Cholera: An overlooked outcome of climate change

In the 21st century, every case of and every death from cholera is preventable. Yet to this day, children around the world are still suffering and dying unnecessarily from the disease – and climate change is making the situation worse.

Climate change-related extreme weather and the destruction it causes are making headlines on a regular basis across the world. Yet the profound health implications of the climate emergency are often left untold.

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Cholera is a diarrhoeal illness that spreads in places where access to clean water is limited and people end up consuming contaminated food and water. Poor sanitation and hygiene practices also accelerate its spread.

Cholera is completely preventable but also extremely dangerous, causing severe dehydration, diarrhoea and vomiting – symptoms that can kill within hours without treatment.

Combined with climate change, this bacterial illness poses an imminent threat to vulnerable communities across the world. In recent years, as the climate crisis has become more severe, there has also been a major surge in the number of cholera outbreaks across the world. We have seen repeatedly in different countries and communities climate-related intense tropical storms, heavy rains and  flooding which damage or destroy water and sanitation infrastructure and cause untreated sewage to spill into clean water sources, and triggering cholera outbreaks. According to UNICEF,  30 countries faced cholera outbreaks in 2022 – an alarming 145 percent increase from the previous five-year average..

Zambia, for example, is currently experiencing its worst cholera outbreak to date with more than 18,000 confirmed infections. The disease has already killed more than 600 people, a third of them children, and led to aid agencies warning of an “uncontrollable health crisis” in the country.

The continued suffering caused by cholera in countries classified as least developed by the United Nations, like Zambia, exposes the deep inequalities within global society and the inadequacy of sustainable water, sanitation and hygiene access among poorer communities.

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More than a quarter (28 percent) of households in Zambia do not have access to clean water. In rural areas, this figure rises to 42 percent. So it is not surprising that the country is currently experiencing a deadly cholera outbreak.

And the outbreak in Zambia is already spreading to neighbouring countries, where millions of people are already struggling with access to clean water and sanitation and dealing with the aftermath of extreme weather, threatening a catastrophic regional health crisis.

Zambia’s neighbour to the east, Malawi, for example, is one of the least developed countries in the world and is still in the process of recovering from a major cholera outbreak that devastated it in 2023. Last year’s outbreak was the worst in Malawi’s history and the worst Africa has seen in the past decade. It hit the country in the aftermath of three devastating storms – Cyclone Freddy, Tropical Cyclone Gombe and Tropical Storm Ana – and severely hindered its recovery. About 59,000 cases and 1,750 deaths were recorded in the outbreak, but with many cases going unreported, these are certainly underestimates.

Yet this suffering is needless. Transmission of cholera can be stopped in its tracks – and sustainably prevented – through adequate access and investment in safe water, sanitation and hygiene. And this crisis is not limited to Southern Africa, we’re seeing surges in cholera cases in Ethiopia too.

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Countries in Europe and North America – once crippled by this disease – have long eliminated the threat of cholera through the provision of safe water and sanitation services for their entire populations. These successes should be replicated in countries fighting cholera today. The catastrophic, preventable cholera outbreaks in Southern Africa must be a wake-up call for all governments and development partners to increase funding for water, hygiene and sanitation, especially at this time of crisis when climate change is fuelling a surge in waterborne diseases.

It is in the economic interest of governments to invest in water, sanitation and hygiene services and infrastructure because the cost of managing a cholera outbreak far exceeds the expense of preventing one.

The sixth UN Sustainable Development Goal of achieving “clean water and sanitation for all” by 2030 is seriously off track. For this goal to be achieved, the pace of progress needs to surge sixfold globally and twentyfold in least developed countries. There is need for immediate action, sustainable investment in clean water and a cholera-free future for all.

This is why WaterAid is calling on world leaders, governments, the private sector and donors to prioritise making safe water, decent toilets and good hygiene a reality for everyone, everywhere, especially the poorest and most vulnerable groups in climate-vulnerable regions.

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 in Southern Africa and across the world.