Conflict, poverty and collapsing services: why cholera is surging again
“Peace is health,” World Health Organization Director-General Tedros Adhanom Ghebreyesus repeats in briefings, a blunt reminder that infectious disease is not merely a biological problem but a political and social one. In late August 2025, WHO warned the world that cholera is resurging — and that the drivers are familiar: armed conflict, broken water and sanitation systems, deepening poverty and strained vaccine supplies.
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The warning is not abstract. In Sudan’s Darfur region, the United Nations Children’s Fund said that more than 2,000 suspected cholera cases and at least 80 deaths were reported by early last month, and that some 640,000 children under five in North Darfur alone face heightened risk. Those figures mark yet another chapter in an unfolding humanitarian catastrophe linked to the Sudanese proxy war that has displaced millions and left services in ruins.
Scenes on the ground
Humanitarian agencies describe the familiar, grim pattern: camps and informal settlements swollen with people fleeing violence; water sources contaminated or cut off; latrines overflowing; and frontline clinics overwhelmed. Where safe water and functioning sanitation disappear, so does the thin barrier that keeps cholera at bay.
For aid workers, the link is immediate. “Outbreaks follow the conflict map,” one regional humanitarian coordinator told colleagues last month. “When people move, they crowd into whatever shelter is available. Without clean water and sanitation, a few contaminated wells can become hundreds of cases in a matter of days.”
More than Darfur: a global pattern
WHO’s August 31, 2025, report left little room for complacency: “The global cholera situation continues to deteriorate, driven by conflict and poverty, posing a significant public health challenge across multiple WHO regions.” That deterioration is part of a broader, worrying trend. Historically, cholera has been linked with poor sanitation and weak public infrastructures — conditions that are worsening in multiple hotspots, from parts of the Sahel and the Horn of Africa to regions in the Middle East and beyond.
There is also an inconvenient modern twist: climate extremes. Floods, cyclones and heavy rains can wash human waste into drinking supplies and trigger explosive outbreaks. In an era of more frequent and fierce weather events, the conditions that allow cholera to spread are multiplying.
Tools exist — but not where they’re needed most
Public health tools to prevent and control cholera are well understood: safe water, improved sanitation, swift case management, community hygiene education and, increasingly, oral cholera vaccines (OCV). Zambian President Hakainde Hichilima, who serves as a champion for the Global Task Force on Cholera Control, has pressed policymakers to scale up investments in these measures and to accelerate vaccine production.
Yet gaps remain. Global estimates from WHO in previous years suggested that the world sees between 1.3 and 4.0 million cholera cases each year, with tens of thousands of deaths. Those figures are wide because surveillance systems are patchy in many of the hardest-hit places; when civil services collapse, so, too, does the ability to count cases and respond.
Vaccine supply is a particular pinch point. The global stockpile of oral cholera vaccines, while lifesaving where deployed, is limited. During synchronized outbreaks across several countries, the stockpile is stretched thin — and manufacturers are not producing at a scale that equals need. That leaves public health teams prioritizing who gets vaccinated and when.
Rethinking cholera as a peace and development issue
The renewed cholera outbreaks force a fundamental question: can the international health community treat cholera like any other epidemic when its root causes are political and economic? Tedros’ phrase — “Peace is health” — is more than rhetoric. In practice, preventing cholera means preventing the conditions that make it spread: ensuring uninterrupted services, protecting water systems in conflict zones, and sustaining funding for long-term sanitation projects.
That agenda demands more than emergency interventions. Investments in water, sanitation and hygiene (WASH) infrastructure are expensive and politically fraught, especially in fragile states. Donors and national governments often prefer short-term, visible projects. But cholera teaches a different lesson: durable gains require patience, financing and above all security for service delivery.
What governments and donors should consider
Practical steps are clear, even if politically difficult. They include:
- Scaling up humanitarian corridors and agreements that protect water and health workers in conflict zones.
- Financing large-scale WASH projects that reach displaced populations and host communities alike.
- Boosting production and equitable allocation of oral cholera vaccines while strengthening surveillance to target vaccinations where they can prevent the most cases.
- Supporting community-led hygiene campaigns that respect local cultures and practices, to ensure uptake and sustainability.
These measures are costly, and the question of political will remains. International attention is fickle; crises that devour headlines one month can be eclipsed the next. Yet when cholera returns, the human toll is immediate and unforgiving — especially for children in fragile settings.
Beyond emergency relief: asking the harder questions
Cholera’s resurgence asks more than technical questions about water and vaccines. It asks whether the international community is willing to treat basic public health as a long-term pillar of peacebuilding. It asks whether investments in sanitation and safe water can be seen not merely as development luxuries but as frontline defenses against conflict-driven epidemics.
History offers a reminder. The cholera outbreaks John Snow traced in 19th-century London led to a revolution in sanitation policy. Today’s outbreaks offer a similar test: will governments choose the short-term politics of neglect, or the longer, harder work of building systems that keep people healthy even in times of crisis?
The answer will determine not only how many lives are saved this year, but how resilient communities become in the face of the next shock — whether it is war, flood, or drought.
By News-room
Axadle Times international–Monitoring.
