Cholera: the deadly disease being fueled by climate change

In recent years, climate change has exacerbated cholera outbreaks that are devastating communities across the world. But there is a solution: ensuring everyone, everywhere, has access to safe and sustainable water, sanitation and hygiene. With the ever-increasing threat of climate change, action has never been more urgent.

In the 21st century, every cholera death should be preventable. Yet people around the world continue to suffer or die unnecessarily from the disease. Cholera is a diarrhoeal illness caused by people eating or drinking contaminated food and water. It spreads in places without access to clean water and is made worse by poor sanitation and hygiene practices. While entirely preventable, cholera is also extremely dangerous, causing severe dehydration, diarrhoea and vomiting – symptoms that can kill within hours if left untreated.  

As the climate crisis has worsened, we have seen a surge in the number of cholera outbreaks across the world. In 2022, there was an alarming 145% increase from the previous five-year average, according to UNICEF. Extreme weather events such as tropical storms, heavy rains and flooding are destroying critical water and sanitation infrastructure, causing untreated sewage to spill into clean water sources and increasing the risk of cholera. This has been the recent reality for tens of thousands of people across southern Africa, including in Zambia.  

Lillian’s story: the devasting impact of cholera

Lillian Lungu, who lost her husband, Anderson, to cholera in January, is one of thousands across Zambia whose lives have been devastated by the disease. In recent months, the country faced its worst cholera outbreak in its history: more than 22,890 confirmed infections and 734 lives lost, with 1 in 3 deaths among children at its peak.

Anderson, who was just 42 years old, fell ill after eating a ‘chilli bite’ he bought from a food stall in Lusaka, the capital of Zambia. Lillian rushed him to a local health clinic, where she learnt he had contracted cholera. When his condition began to deteriorate, Anderson was transferred to Lusaka’s National Heroes Stadium, the country’s main cholera treatment centre at the peak of the outbreak. This was the last Lillian heard of her husband. She visited the centre every day with her family, but among the chaos, stopped receiving information on her husband’s condition.

“We then decided to be firm on them and vowed to only leave the facility after we heard news of my husband,” she said.  

That’s when Lillian learnt that Anderson had died 11 days earlier. She is now left to care for their 11 children on her own.

The spread of cholera across southern Africa

The devastation is not confined to Zambia. Cholera outbreaks have also occured in Malawi, Mozambique, South Africa and Zimbabwe.

Malawi, one of the least developed countries in the world, struggled to recover from its 2023 cholera outbreak. This outbreak was the worst in its history, the largest and deadliest in Africa last year, and one of the worst the continent has seen in the past decade. The country struggled with a slow and hindered recovery from three devastating storms – Cyclone Freddy in 2023, and Tropical Cyclone Gombe and Tropical Storm Ana in 2022 – that all led to widespread flooding and deadly disease outbreaks. The number of cases reported in Malawi’s 2023 outbreak was more than 59,000 with 1,750 deaths. But with many cases going unreported, these are certainly underestimates.

How can we stop the spread of cholera?

The suffering caused by cholera is needless. Transmission of the disease can be stopped in its tracks – and sustainably prevented – through adequate access and investment in safe water, sanitation and hygiene (WASH).

Cholera exposes the deep inequalities within global society and the inadequacy of sustainable WASH access, especially in the least developed countries and among poorer communities. More than a quarter (28%) of households in Zambia, for example, do not have access to clean water. In rural areas this figure rises to 42%. On a global stage, Sustainable Development Goal 6 is seriously off-track: for everyone, everywhere to have safe water at home by 2030, the pace of progress needs to surge sixfold, while the least developed countries demand a twentyfold increase in progress.

In light of this, the prevalence of deadly outbreaks might not be surprising. However, the unnecessary destruction of people's lives should enrage us, considering we have the tools readily available to prevent such tragedies. This must be a wake-up call for all governments and development partners to increase funding for WASH services and infrastructure, especially as climate change fuels the global surge in outbreaks. Not only would this save lives, it is also in the economic interest of governments, with the cost of managing a cholera outbreak far exceeding the expense of preventing one.

What is WaterAid doing?

When cholera cases began to significantly rise across Zambia in late 2023, we supported the government in providing immediate relief, as well as working towards long-term sustainable solutions that will safeguard the health and wellbeing of communities for generations to come.

This included donating 200 aid kits containing life-saving hygiene and sanitation supplies to mothers and children receiving care at the National Heroes Stadium. The kits included: soap, diapers, sanitary towels, Vaseline, chlorine, and 20 litre buckets. We also launched peer-to-peer hygiene and sanitation sessions for young people and children, aiming to educate and instill healthy long-term hygiene habits like handwashing with soap, in a concerted effort to break the cholera cycle.

WaterAid Zambia has embarked on a pivotal partnership with Standard Chartered Bank as well as working with government ministries to address the crisis head-on. This coalition is focused on promoting equitable access to WASH services, while conducting extensive awareness campaigns on cholera prevention and fostering good hygiene practices, especially among populations most at risk of contracting the disease. The initiative aims to not only combat the immediate challenges posed by cholera, but also to lay the groundwork for sustained community health and resilience.

Zambia’s cholera outbreak has now waned from its historic high. Yet we continue our relentless call on world leaders, governments, the private sector and donors to address the root cause of cholera: inadequate water, sanitation and hygiene.

In the face of the ever-growing threat of climate change, only by taking decisive action can we finally consign cholera to the history books and put an end to more unnecessary and avoidable deaths. The answer is – and always has been – making clean water, decent toilets and good hygiene a reality for everyone, everywhere.

Robert Kampala is the Regional Director of WaterAid Southern Africa. 

Top image: Dulce Martins takes down Natalia Samuel's biodata at a health centre in Niassa Province, Mozambique. July 2022.