How MSF is tackling cholera outbreaks in 11 countries

Pillars of MSF's cholera response

Cholera is easy to treat, with oral rehydration for most patients, and intravenous rehydration for more severe cases. If treated in time, more than 99% of patients will survive the disease. An effective response to cholera involves engaging on several different fronts at the same time—and as fast as possible—to treat sick patients and to stop transmission within communities.

The key pillars of this strategy rely on MSF's medical staff working alongside epidemiologists, water and sanitation experts, logistics managers and community health promoters. Since an effective oral vaccine became available within the past decade, we have also incorporated large-scale vaccination campaigns into our response. 

A big part of MSF’s ability to respond quickly is our standardized, pre-positioned cholera treatment kits that come equipped with rehydration salts, antibiotics, and IVs, along with buckets, boots, chlorine, and plastic sheeting—in short, everything needed to hit the ground running after an outbreak is confirmed.

Causes of Cholera

Cholera is a highly contagious disease that occurs in settings without clean water and proper sanitation. It causes profuse diarrhea and vomiting, and without treatment can quickly lead to death by intense dehydration. For most countries, the current surge of cholera is due to specific, local conditions.

Protracted political and/or military crises

This type of crises can lead to a lack of maintenance of drinking water and/or sewage infrastructure. This is the case today in countries like Haiti, Somalia, and Syria.

Natural disasters

Heat and drought can reduce the amount of safe drinking water, forcing people to use unsafe sources. Floods on the other hand, can facilitate the bacteria’s spread to previously safe water sources. In 2022, countries like Somalia, Kenya, and Ethiopia suffered from severe droughts. Others, like South Sudan and Nigeria, faced floods.

Displacement 

Refugees often have to stay in places where there’s not enough access to clean water, and authorities often don’t invest in proper water and waste infrastructure in refugee camps. This year, there were cholera outbreaks in refugee camps in Lebanon, Somalia, and Nigeria.

Challenges to the cholera response

Treatment and prevention of cholera come with considerable logistic challenges. Setting up cholera treatment centers requires a lot of supplies, and so do water and sanitation projects. In places that are unsafe or otherwise difficult to access, that is a huge constraint. The number of outbreaks this year makes it very challenging. There’s already a shortage of cholera vaccines and the supply of other essential materials, like the fluid for intravenous rehydration, is also under pressure.

For political reasons, some governments don’t want to officially declare cholera outbreaks. This makes it very difficult to adequately inform people about how they can protect themselves, and impossible to do cholera vaccination campaigns.

Cholera is notoriously underreported and reliable global figures about the number of cases aren’t available. The best estimates are between 1.5 and 4 million cases every year.