Yemen, on the southern edge of the Arabian Peninsula, is in the middle of a cholera epidemic, with 5,000 new cases being reported every day. The country is in the midst of a devastating civil war that has claimed the lives of thousands and left millions of people without access to food, water and basic sanitation.
These conditions have contributed to the outbreak of the disease, which the WHO has described as being the worst in the world. As of June, they estimate that there have been over 260,000 cases and that the epidemic has claimed the lives of 1,300 people, a quarter of whom were children.
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Cholera is caused by Vibrio cholerae – a bacterium that typically lives in saltwater environments. When a person ingests water contaminated with V. cholerae the bacteria pass through the body and attach themselves to the wall of the small intestine. By producing a toxin, V. cholerae is able to induce the symptom most associated with the disease: huge amounts of watery diarrhoea.
This occurs in about one in ten people infected and leads to them passing a massive amount of fluid – up to a litre an hour – which can result in lethal levels of dehydration. The symptom gives the bacteria a route back into the water system, where they can go on to infect more people.
On paper, cholera is a disease that’s relatively easy to treat. Quickly replacing lost fluids – either orally or intravenously – and using antibiotics where necessary results in the majority of patients making a full recovery. Controlling the disease should be straightforward too – providing clean water and an adequate sanitation infrastructure helps to prevent outbreaks occurring.
However, infrastructure in Yemen has collapsed since the war, making prevention and treatment incredibly difficult to achieve. Last week, the WHO sent over 400 tonnes of health supplies to the country – including 100 cholera kits and 128,000 bags of intravenous rehydration fluids – but the breakdown of healthcare systems will make it hard to get these to the people who need them.
Yemen is not the only country experiencing an outbreak of this disease. There have been almost 7,000 suspected cases in South Sudan and around 53,000 in Somalia – two countries also ravaged by conflict.
Cholera is a disease that thrives when infrastructure fails, either as the result of war or natural disaster. To beat it, we need to ensure that everyone, everywhere has access to the things that many of us take for granted, not least clean water and food that’s safe to eat.