Southern Africa's cholera outbreak is a multinational fight

In Brondo in the southeastern Democratic Republic of the Congo (DRC), accessing clean water is essential for survival. Despite enjoying rich rainfall for much of the year, the region lacks proper water treatment.

For residents like Betty, access to sanitation and treated water is extremely limited.

"We drink the unclean water. There are overflowing septic tanks and rainwater that brings the city's garbage into the houses," Betty told DW. Health experts have issued renewed warnings about surging cholera cases in the region.

The disease is spreading rapidly in Zimbabwe, Malawi, Mozambique and the DRC, with neighboring countries keeping a watchful eye on their borders.

Yet most longterm remedies against the outbreak are to be found at the local level.

Zimbabwe's search for clean water

In Zimbabwe, the situation has reached a critical point. Since the beginning of the outbreak, more than 22,000 cases and over 450 deaths have been repoted.

Doctors have criticized a lack of awareness about preventive measures among communities.

"People are not keen on treating borehole water,"  Michael Vere, an epidemiologist at Harare Central Hospital, said in reference to water extracted through narrow shafts bored into the ground. "They assume that borehole water is safe, but the water is not safe." 

In Zimbabwe's capital, the issue is further exacerbated by the population density in certain areas, such as the Highfield suburb. Communities are now facing a shortage of safe playing areas for children, as raw sewage continues to flow in backyards and on the streets.

Chiedza Zulu, a concerned mother of four, summarized the fear that has been gripping the community.

"Cholera cases are cropping up around us. We now keep oral hydration salts in case we contract the disease. Sewage is flowing, and refuse is not being collected. Flies, rodents and mosquitos are plenty here. This is unbearable," she told DW.

'Treat all water'

Dr. Vere emphasized the importance of addressing inadequate water and sanitation conditions to protect local residents. "We encourage people to treat all water, regardless of source," he said.

With suspected and confirmed cases reported in 61 out of 64 districts, Zimbabwe's government has now taken action to address the outbreak head-on.

Health authorities have set up 153 cholera treatment centers and have initiated a cholera vaccination campaign.

Not enough vaccines available

However, a global shortage of the cholera vaccine has been hampering Zimbabwe's efforts to vaccinate a large portion of its population.

Douglas Mombeshora, Zimbabwe's Health and Child Minister, said the vaccine was not a quick fix for ending the cholera crisis.

"The vaccine is not an end to cholera," Mombeshora told reporters. He added that it rather amounted to "a temporary response which should be complemented with tangible investment in safe water provision."

According to a UNICEF report, Zimbabwe is facing a shortage of investment in water and sanitation infrastructure. As a result, only about one in three households have access to treated water sources and sanitation.

Southern Africa on high alert

Mozambique appears to be in a similar situation as Zimbabwe, with around 40,000 cholera cases and 151 resulting fatalities reported so far.

However, Mozambique's numbers reach as far back as September 2022, marking a slow march towards endemic propotions.

Similarly, the DRC is also currently grappling with a longer-lasting cholera outbreak.

Despite ongoing efforts to strengthen disease surveillance and response activities, there have been nearly 300 cholera cases recorded in the DRC's southeastern Haut-Katanga province since the beginning of the year.

Albert Tambwe, director of the School of Public Health at the University of Lubumbashi, attributes the rise in cases to overall unsanitary conditions.

"The conclusion is that our water is indeed 52% contaminated but with salmonella and other germs," he said, highlighting the daily struggle people face whenever they turn on their taps.

Tambwe, however, added that there wasn't any notable rate of cholera bacteria in the water — yet.

Low incidence rate in Malawi

Meanwhile in neighboring Malawi, there have only been 58 cholera cases reported so far.

However, health experts are calling on the government to nevertheless allocate more funds towards water, sanitation and hygiene (WASH) programs and not be appeased by lower case numbers compared to its neighbors.

Maziko Matemba, a public health expert in Malawi, highighted the need to improve access to safe and clean water in a bid to curb the spread of the disease.

"If it is not well supported in terms of buying commodities and other necessities, I think it will be challenging," Matemba told DW.

Cleaning up with dirty water

The Ministry of Health in Malawi has actively been monitoring the disease since the start of its national campaign to end cholera in 2023.

Adrian Chikumbe, spokesperson for the Ministry of Health, says the government has a comprehensive set of measures aimed at containing the spread in place, including intensified communication efforts and enhanced surveillance.

Matemba believes this is not enought. He underscored the magnitude of the persistent cholera risk in Malawi, and cited factors like limited access to clean water and the urgent need for substantial support in terms of resources as solutions to a "ticking time bomb."

Malawi's Minister of Water and Sanitation Abida Mia believes that it is not so much the quality of the water itself but rather its use that needs be highlighteed in campaigns.

She believes that promoting better hygiene practices are key components of the ongoing efforts to combat the disease. "Hygiene is the main problem that we are facing regarding the spread of cholera," she told DW.

A regional response

In response to the escalating health crisis, leaders of the intergovernmental organization the Southern African Development Community (SADC) have devised a collective strategy to combat cholera.

They have pledged to increase investment in water and sanitation infrastructure in the region.

"The public health crisis plaguing our region poses a serious threat to sustainable development and the well-being of our peoples," said Angolan President Joao Loureco, who currently chairs the rotating presidency of SADC.

"Cholera knows no borders and requires a regional approach to address it," Loureco added.

In a virtual summit, SADC leaders agreed to provide efficient waste management and a sustainable supply of clean water. They also recognized that at least 40% of the region's population lacked access to safe water.

This article was translated by Mimi Mefo Takambou.