of his child's bed in a UNICEF cholera treatment center (CTC) in Melka Buta, Oromia Region, southern Ethiopia. The Horn of Africa — Ethiopia, Kenya and Somalia — is experiencing a prolonged drought, the worst in decades, severely straining the health and WASH systems children rely on for survival.

"We are here because our child has diarrhea and is vomiting," Aleyi said. "The disease started three months ago. It's due to the lack of clean water."

Children fill jerry cans with contaminated water from the Mena River in Ethiopia's Oromia Region.
Children collect water for household use from the contaminated Mena River in Ethiopia's Oromia Region.  © UNICEF Ethiopia/Tesfaye/2023

Community awareness campaigns spread health and hygiene information

UNICEF is focused on mobilizing essential lifesaving support, including emergency health supplies, medical products, technical support for outbreak control, risk communication, community awareness activities to promote health and hygiene measures, safe water and nutrition supplies.

"We have treated more than 200 patients," Abdulbaarii Muhamed, a health officer in Melka Buta, said in early March. "This CTC is too small compared to the population here, so we need to expand it and we need additional manpower, as the number of patients is increasing by the day. Our message is that we need special support, and we need your help."

Cyclone Freddy: too much water, not enough water 

Flooding and damage caused by Cyclone Freddy, the longest-lasting tropical cyclone ever recorded, have destroyed infrastructure and severely disrupted critical services in Malawi and Mozambique. Enormously high water levels are affecting sanitation; farmlands are flooded and crops ruined. An estimated 4.2 million children are in need of humanitarian aid.

Displaced families are living in crowded emergency shelters with limited access to safe water, hygiene and sanitation — the perfect recipe for an uncontrolled cholera outbreak. 

“Cyclone Freddy has taken a devastating toll," said Mohamed M. Malick Fall, UNICEF Regional Director for Eastern and Southern Africa. "Many families in Malawi and Mozambique have had their lives swept away, leaving them with very little, and putting children and the most vulnerable in particular at immense risk."

A child is vaccinated against cholera during a campaign conducted by the Ministry of Health in Mozambique with support from UNICEF and WHO.
Between Feb. 27 and March 3, 2023, Mozambique's Ministry of Health vaccinated 719,240 children ages 1 and older against cholera, with the support of UNICEF and the World Health Organization. © UNICEF/UN0799408/Franco

Malawi's deadliest cholera outbreak in recorded history

Even before Cyclone Freddy, Malawi and Mozambique were among the countries most seriously affected by the cholera outbreak. In Malawi, the disease has already claimed more than 1,660 lives. Thousands of children have been infected in all 29 districts. 

Lilongwe, Malawi's capital city and one of the country's cholera epicenters, has a case fatality rate of 5.9 percent. When people with cholera receive quality care, case fatality rates are typically below 1 percent — an indication that standards of care in Malawi are inadequate.

A child in Malawi receives cholera treatment from a health worker at the Chilumba rural hospital.
A child in Malawi receives cholera treatment from a health worker at the Chilumba rural hospital. © UNICEF/UN0711207

Cholera cases in Mozambique nearly quadrupled from early Feb. to late March 2023

In Mozambique, where Freddy made landfall twice, cholera has been a rising threat since September 2022. Cases have been reported in 35 districts across 7 out of 11 provinces. Between early February and March 20, 2023, the number of cases nearly quadrupled to almost 10,700.

“We are now facing a very real risk of a rapidly accelerating cholera outbreak in Mozambique, a disease which is particularly dangerous for young children, especially those who are malnourished,” said Maria Luisa Fornara, UNICEF Representative to Mozambique.

“UNICEF is working closely with the government to urgently restore access to health, water, hygiene and sanitation interventions to areas hit by the cyclone, but additional support is needed to meet the rapidly growing needs of children and families.”

UNICEF is providing water, sanitation and hygiene supplies to families displaced by Cyclone Freddy in Mozambique's Zambezia Province.
On March 25, 2023, 8-year-old Gisela and 9-year-old Marco take turns carrying a bucket of safe water to the school building where they have been living since their home in Mozambique's Zambezia Province was destroyed by Cyclone Freddy. UNICEF is providing families with water, sanitation and hygiene supplies to prevent the spread of cholera. © UNICEF/UN0820848/Zunig

To respond to the increasing needs of children and families in eastern and southern Africa impacted by cholera, UNICEF is urgently calling for funding of $171 million. 

Every year, UNICEF responds to hundreds of emergencies in dozens of countries. Your unrestricted contribution helps UNICEF stay at the ready to help children when they need it most. Please donate.

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With reporting by Naomi Kalemba

TOP PHOTO: A child recovers from cholera at a UNICEF treatment center in Bale Zone, Oromia Region, Ethiopia, in March 2023. Video edited by Tong Su for UNICEF USA.
© UNICEF Ethiopia/Tesfaye/2023