Cholera outbreak in West and Central Africa poses crisis for children

“The heavy rains, widespread flooding and the high level of displacement are all fuelling the risk of cholera transmission and putting the lives of children at risk,” said UNICEF regional director for West and Central Africa Gilles Fagninou.

Cholera is an acute diarrhoeal infection caused by consuming food or water contaminated with bacteria. The disease can be treated with oral rehydration solution and antibiotics, but can be fatal within hours if untreated.

Young children are particularly vulnerable to cholera due to factors such as poor hygiene, inadequate sanitation and access to safe water and a greater risk of severe dehydration.

Regional hotspots

Active outbreaks in the hotspots of the Democratic Republic of the Congo (DRC) and Nigeria are fuelling the risk of cross-border transmission to neighbouring countries.  

The DRC is the hardest hit country in the region, reporting more than 38,000 cases and 951 deaths in July. 

Children under five now account for nearly 26 per cent of cases in the DRC, and without stronger containment measures, they may face the worst cholera crisis since 2017.

The situation in the capital, Kinshasa, is particularly critical as intense rainfall and widespread flooding have caused cases to surge sharply over the past four weeks. Straining an already overwhelmed healthcare system, the city is now facing an alarming case fatality rate of eight per cent.

Nigeria is the second most affected country in the region, with 3,109 suspected cholera cases and 86 deaths as of the end of June. Cholera is endemic in the country, where major outbreaks have re-occurred in recent years.

Region-wide crisis

Chad, Republic of Congo, Ghana, Côte d’Ivoire and Togo are also facing ongoing epidemics.

A total of 612 cholera cases were reported in Ghana as of 28 April, 322 cases and 15 deaths in Côte d’Ivoire as of 14 July and 209 cases and five deaths in Togo as of June 22.  

Niger, Liberia, Benin, the Central African Republic and Cameroon are also under close surveillance due to their vulnerability.

UNICEF response

Urgent and scaled-up efforts are needed to prevent further spread and contain the disease across the region.

Throughout the outbreaks, UNICEF has delivered lifesaving health, water, hygiene and sanitation supplies to treatment facilities and communities.  

The agency has also supported cholera vaccinations, scaled up preparedness and response efforts and encouraged families to seek timely treatment and improve their hygiene practices.

“We are in a race against time, working hand in hand with the authorities to deliver essential healthcare, safe water and proper nutrition to children already at risk of deadly diseases and severe acute malnutrition,” said Mr. Fagninou.  

“Together with an array of partners, we are strengthening community engagement and extending our reach to remote and underserved areas, making every effort to ensure that no child is left behind.”

UNICEF West and Central Africa urgently requires $20 million over the next three months to scale up critical support in health, WASH, risk communication and community engagement. 

South Sudan’s longest cholera outbreak enters critical stage

The outbreak – which started in September 2024 and was confirmed a month later – comes amidst a protracted humanitarian crisis exacerbated by rising intercommunal violence, climate shocks such as flooding and catastrophic hunger.  

“Now, more than ever, collective action is needed to reduce tensions, resolve political differences and make tangible progress in implementing peace,” said Anita Kiki Gbeho, UN Resident and Humanitarian Coordinator in South Sudan.  

Alarming escalation

Since the cholera outbreak was declared in October 2024, UN agencies and partners have documented over 80,000 cholera cases and 1,400 deaths.  

This is in addition to regional outbreaks of mpox, hepatitis and measles among other communicable diseases.

South Sudanese authorities, civil society and UN agencies held an inter-ministerial meeting on Monday to discuss what they called an “alarming escalation” in the spread of the outbreak. 

“This is not merely a public health crisis, but a multi-sectoral emergency exacerbated by flooding, displacement, and limited access to basic services,” the ministers wrote in a communiqué released.  

The group resolved to facilitate unimpeded humanitarian access to areas which already have outbreaks and to other areas at risk for outbreaks. The Government of South Sudan will coordinate these efforts.

Partners will also work to preposition materials, improve water and sanitation infrastructure and coordinate proactive and reactive vaccination campaigns.  

Time is running out

With the peak of the rainy season on the horizon, the next eight weeks are critical in containing and mitigating the outbreak before severe flooding begins.  

“Time is of the essence to prevent a further escalation of the outbreak,” the officials wrote.  

Floods more than double the frequency of cholera outbreaks by imperiling access to clean water and impeding humanitarian access to affected areas. And with rising global temperatures making floods more severe, millions of South Sudanese who were not previously in regions of concern may now be at risk for cholera outbreaks.

A preventable disease  

Cholera is an acute diarrhoeal infection caused by consuming contaminated water or food. Although highly communicable, it is preventable through proper hygiene, regular handwashing, safe food preparation and storage, improved sanitation infrastructure, and vaccination.

Symptoms typically include watery diarrhoea. Most cases are mild to moderate and can be treated effectively with oral rehydration salts (ORS) mixed with clean, boiled water.

However, in severe cases, cholera can be fatal—sometimes within hours—if not treated promptly.

Infected individuals can also transmit the disease through their faeces for up to ten days, even if they show no symptoms.

Need for additional funds

In South Sudan, the already inadequate water and sanitation infrastructure and overstretched public health system has further deteriorated as a result of displacement and conflict. This has ripened the conditions for the spread of cholera.

The UN and its partners are working quickly to preposition emergency supplies, especially in these previously low-risk areas, but they are hampered by funding shortfalls. Agencies estimate that they will need $1.69 billion – of which they have only received $368 million – to address the many intersecting humanitarian needs in the country.  

Nevertheless, the group of ministers insisted that this outbreak is and must remain a priority for all involved.

“Cholera response and flood preparedness must be treated as urgent national priorities,” they said in the communiqué. 

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Anthrax outbreak compounds security crisis in eastern DR Congo

And with nearly seven million people forcibly displaced by violence since advances by M23 rebels earlier this year, the DRC is facing one of the world’s most complex displacement crises, according to the UN migration agency (IOM).

Living in overcrowded and under-resourced camps, displaced populations are increasingly vulnerable to both disease and attack.

Since January 2025 alone, over 660,000 people have been forced to flee the Goma region after Government forces lost control of the key city along with Bukavu to the south.

Tipping point

The scale of the humanitarian needs in the country has reached a tipping point, according to IOM, with outbreaks of mpox and anthrax underway in the east.

While both mpox and anthrax typically affect livestock and other animals, food insecurity resulting from the ongoing conflict, paired with unsanitary living conditions in displacement camps, puts humans at greater risk of transmission.

Dangerous infections

Both the potentially deadly infections can be contracted through contact with infected or contaminated animals. Although anthrax is not generally contagious, mpox is, the World Health Organization (WHO) underlines.

Mpox is typically accompanied by fever and rash and rarely requires hospitalisation, while all human cases of anthrax do, the UN health agency added.

Since 22 March, following the deaths of dozens of buffalo and hippopotamuses in Virunga National Park from anthrax poisoning, 16 suspected human cases of anthrax have been reported, including one confirmed case. One person has died so far.

Outbreak response

WHO is conducting assessments in the eastern part of the DRC to determine the risk of the anthrax infection spreading further across the region.

As both mpox and anthrax are treatable with antibiotics, and preventable through vaccination, WHO and its partners are working to prevent future outbreaks by adopting a unified approach, prioritising human, animal and environmental safety.

Awareness campaigns and efforts to vaccinate livestock against anthrax are now underway.