Africa’s Worst Cholera Outbreak in 25 Years: What Medical Experts Want You to Know Now

Cholera — an acute, watery diarrheal disease caused by the bacterium Vibrio cholerae — remains one of the world’s most insidious public health threats, especially in regions where clean water and sanitation are lacking. In 2025, Africa is reeling under what health authorities are calling its worst cholera outbreak in a quarter-century. The scale and severity of this epidemic raise alarm bells, not just for individual countries, but for the continent as a whole.

The Scope of the Crisis

According to the Africa Centres for Disease Control and Prevention (Africa CDC), around 300,000 cases of confirmed or suspected cholera have been reported so far in 2025, with more than 7,000 deaths. These figures represent a more than 30% increase compared to the previous year.

On a regional level, the World Health Organization (WHO) Regional Office for Africa (AFRO) reported that as of March 30, 2025, there had been 67,496 cases and 1,398 deaths in that month alone. Cumulatively, from January 2024 onward, almost 246,896 cases and 4,626 deaths were recorded in WHO’s March bulletin.

These numbers, however, only tell part of the story. The geographic spread is vast, touching dozens of countries across the continent. According to WHO, more than 23 African nations have reported cholera cases in 2025. UNICEF has highlighted that Eastern and Southern Africa remain deeply affected, with over 178,000 cases in 16 countries between January 2024 and March 2025.

Why Are Experts Calling It the Worst in 25 Years?

The description “worst in 25 years” comes from both epidemiological data and systemic risk factors. On one hand, the sheer volume of cases and deaths is extraordinary — especially concentrated in a relatively short time frame. On the other, the underlying drivers of this crisis are deeply structural: fragile water systems, conflict, displacement, and weak health infrastructure.

Jean Kaseya, Director-General of Africa CDC, emphasized in a press briefing that inadequate WASH (water, sanitation, hygiene) infrastructure is at the heart of the outbreak. In regions ravaged by conflict, access to safe water has broken down entirely; sewage treatment systems are non-functional, and overcrowding accelerates transmission.

In countries like Angola and Burundi, recent surges are linked to limited access to treated water and poor sanitation. In Sudan, the situation is exacerbated by decades-long civil strife: much of the water and sewage infrastructure has been destroyed, and many people live in cramped, displaced-person camps where basic hygiene is impossible.

Hardest-Hit Countries: Who Is Suffering Most?

While the outbreak is widespread, certain nations are particularly under siege.

• Sudan: The 2024–2025 cholera epidemic in Sudan (including parts of South Sudan and Chad) is especially devastating. According to Sudan’s Ministry of Health, by October 2025 there were 120,496 reported cases and 3,368 deaths. Regions like Darfur, long affected by conflict and displacement, have seen alarming mortality rates.
• Democratic Republic of the Congo (DRC): The DRC has emerged as a regional hotspot, particularly in its eastern provinces. According to a UN report, in July alone Kinshasa saw a case fatality rate (CFR) as high as 8%, compounded by flooding, overcrowding, and poor sanitation.
• Nigeria: Cholera remains endemic in Nigeria, with UNICEF reporting 3,109 suspected cases and 86 deaths across 34 states by the end of June 2025. Moreover, UNICEF estimates 80,000 children are at high risk in West and Central Africa, including Nigeria, because of flooding and displacement.
• Angola & Burundi: These two countries are flagged by Africa CDC for showing renewed, active transmission in 2025. Angola’s surge is fueled by weak sanitation systems, particularly in its urban areas. Burundi, while smaller in absolute numbers, reflects a troubling trend of resurgence.

Why Is Cholera Spreading So Rapidly — According to Experts

Medical experts and public health authorities point to a convergence of risk factors making this outbreak particularly deadly and persistent:

