Outbreaks can rapidly spread in over-crowded communities and in dense living conditions, such as refugee camps and in slums, when there is inadequate access to clean water, waste collection, and proper toilets. People being displaced, destruction of infrastructure, or a lack of public services can mean cholera is a serious risk in the aftermath of a natural disaster or during a conflict. Both drought and flooding can increase the risk for cholera. Drought decreases the available amount of clean water, forcing people to use contaminated water. Flooding can spread the bacteria and contaminate water sources.

Cholera is relatively simple to treat in most cases, with people with mild to moderate forms usually able to recover through treatment with fluids and oral rehydration salts, which are easy to administer. People who are severely dehydrated may need intravenous fluids and hospitalisation. In these cases, they should be admitted to a Cholera Treatment Centre (CTC). Without treatment, the mortality rate can reach 50 per cent. With proper medical care, it's around 0.2 per cent.

Cholera occurs in areas with poor access to sanitation and unsafe drinking water - so providing people with clean drinking water and proper sanitation facilities is vital to preventing and curbing any outbreaks. Our water and sanitation teams provide people with sachets to purify water, truck clean water in, and install, fix and clean out sanitation facilities such as toilets in affected areas. Informing people about good hygiene practices such as washing hands, using clean toilets, and using only clean water to drink and wash food, can also curb outbreaks of the disease.

Vaccines against cholera are orally administered, which is practical for mass vaccination and does not require medical personnel. Of the two vaccines used for mass vaccination, one does not even need a cold chain. We know that one dose of a vaccine provides sufficient protection and can reduce or prevent transmission of the disease, but vaccination officially requires two doses. However, in October 2022, a WHO-hosted vaccination coordination group – of which MSF is a member – exceptionally approved one-dose strategy, given a shortage of cholera vaccines and the high number of outbreaks around the world.

A rapid response is vital to containing the spread of a cholera outbreak. Quickly putting in place health promotion activities - educating people about how to help to limit the spread - plus water and sanitation activities, establishing treatment centres and vaccinating in an emergency response can help limit how far an epidemic spreads and reduce the number of people who fall sick or die.

The design of the Cholera Treatment Centre (CTC) by MSF was a significant contribution to cholera epidemic response. A CTC is set up outside of the main hospital to prevent the spread of the disease and is fully autonomous. In open settings, with spread-out populations, treatment needs to be as close as possible to affected populations. Care can be decentralised to smaller-scale CTCs known as cholera treatment units and oral rehydration solution (ORS) points, supported by mobile teams.