Cholera is endangering children’s lives.

Eastern and Southern Africa is grappling with one of the worst cholera outbreaks in decades, with cases rapidly spreading across the region – especially in densely populated urban areas where contaminated water supplies are infecting large numbers of people, including children.

Over 230,000 cholera cases and 4,000 deaths have been recorded across 14 cholera-affected countries in Eastern and Southern Africa since the beginning of 2023. As of February 2024, 11 countries are reporting active outbreaks, with six countries currently classified by the WHO as in ‘acute crisis’ for cholera.

Of grave concern is the high fatalities recorded in these deadly outbreaks, with 9 of the 14 cholera-affected countries in ESAR surpassing WHO’s case fatality rate threshold of <1 per cent.

Available data suggests that across Eastern and Southern Africa, children and adolescents are disproportionately affected, accounting for up to 52 per cent of all reported cases in some countries. Moreover, high death rates of up to 40 per cent are being recorded among children under 5 years of age. The impact of cholera on children is also observed through the disruption of learning due to school closures. Lessons learned from the COVID-19 pandemic highlight the devastating consequences of such closures on the safety, learning, mental health, and protection of children, with evidence showing that it is in the best interest of children that schools remain open.

The unprecedented increase in frequency, number, and scope of outbreaks in the region is worsened by the impacts of climate change in the region, which is exacerbating the situation by limiting access to safe water and sanitation, triggering population movements (with evidence of cholera easily spreading across borders), and straining weak health systems.

In 2023, cholera cases increased due to extreme weather events such as protracted droughts, multiple cyclones, heavy rainfall, and major floods. The cholera outlook in 2024 remains dire, with many countries in the region already experiencing heavy rainfall and El Niño effects triggering spikes in some countries.

Cholera is both preventable and treatable. Simple handwashing measures and access to safe water keep cholera at bay. However, access to clean water and sanitation is sadly becoming a privilege, particularly in countries most impacted by extreme weather due to climate change.

Responding effectively to the cholera situation in Eastern and Southern Africa requires the urgent strengthening of water and sanitation systems, awareness-raising and engagement among at-risk and affected communities, enhanced surveillance, and improved case management. Significant investments are needed to implement longer-term WASH strategies and achieve the Global Task Force on Cholera Control (GTFCC) roadmap 2030 goal of reducing cholera deaths and stopping cholera transmission.

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