Cholera ravages war-torn areas, but why?

Most people have probably heard by now that Yemen is in the midst of a massive cholera outbreak. And has been for the past three months. Current estimates put the number of cases in the 300,000 range, with over 1800 deaths. The International Committee of the Red Cross estimates the case count will be 600,000 by the end of the year. That means one in 45 Yemenis will have cholera by 1 January 2018. One in 45. To put that into some perspective, the US would need over 7 million cases of cholera by year’s end, when in fact the US in 2015 had four cases of cholera.

Attack rate and distribution of cholera cases in Yemen as of 17 July 2017.

Attack rate and distribution of cholera cases in Yemen as of 17 July 2017.

Cholera is unfortunately a pretty common pathogen in war-torn and natural disaster ravaged areas. You probably haven’t forgotten the Haiti outbreak where in 2010 United Nations peacekeepers from Nepal arrived to help after the earthquake. They then introduced cholera to the island of Hispaniola (which contains Haiti and the Dominican Republic), which hadn’t seen the disease in over a century.

Cholera and war

War-torn areas and areas damaged by natural disasters have some things in common that help the spread of cholera along. In both instances health infrastructure is damaged. Yemen has been in a civil war since 2015 and around half of country’s medical facilities have been closed or destroyed. Medecins Sans Frontieres (MSF) is there working to help provide healthcare to Yemenis. MSF is also trying to maintain the healthcare facilities that haven’t been closed or destroyed. Many Yemenis are internally displaced, meaning they have fled their homes due to the fighting but haven’t left the country. The healthcare system in Yemen is understaffed and under-supplied due to the war. A lack of health infrastructure means the easily treatable cholera now becomes deadly.

Cholera also thrives in areas without clean water. A lack of clean water is pretty common in war-torn areas. If war is all around, the person responsible for making sure the garbage is picked up probably has bigger concerns on their mind. Additionally war can cause damage water and sewage infrastructure. And people have to drink water to survive, so they drink contaminated water because it’s all they have.

The front lines of the Yemen civil war.

The front lines of the Yemen civil war.

Add to this large groups of people crowded together in potentially unsanitary conditions allows cholera to spread rapidly. In war folks are fleeing with the things they can carry and people tend to move towards larger cities or camps for displaced persons. Many of the camps have water, sanitation and healthcare facilities. But cholera spreads quickly and it can be hard to contain an outbreak once it starts.

Now you can see how this outbreak came into existence. The war in Yemen has created a “perfect storm” of opportunity for cholera: damaged healthcare infrastructure, lack of clean water, and crowded conditions. Unfortunately, the cholera outbreak in Yemen is just an example of what war can do to improve the spread of infectious diseases.

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