Cholera is making a comeback. Syria, Lebanon, and Haiti are all facing outbreaks right now, with millions of people under the threat of the disease.
More than 13,000 cases of cholera have been reported in Syria in the past month, with at least 60 deaths, and the outbreak has now spread into Lebanon, where more than 50 suspected cases have been identified, and millions are at risk of contracting the infection.
On the other side of the world, in Haiti, one person has died and more than 50 cases were confirmed in the capital, and international health authorities say that at over a million children, on top of millions of adults, are at risk of illness.
These outbreaks are occurring in areas where there hadn’t been cases for several years (three in Haiti, more than a decade in Syria, and nearly 30 years in Lebanon). They add to a growing number of cholera cases around the world, in areas where the disease is more common, where the impact of the disease is being worsened by climate change. Altogether, the outbreaks give a preview of the near-future health consequences of climate change.
Cholera is on the rise
“Not only are we seeing more outbreaks but more deadly outbreaks,” said World Health Organization (WHO) director-general Tedros Adhanom Ghebreyesus last week in a press conference. Current WHO estimates suggest the number of cholera cases this year is three times the average yearly rate over the past five years.
Cholera, which is transmitted through contaminated water, is highly treatable and preventable. There are effective vaccines and antibiotics, and often simple interventions such as oral rehydration are sufficient to keep victims alive. Yet it can kill in a matter of hours without access to these lifesaving measures, especially clean water.
The WHO has a stockpile of 27 million vaccines against cholera, but they are not enough to keep up with the increased number of cases and expanded areas of vulnerability. The surge in cases and deaths points to a complex set of interconnecting risk factors, including poverty and lack of access to clean water sources and healthcare, all of which are worsened by conflict. In Haiti, violent tensions following last year’s presidential assassination have led to a collapse of essential services including garbage disposal and sanitation issues. In Syria and Lebanon, too, conflict increases the hardship involved in getting access to clean water.
Cholera is turbocharged by climate change
But there is one extenuating factor that public health authorities are particularly concerned about: climate change. “Cholera thrives on poverty and conflict but is now being turbocharged by climate change,” said Tedros at the press conference. “Extreme climate events like floods, cyclones, and droughts further reduce access to clean water and create the ideal environment for cholera to spread.”
Any event that drives population movement and reduced access to clean water can exacerbate the risk. For instance, following the disastrous floods in Pakistan that have impacted 33 million people, killing at least 1,200, people have been forced to drink flood water in absence of clean water. This puts them at higher risk of waterborne diseases, including cholera.
Climate change is worsening outbreaks even in areas where they are more common. Fifteen of 27 outbreaks reported this year were located in south-eastern African countries, which are especially affected by changed rain patterns, cyclones, and drought. According to the WHO, cholera mortality in Africa is now 3%. With proper treatment, the mortality would go down to under 1%, yet climate adversities will make it logistically harder to provide the healthcare and sanitation required to control the outbreaks.