1. Poor Water, Sanitation, and Hygiene Infrastructure (WASH)
   At the root of cholera transmission is contaminated water. When clean water systems fail or don’t exist, Vibrio cholerae can multiply and spread rapidly. Africa CDC has repeatedly emphasized that fragile water systems — often destroyed or never built — are fueling the crisis.
2. Conflict and Displacement
   In conflict zones, infrastructure collapses. In Sudan, for example, fighting has damaged sewage systems and water treatment works, leaving many communities dependent on unsafe water. Displaced populations living in camps are particularly vulnerable — crowded living conditions, poor sanitation, and limited health access combine dangerously.
3. Climate and Environmental Shocks
   Cyclones and flooding exacerbate cholera risk by overwhelming sanitation infrastructure. The WHO Regional Office for Africa highlighted the impact of tropical cyclones (e.g., Cyclone Dikeledi in January 2025) on cholera transmission. Floodwaters can mix with sewage, contaminate wells, latrines, and communal water points — turning everyday water sources into hazards.
4. Limited Access to Vaccines
   Health officials have warned of a vaccine supply gap. According to Africa CDC, although the continent needs about 54 million doses of the oral cholera vaccine (OCV) annually, it only receives about half. This deficiency severely constrains preventive campaigns, especially in high-risk zones.
5. Weak Health Systems & Delays in Treatment
   Fatalities from cholera spike when cases are not treated quickly. In many affected areas, health facilities are under-resourced or non-functional. According to WHO, in 2024, a quarter of cholera deaths occurred outside health facilities, highlighting critical gaps in treatment access. Limited access to rehydration therapy — the cornerstone of cholera treatment — increases mortality.
6. Children at Disproportionate Risk
   Children, particularly under the age of five, are especially vulnerable. In the DRC, UNICEF reports that nearly 26% of cholera cases are among children under five. The risk is further amplified by malnutrition, which weakens immunity and makes dehydration more deadly.

What Medical Experts Are Urging Now

Given the scale and severity of the outbreak, medical and public health experts are calling for urgent, coordinated action across multiple fronts:

1. Strengthening WASH Infrastructure
   The most sustainable way to control cholera is to invest in robust water and sanitation systems. Experts urge governments and international partners to prioritize funding for clean water delivery, sewage systems, and hygienic latrines — especially in conflict-affected and displaced communities.
2. Scaling Up Oral Cholera Vaccination (OCV)
   There is a strong push to expand the use of cholera vaccines. The African Union, Africa CDC, WHO, and other partners are calling for local manufacturing of OCVs to reduce dependence on external donors and address supply shortages. Rapid vaccination campaigns, especially in hotspots, are critical to blunt transmission.
3. Rapid Case Detection and Treatment
   Health systems must be strengthened to rapidly identify and treat cholera cases. This includes mobilizing treatment centers, ensuring the availability of rehydration salts, IV fluids, and trained staff. Experts also advocate for mobile clinics, particularly in remote and conflict-affected areas.
4. Community Engagement & Education
   Public health messaging is vital. Communities need to know how cholera spreads, how to treat it, and how to prevent it. Simple but life-saving advice — like boiling or chlorinating water, hand-washing with soap, and using latrines — must be reinforced. Building trust is essential, especially in communities with limited access to health services.
5. Surveillance and Early Warning Systems
   Experts emphasize the need for better disease surveillance. That means strengthening laboratory capacity across countries to confirm cholera cases, tracking outbreaks in real time, and using early warning systems to trigger rapid responses. Cross-border coordination is also vital, since cholera does not respect national boundaries.
6. Political Will and Leadership
   High-level political commitment is urgently needed. African leaders, Africa CDC, and partners have called for bold, coordinated political action to tackle the crisis. This means investing in health systems, mobilizing funding, and ensuring cholera response is a continental priority.

Real-Life Impacts: Human Stories

To understand the scale of this crisis, consider the real-world implications:

• In Sudan, health workers report being overwhelmed. In Darfur alone, Médecins Sans Frontières (MSF) treated over 2,300 patients in just one week. The outbreak has hit displaced populations hardest; many are living in makeshift camps without reliable access to clean water.
• In Kinshasa (DRC), intense rainfall and flooding have distorted urban water systems, sending cholera rates soaring. Hospitals in the city are under stress, and the death rate in some neighborhoods is alarmingly high.
• Across West and Central Africa, roughly 80,000 children are considered at high risk amid rainy season floods, displacement, and overwhelmed sanitation systems. For many children, the threat is not just the disease, but the lack of any safety net.

Challenges to the Response

Even as health experts race to contain the outbreak, several obstacles persist.

