What is cholera and how can we prevent it?

By Chris Hufstader
National Road 6 runs west from Mozambique’s port city Beira towards Chimoio and Manica province and the Zimbabwe border. Near the coast it goes through a low-lying agricultural area that was flooded by Cyclone Idai. Tina Kruger / Oxfam

Survivors of Cyclone Idai in southern Africa are at risk of cholera. It’s a threat after any significant disaster or wherever people struggle with lack of clean water, inadequate sanitation systems, or poor hygiene.

A few years ago I took a drive on Mozambique’s National Road 6 from Beira on the central coast west towards Chimoio and into Manica province. At the beginning, the road goes through kilometer after kilometer of agricultural fields, mostly sugar cane. A colleague in the truck that day told me: In bad weather, this entire zone is prone to floods.

And when Cyclone Idai hit Beira earlier this month, I could see he was right. The photo above shows what N6 looked like the other day.

Oxfam is part of a coalition of aid organizations providing assistance to people displaced by this flooding, because just surviving a dangerous storm is not enough―the threat of disease is just as serious.

“When floods happen, you have a large number of people displaced and then confined to a small area,” says Daniela Giardina, Oxfam’s public health and disaster risk reduction specialist. “Disrupted water supplies and poor sanitation means there is a higher risk of diseases like cholera.”

Cholera is one of the more deadly water-borne diseases–—it can kill people very quickly. In fact, cholera and other diseases can kill many more people than an initial disaster (earthquake or storm); that’s why we work as quickly as we can to prevent it.

The vast areas of central Mozambique now under water, parts of Zimbabwe affected by landslides, and flooded farms and fields in Malawi are all perfect areas for breeding the disease. And we are already seeing a few suspected cases of cholera in Beira.

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Flood survivors in Mozambique are at risk of diseases from water contaminated by sewage. Oxfam and other aid organizations responding to the emergency are prioritizing clean water and hygiene items to help people survive. Sergio Zimba / Oxfam

Cholera: The deadly facts

Cholera is a bacterium that attacks your intestines, and causes intense diarrhea and vomiting. If not treated with oral re-hydration solutions, some strains of cholera can rapidly dehydrate someone and they can die in a matter of hours.

The disease is spread through contaminated water and food. Improper disposal of feces from people infected with cholera is frequently the source of the problem. So people in flooded areas where latrines are overflowing are particularly vulnerable.

How to prevent cholera

Clean water, sanitation, hygiene: Ensuring people have clean water, proper toilets, and soap to wash their hands after going to the bathroom and before eating and preparing food are the basic ways to prevent the spread of an infectious disease like cholera. Oxfam will truck in water and repair wells to improve the supply of clean water, and install latrines and repair sanitation systems to protect the water supply.

All this also helps prevent cholera and many other stomach bugs that can cause really bad diarrhea, which are serious threats to malnourished people, particularly children. As many as 800 children die every day due to preventable diseases arising from lack of access to clean water and sanitation, according to UNICEF.

While an emergency like the war in Yemen right now can create ideal conditions for a cholera epidemic (more than 2,500 people dead from cholera in Yemen), straight up poverty can also create a good environment for cholera and other deadly bacteria.

Promoting good hygiene: Many people caught up in an outbreak of cholera don’t know what it is and how to prevent it. So Oxfam and many other organizations invest in hygiene promotion: When we distribute soap, buckets, water purification tablets, or chlorine bleach to people affected by a disaster or war, we encourage them to wash their hands and teach them how to make their water safe to drink. (I once spent a day with a hygiene promoter in Haiti in the middle of a cholera outbreak, see the video for more on that experience...) We frequently train local people to take on this hygiene promotion, providing a much-needed salary to people who need work. In camps for refugees and displaced people, Oxfam helps set up temporary latrines, and organizes committees to keep them clean and ensure there are functional hand-washing stations nearby that are all safely accessible for women and girls.

Update: After publishing this in late March, Oxfam staff in Mozambique reported in early April that there were 500 suspected cases of cholera in Beira. They estimated that figure had nearly doubled in just 24 hours. By the beginning of May, the rate of new reported cases fell from a high of 400 per day to just four, according to the World Health Organization. The WHO also says there have so far been 6,743 cases in areas affected by Cyclone Idai. Eight of these people died. Oxfam has been part of the effort to reduce the risk of cholera thought its work to repair water systems, provide clean water by truck where possible, repair and build latrines, and distribute soap and water treatment chemicals along with information on how good hygiene can prevent cholera. Oxfam and other humanitarian groups are now turning their attention to areas affected by Cyclone Kenneth in northern Mozambique where they are implementing similar cholera prevention efforts.

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