A Resurgence of Cholera in Flood-Stricken Ethiopia

Recent flooding has exacerbated the spread of a recent cholera outbreak [Oxfam East Africa via flickr]

The Ethiopian government and the World Health Organization (WHO) released a report on September 13 tracking a cholera outbreak that has recently eclipsed 14,500 cases and 250 deaths. The outbreak, which started on April 28, shows no signs of stopping—and it may be reenergized by the country’s recent flooding and from the COVID-19 pandemic. 

Cholera has been common in Sub-Saharan Africa for the past several hundred years, infecting an estimated 2.86 million people and killing nearly 100,000 people each year. Past outbreaks have stemmed from inadequate education programs and a lack of effective humanitarian assistance. However, this outbreak is different.

The current outbreak started in the Amhara region, and it quickly spread into the nearby regions, called woredas. Although 76 woredas have been impacted, the WHO reports that the outbreak is slowly declining, with a 52 percent decrease in cases for September compared to July. However, the outbreak may continue to fester, as the cholera outbreak directly coincides with Ethiopia’s rainy season. 

For the past several months, Ethiopia has been suffering from severe flooding, which has displaced nearly 900,000 people. The displacement has placed considerable stress on the people and their water sources. Many of the wells and holy water sites have been contaminated with Vibrio cholerae, the bacteria that causes cholera. With no other option, the displaced Ethiopians have reluctantly opted to use contaminated water sources for their households and agriculture. As a result, the current outbreak was most likely caused by the consumption of contaminated vegetables, a lack of safe water, and improper sanitation. 

The Vibrio cholerae bacteria causes a variety of symptoms: watery diarrhea, appetite loss, abdominal discomfort, and vomiting. These symptoms are particularly deadly for children and adolescents, as their bodies quickly drain water and their immune systems are unable to react to V. cholerae’s fast incubation period. However, prevention methods have drastically improved in the past several years, with regular hand-washing being the most effective. 

With nearly 70 million Ethiopians at risk of contracting cholera, the WHO and the Ethiopian government decided to establish 98 cholera treatment centers across the country. WHO teams have been actively participating in the treatment and identification of cholera infections. These teams have been actively surveying the 76 affected regions, which has led to a marginal decline in cases. Unfortunately, Africa has been preoccupied with another, more-pressing disease: COVID-19.

Much like the situation in the Democratic Republic of the Congo with Ebola, Ethiopia’s response to the cholera outbreak remains underfunded, as resources are diverted to assist COVID-19-related cases. The resurgence of coronavirus cases in Northern and Sub-Saharan Africa has the potential to negatively impact Ethiopia’s already frail health infrastructure, leading to a deadly comorbidity forming in the Horn of Africa.