1. Funding Gaps
   Tackling a cholera epidemic of this magnitude requires massive investments — not just in emergency response but in long-term infrastructure. But many countries are financially constrained, and international aid is not always sufficient or sustained.
2. Vaccine Shortages & Distribution Issues
   As noted, oral cholera vaccine supply is limited. Even when vaccines arrive, distributing them in conflict zones or remote areas is logistically difficult. Cold-chain requirements, personnel shortages, and insecurity can hamper campaigns.
3. Insecurity and Conflict
   In war-torn areas, delivering humanitarian aid is inherently risky. Health teams and water/sanitation engineers may not be able to reach some communities. In places like Sudan, attacks on infrastructure have left water treatment plants nonfunctional.
4. Community Distrust
   In some regions, communities are suspicious of health interventions. Misinformation and stigma can lead to reluctance in reporting cholera symptoms, seeking treatment, or accepting vaccination.
5. Climate Variability
   As environmental shocks like cyclones or floods become more frequent, the pressure on already fragile systems intensifies. Without climate-resilient infrastructure, cholera risk remains persistent.

What You Should Know (Public Take-Home Messages)

From a public health perspective, here is what individuals and communities should understand about this outbreak — and what they can do to protect themselves:

• Cholera spreads through unsafe water. If water sources are unclean, or if sanitation is compromised, the risk skyrockets. Boiling, filtering, or chlorinating water can save lives.
• Hygiene matters, always. Frequent hand-washing with soap, especially after using the toilet and before eating, is a simple but powerful shield against cholera.
• Act quickly on symptoms. Cholera causes severe diarrhea and dehydration. If you or someone you know experiences these symptoms, especially in an outbreak zone, seek medical help immediately. The disease can kill within hours if untreated, but timely rehydration dramatically improves chances of survival.
• Vaccination helps — where available. If oral cholera vaccines are offered in your community, taking them can reduce risk. But vaccination is only one layer of protection: it doesn’t replace clean water and hygiene.
• Stay informed. Reliable information from health authorities matters. Ignore rumors and misinformation — follow trusted public health sources and community health workers.
• Raise your voice. Advocate for better water and sanitation infrastructure. Demand political accountability. Communities can push for more investment in WASH systems, stronger surveillance, and robust health services.

The Bigger Picture: Why This Matters for the World

This cholera outbreak is not just an African problem — it’s a stark reminder of global health inequalities and the perils of underinvestment in basic infrastructure.

1. Global Health Equity
   Countries experiencing cholera outbreaks often lack the resources to respond effectively. The disparity between vaccine supply and need highlights systemic inequities: wealthier nations may have access to tools that poorer nations desperately require.
2. Migration and Cross-Border Risk
   As conflict pushes people to flee their homes, cholera can spread across borders. Without coordinated surveillance and response, regional outbreaks can become continental ones.
3. Climate Change Linkages
   The outbreak underscores how climate shocks exacerbate health risks. Floods, cyclones, and extreme weather amplify vulnerabilities, especially in regions with weak infrastructure. As climate change intensifies, such outbreaks may become more frequent and severe.
4. The Need for Sustainable Investment
   Short-term emergency aid is critical, but not sufficient. The world needs to invest in durable water, sanitation, and health infrastructure that can withstand both disease and environmental stress.
5. Pandemic Preparedness Lessons
   Cholera may seem “old-fashioned” compared to newer diseases, but its re-emergence on a massive scale is a warning. Preparedness matters: we need strong surveillance, robust health systems, and global solidarity to prevent and manage outbreaks of all kinds.

Conclusion: A Moment of Reckoning

Africa’s cholera outbreak in 2025 is a wake-up call. The numbers — hundreds of thousands of cases, thousands of deaths — are tragic, but not inevitable. Experts consistently point to one central truth: this outbreak is driven by neglect.

Fragile infrastructure, conflict, poverty, and inequity have combined to create a deadly storm. But the same factors can be addressed — with political will, funding, and community engagement.

Medical experts, public health leaders, and international partners are urging bold, urgent action: expand vaccine coverage, rebuild water and sanitation systems, strengthen health services, and empower communities with knowledge and resources.

For people on the ground, the message is clear: take precautions, seek help early, and demand better. For governments and global partners, the time to act is now — not just to stop this outbreak, but to prevent the next one.