South Africans prepare for cholera outbreaks amid climate change

As climate change increases the frequency and scale of cholera outbreaks, MSF is training health and disaster management workers to respond.

An MSF staff member in white vest shows a South African woman how to prepare for future cholera outbreaks.

South Africa 2023 © Sean Christie/MSF

NEW YORK/JOHANNESBURG, SEPTEMBER 5, 2023—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) recently trained health and disaster management workers across South Africa to better respond to future cholera outbreaks. Earlier this year, the country experienced its second biggest cholera outbreak this century. Cholera outbreaks have become increasingly common worldwide due to climate change, vaccination shortages, and other factors.

South Africa’s cholera outbreak earlier this year killed 34 people and infected approximately 900 in and around the region of Hammanskraal in South Africa’s Gauteng Province, which was the epicenter of the outbreak. MSF’s recent cholera readiness trainings—carried out in partnership with South Africa’s National Department of Health (NDoH), the World Health Organization (WHO), and the United Nations International Children's Emergency Fund (UNICEF)—should help reduce infection and mortality figures during future outbreaks.

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“The frequency and scale of cholera outbreaks is rising,” said Danish Malik, an MSF water, sanitation, and hygiene expert. “Outbreaks are occurring in places that rarely experienced them before, with impacts that are often more severe than they should be. [Partnerships with organizations like MSF that have experience responding to cholera] can help to save lives in an outbreak and build the capacity that is needed to respond effectively to future outbreaks.”

An MSF staff member in white vest holds a microphone in front of a projector at a cholera readiness training in South Afriac
In mid-May 2023, Hammanskraal in South Africa’s Gauteng province became the epicenter of the second-biggest cholera outbreak in the country this century, resulting in approximately 900 cases and 34 deaths. South Africa 2023 © Sean Christie/MSF

Cholera and climate change

Cholera is not endemic to South Africa but can spread rapidly in settings without clean water and proper sanitation, including communities like many in South Africa’s towns and cities where failing water infrastructure is leading to the pollution of nearby water sources. Cholera causes profuse diarrhea and vomiting and, without treatment, can quickly lead to death of severe dehydration. Drinking and using safe water, using clean latrines or toilets, washing hands with soap, and ensuring good food hygiene can help people avoid contracting the disease.

Climate change and other factors are exacerbating the global cholera situation as people are increasingly forced to live in crowded conditions like refugee and displacement camps where waterborne diseases like cholera can spread rapidly. Additionally, heat and drought can reduce the amount of safe drinking water, forcing people to use unsafe sources. Floods can facilitate the bacteria’s spread to previously safe water sources.

MSF holds a cholera readiness training in South Africa, where participants learn to read a meter.
Hands-on cholera readiness training will help communities respond immediately the next time a cholera outbreak occurs. South Africa 2023 © Sean Christie/MSF

“Nobody owns an outbreak"

MSF, WHO, and UNICEF first worked together during the Hammanskraal outbreak, providing technical and supply support. However—as no new cholera cases have been confirmed in South Africa since June 20—MSF reviewed the response with its partners and was subsequently asked to assist with updating the national cholera guidelines and the roll-out of cholera readiness training, which reached government teams from all of South Africa’s nine provinces. Training participants learned about chlorinating water to help prevent the spread and setting up cholera treatment units (CTUs).

“Nobody owns an outbreak,” said Tsakani Furumele, director for communicable diseases at South Africa’s NDoH. “Institutions are not jacks of all trades—if other organizations have the expertise and the willingness to help, let them help. This is what happened in response to South Africa’s recent cholera outbreak.”

In 1988, MSF first employed cholera treatment centers (CTCs) in southern Africa—in Malawi—to address an epidemic among refugees from Mozambique. The CTC model provides rapid medical care to large numbers of patients while also isolating them to prevent further spread of the disease. In the 1990s, this model was adapted for use on a massive scale to address epidemics in camps inhabited by hundreds of thousands of people. CTUs are smaller versions of CTCs that can be set up more quickly in the event of an outbreak.