This blog was updated on 15 May 2019

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Yemen is in the grip of an unprecedented cholera outbreak.

It is the largest and fastest-spreading epidemic since the World Health Organization began recording outbreaks in 1949. After the outbreak peaked in 2017, a second wave of cases began in August 2018 and has continued into 2019. 

Since Cyclone Idai tore through southern Mozambique in March, there have been at least 6,596 cases of cholera. More than 90 health centres were either damaged or destroyed and sanitation facilities remain inadequate, making the situation very dangerous.

In this blog, British Red Cross health adviser Greg Rose explains the threat posed by this potentially life-threatening disease.

What is cholera?

Cholera is a bacterial infection that is spread when people consume contaminated food or water – it is nearly always waterborne.

It is preventable and treatable. Without treatment, however, death can occur within hours.

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Where is cholera found?

The disease is usually found in places where there is a lack of clean water, poor hygiene and limited access to health care.

It is most prevalent in sub-Saharan Africa, Central America, the Caribbean, South Asia and parts of South-East Asia.

What are the symptoms?

Cholera has a short incubation period, between two hours and five days. This explains why you often see a sudden burst of cases.

Most people have mild or no symptoms. Those who do develop symptoms will usually experience:

  • Severe, watery diarrhoea
  • Stomach cramps
  • Vomiting

It’s important to note that even if people do not display symptoms, the bacterium, Vibrio cholerae, stays in their faeces for up to two weeks.

So if people are practising open defecation (associated with poor hand washing or water course contamination and transmission by flies), or if infrastructure is damaged after a natural disaster, then you can see how the bacteria can spread.

Can it be treated?

Absolutely – there is no reason why anyone should die from cholera. Treatment is often very simple depending on the stage of infection.

If cholera is detected early, then the patient may just need an oral rehydration solution to prevent dehydration.

If it’s more serious, then the patient may require intravenous fluid replacement at hospital.

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A woman recovering from cholera at treatment centre in Burundi

It’s not the bacterium that will kill a person. A combination of acute diarrhoea and vomiting can lead to severe dehydration – a victim can lose several litres of fluid in a matter of hours. This is what proves fatal.

While cholera is easily treatable, the issue is that in places where cholera is prevalent, such as in Yemen and sub-Saharan Africa, health care is not always readily available.

Why is cholera so common after a conflict or natural disaster?

An elderly man in Yemen walks with a stick over the rubble of his destroyed town

In Yemen and Mozambique hundreds of thousands of people have had to flee their homes.

Conflict has destroyed essential infrastructure in Yemen, while the cyclone has devastated homes and health centre in Mozambique. Water and sewer systems no long function in many cities.

Conditions then become ripe for waterborne diseases like cholera.

So how do you prevent cholera?

The most effective solution in the aftermath of a disaster is to make sure people are aware of the dangers and have access to clean, chlorinated water, soap and toilets.