Save the Children analysed data from the World Health Organization and national governments, which showed that cholera cases surged more than four-fold in Malawi, Zimbabwe and Mozambique between 2022 and 2023. The number of cases jumped to about 95,300 from about 26,250 including over 1,600 deaths in the three countries, making it one of their worst cholera outbreaks in decades.
Already 2024 is threatening to be another devastating year for cholera in the region as warmer weather and unusually heavy rains and storms in southern Africa have fuelled the disease's spread. Zimbabwe, Mozambique and Malawi have reported more than 13,000 cases of the disease so far in 2024.
In Zimbabwe children aged under 15 account for about three in 10 cholera cases while children under five account for one in six cases, according to the UN [1]. In Malawi, which has counted over 160 cases so far this year, about four in 10 cases are children and young people under 19, according to the Ministry of Health. Both adults and children can contract cholera, but cases in children are more likely to lead to severe illness or death, with children under five especially vulnerable [2][3].
Cholera, a highly contagious disease, spreads quickly through contaminated water. It can also spread rapidly in areas with inadequate treatment of sewage, flooded areas, and areas without safe drinking water – all issues that can be exacerbated by flooding from tropical cyclones.
Last year, cholera cases surged in Malawi and Mozambique following Cyclone Freddy, the longest-lived tropical cyclone in history, that traversed the southern Indian Ocean for more than five weeks in February and March. In Malawi, over 200 children died in the cholera outbreak which began in 2022 and ended in mid-2023.
Save the Children said that the three countries, which have been worse-hit by cyclones in recent years amid climate change, are currently battling their biggest cholera outbreaks as the peak of another cyclone and rainy season approaches.
Save the Children's Malawi Country Director, Ashebir Debebe said:
"Children in Malawi faced repeated tragedies last year having battled the worst cholera outbreak on record, as well as the devastation of Cyclone Freddy. While the number of cholera cases in Malawi in 2024 are not at the levels seen in some other countries in the region, with the peak of this year's cyclone season fast-approaching there's a real risk that heavy rains and floods could lead to a repeat of last year's deadly outbreak. With the destruction and displacement that cyclones bring, it's not difficult to imagine a worst-case scenario for the spread of diseases such as cholera and malaria if we are not prepared and ready to respond."
Save the Children's Country Director in Mozambique, Brechtje van Lith, said:
"Mozambique is being hit from all directions as the country grapples with conflict, food insecurity, a cholera outbreak on a scale that it has not seen in decades – and all as it braces itself for another cyclone season. Any extreme weather event has the potential to cause cholera in the country to spin out of control. A malnourished child is at eleven times greater risk of dying from cholera than a healthy one. As with so many crises, it is young children who tend to bear the brunt of the disease."
Save the Children's Country Director in Zimbabwe, Bhekimpilo Khanye, said:
"Access to safe, clean water and sanitation is critical to control the transmission of cholera and other waterborne diseases and additional funds must be mobilised to support restoration of basic services, including water and sanitation and structural support to help communities absorb and recover from the impact of cholera and climate and weather-related disasters."
Save the Children has stepped up its preparedness efforts in the region to help mitigate the risk of diseases such as cholera and malaria spreading during the cyclone and rainy season.
In Malawi, we have prepositioned chlorine to disinfect dirty water, mosquito nets and buckets, while we are also supporting families with cash for food and weather-resistant crops.
In Mozambique we are working with local governments to provide soap, water purifiers and other items to facilitate access to safe water. We are also prepositioning essentials such as hygiene supplies and toilet constructions kits.
In Zimbabwe we are working with a local partner to tackle the cholera outbreak. We are conducting awareness sessions on sanitation and hygiene practices in schools and communities, training health workers, supporting community-led clean-up campaigns, providing water treatment tablets to households, and supplying cholera treatment centres with necessary equipment and fluids. Save the Children in Zimbabwe is also implementing a programme which aims to enhance access to clean and safe water for more than 60,000 individuals by installing solar-powered water schemes.
Save the Children has been working in Malawi and Zimbabwe since 1983 and in Mozambique since 1986 working on education programmes, child protection services, health and nutrition, child rights governance, climate adaption projects and humanitarian responses.
