Children's lives at risk in 11 countries across eastern and southern Africa as cholera cases peak

With extreme weather events exacerbating chronically underfunded water and sanitation infrastructure, UNICEF is appealing for US $150 million to support affected communities

10 March 2023
A child in the cholera treatment unit at Area 18 health centre
UNICEF Malawi/2023/Homeline Media

NAIROBI/JOHANNESBURG/NEW YORK, 9 March 2023 – Eleven countries in eastern and southern Africa are experiencing an extremely worrying cholera outbreak, with 67,822 cases and 1,788 estimated deaths.  However, actual figures are likely higher as limitations in surveillance systems, underreporting, and stigma hampers monitoring.

Two of the countries with the heaviest burden — Malawi and Mozambique — have a combined total of more than 5.4 million people in need of support, including more than 2.8 million children. 

“We thought this region won’t see a cholera outbreak this widespread and this deadly in this day and age,” said Lieke van de Wiel, UNICEF Deputy Regional Director, attending an Emergency Ministerial meeting on cholera in Lilongwe, Malawi. “Poor water and sanitation, extreme weather events, ongoing conflicts, and weak health systems are compounding and endangering the lives of children across southern Africa.”

UNICEF’s integrated response at the country level focuses on the provision of safe water and sanitation, water treatment, soap for handwashing, oral rehydration salts solution, and social, behaviour change, and communication engagement messages.

In addition, UNICEF with its partners is providing essential medical supplies and high-performance tents to better manage severe cases. As part of the integrated approach, UNICEF will provide lifesaving nutrition interventions, including nutrition screenings in all cholera treatment units, train healthcare workers to provide quality case management and infection prevention and control and establish community-based oral rehydration points to prevent progression to severe cholera for non-severe cholera cases.

UNICEF’s known expertise in Risk Communication and Community Engagement is building on the COVID-19 and other outbreak responses and innovative ways to engage communities and bring about the social and behavioural change required to increase health seeking practices and stop further spreading of disease.

Due to the rapidly deteriorating public health situation, particularly in the hardest hit countries, UNICEF is appealing for US $150 million for all 11 cholera outbreak countries in the region, including US $34.9 million for Malawi and US $21.6 million for Mozambique, to provide lifesaving services to people affected by the outbreak. 

The continuity of essential health services is critical given the outbreak’s potential to disrupt routine maternal, newborn, infant, child, and adolescent care that is the cornerstone of long-term child survival and well-being.

The region has been experiencing extreme weather events in the past months. Tropical storms Ana and Gombe hit Malawi just over a year ago, and Tropical Storm Freddy which made landfall in Mozambique last month, and continues to wreak havoc, with substantial flooding and displacement which creates conditions ripe for outbreaks to spread as people migrate to escape the devastation.

Partners have already contributed US $2.9 million to the response in Malawi, and US $550,000 to the response in Mozambique. With those funds, UNICEF has been able to scale up the supply of chlorine for water purification, medicine and equipment for infection prevention and control, and risk communication messages.

However, UNICEF currently has a combined funding gap of 92 per cent for both countries, which is limiting its ability to meet the needs of children affected by the crisis. For UNICEF and its partners to respond quickly and equitably based on the growing need, especially in underfunded sectors, flexible resources will play a critical role. 

Last month, WHO warned that 22 countries around the world are currently fighting cholera outbreaks – a number that has since increased following additional outbreaks. After years of declining cases of cholera globally, cases went up last year and were expected to continue to do so this year.

“This is a serious cholera crisis – and all signs point to this getting much worse before it gets better,” said van de Wiel. “We need urgent and sustained investment to respond to the immediate outbreaks and strengthen systems and communities to be better prepared for what is likely to be more severe occurrences in the future.”

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