Fighting Cholera: A Race against Time

Cholera is a disease many of us have heard of since childhood. While it has largely vanished from our daily lives in Hong Kong, outbreaks still occur in around 60 countries, especially the ones with limited resource, claiming thousands of lives each year.

Lack of access to clean water and sanitation facilities is often the root cause of cholera outbreaks. Conflicts and natural disasters displace large numbers of people, forcing them into dire living conditions. When people consume food or water contaminated with bacteria from the faeces of infected individuals, symptoms like vomiting and diarrhea can strike. The disease not only spreads rapidly, in severe cases, patients can also lose up to 25 liters of bodily fluids in a single day, leading to death from dehydration within hours. The fatality rate can exceed 50%.

To combat cholera, we must race against time. MSF sets up Cholera Treatment Centres (CTCs) in over 10 affected countries and regions, providing rehydration and specific care to those in need. We also work to supply clean water, conduct disinfection, administer vaccinations, and carry out health promotion campaigns in affected communities to curb the spread of cholera as much as possible, and protect those who are not yet infected.

Cholera can be deadly, but with timely and proper treatment, it's entirely curable. Let's see how we respond swiftly and efficiently to cholera outbreaks.

The critical 72 hours in responding to cholera outbreaks 

According to World Health Organization (WHO), cholera affects 1.3 to 4 million people globally each year, leading to up to 140,000 deaths. However, if patients receive timely and appropriate treatment, the fatality rate can drop dramatically from as high as 50% without treatment to just 0.2%! This underscores that every second counts in tackling Cholera. 
MSF has extensive experience in responding to infectious diseases like cholera over the years and has developed a set of response protocols to control outbreaks as early as possible. In March 2023, our medical team in Malakal, South Sudan, received the first group of children with severe diarrhea, signaling a potential cholera outbreak. The team on the group acted within the critical 72-hour to control the number of cases:

0-12 Hours: Monitoring epidemic trends 

We collected and sent patient samples for testing while monitoring the number of cases. As soon as the first tests came back positive for cholera, we moved to the next steps. 

12-24 Hours: Isolating patients and promoting health 

We set up cholera isolation wards in the local hospital to separate infected patients and provide timely treatment, breaking the chain of transmission as quickly as possible. At the same time, we added multiple handwashing stations and deployed health promoters to educate the community on maintaining hygiene, recognising early symptoms of cholera infection, and seeking for treatment immediately if needed. 

24-48 Hours: Improving water and sanitation 

South Sudan was in the dry season at the time, making safe water even harder to access and favoring the spread of cholera bacteria. While treating patients, we began assessing the water supply. Together with WHO and other partners, we tested the water quality and investigated potential sources of contamination. We collaborated with the WHO to test water quality in the area and investigate sources of contamination, aiming to prevent further infections. 

We also distributed safe drinking water in some villages and taught people how to filter water with charcoal filters or purify it with “Aqua tabs”. Additionally, we installed toilets and other sanitation facilities to improve long-term hygiene. 

48–72 Hours: Vaccination

Vaccination is key to controlling outbreaks. We administered oral cholera vaccines in various communities, and raise awareness by explaining the benefits of vaccination to increase acceptance among the population.

In the end, we were able to respond quickly and limit the number of cases to below 1,500. As numbers dropped significantly, we closed the intervention after two months. This example shows how the actions taken in the first 72 hours of an outbreak can determine whether it is controllable. Early diagnosis, isolation, source tracing, and vaccination—each step is vital to saving lives.

The treatment hub! MSF’s Cholera Treatment Centre (CTC)  

The response in Malakal highlights the importance of centralised care. Here’s a look inside a typical MSF Cholera Treatment Centre, designed to manage outbreaks efficiently:

Observation area

Inpatient area

Intravenous fluids therapy - Patients with severe vomiting and diarrhoea become dehydrated, so they require intravenous rehydrating and typically stay in the inpatient area for 3-5 days of treatment.

Staff Logistics Area

We respond as rapidly as we can to cholera outbreaks around the world, but number of cases remain high each year due to various crises and constraints. WHO reported over 560,000 cholera cases last year, a 5% increase from 2023, with deaths surged by 50% from 4,000 to over 6,000. 

Sudan and neighboring countries 

Countless civilians and families fleeing the conflict in Sudan have been displaced within the country or to neighboring nations like South Sudan, Ethiopia, and Chad. Many are forced into temporary camps with poor sanitation, creating breeding grounds for cholera. 

In late February this year, our team at Kosti Teaching Hospital in Sudan's White Nile State, which we support, treated over 2,700 cholera patients. In August, in the Darfur region, we cared for more than 2,300 cholera patients in a single week, which 40 of them died. 

We mentioned earlier that our team effectively contained the cholera outbreak in Malakal, South Sudan, in 2023. However, from late last year into early this year, cholera ravaged parts of the country, possibly due to movements of Sudanese refugees. At least 25,000 people across seven states were infected, with nearly 500 deaths. 

Chad also saw an outbreak starting mid-year, recording nearly 2,400 cases and 141 deaths in three months. The eastern region has been hit hardest, where it has become endemic. 

Democratic Republic of the Congo 

Since the beginning of 2025, the DRC has been facing a significant increase in the number of cholera outbreaks[JS1.1]. More than 58,000 cases have been recorded from January to mid-October, with more than 1,700 deaths. Twenty of 26 provinces are already affected.

In the middle of 2025, a "gold rush" drew large crowds to Lomela in South Kivu Province, swelling the population from 1,500 to over 12,000 in a year. People lived in makeshift shelters without proper sanitation, leading to a cholera outbreak. We launched an emergency response, vaccinating 8,000 people and treating 600 patients in a month’s time. 

Eradicating cholera by 2030?

In 2017, the Global Task Force on Cholera Control, comprising dozens of organisations, launched the "Ending Cholera: A Global Roadmap to 2030," aiming to reduce cholera deaths by 90% and eliminate outbreaks in 20 countries. 

Global cholera vaccine stockpile runs low

Yet with outbreaks erupting worldwide, demand for cholera vaccines remains high, and few new manufacturers are entering the supply chain, supply stress on existing qualified suppliers has exacerbated. The stockpile even ran dry for a period of time in 2024.

Despite the positive development in vaccine dosage availability, international efforts to combat cholera still face significant uncertainties. For example, cuts in international aid funding have led organisations to prioritise limited resources for short-term emergencies in conflict zones, putting some long-term public health and sanitation projects at risk of suspension. This is especially devastating in areas where health systems have already be overwhelmed or disrupted. There will still be many challenges in combating cholera outbreaks in the future, and joint efforts from all key stakeholders are needed to truly achieve the goal of eradicating cholera.