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Cholera in Yemen on Track to Kill More People Than Ebola Did in Guinea



The map above reveals where cholera cases are most concentrated in Yemen, as of Aug. 13, 2017. (Andrew Schroeder/Direct Relief)

A cholera epidemic is exploding in war-torn Yemen. At its current pace this easily treatable disease could soon kill more people than the Ebola epidemic of 2013-2015 in Guinea. Roughly four weeks from now, if left unchecked, cholera in Yemen could claim more than 2,544 lives. That’s how many Guinean lives were lost to Ebola in the West Africa outbreak that escalated to pandemic levels. In 12 weeks cholera deaths in Yemen could surpass the nearly 4,000 killed by Ebola in Sierra Leone.

Cholera is spreading so fast that the World Health Organization was forced in July to cancel a planned million-dose cholera vaccination campaign. The WHO judged that the epidemic was spreading too fast for a vaccination campaign to make enough of an immediate impact to justify the security risks amid ongoing conflict.

As a result, the WHO and other global health authorities are urging a rapid and distributed scale-up of conventional infection control methods, including water purification and aggressive rehydration.

While the ongoing armed conflict in Yemen compounds the difficulty of controlling the epidemic, it is still possible to get assistance to areas in need. Several national and international NGOs like Save the Children are providing essential aid in the most affected areas, and Direct Relief is continuing to supply critical medical resources needed to treat cholera.

In February of this year, the UN Secretary General announced that over 20 million people in four countries from West Africa to the Middle East were on the cusp of famine. The four countries of Nigeria, South Sudan, Somalia and Yemen all share a tragic confluence of conflict, drought and disease, which accelerates underlying issues of poverty, inequality and weak infrastructure at sufficient scale to create conditions for what the UN and many others soon named “the worst humanitarian crisis since WWII.”

Since February, conditions for these four countries have not markedly improved, nor have humanitarian funding targets come close to being met. For Yemen, the poorest country in the Middle East, famine only accelerates the country’s descent into crisis. At the end of May, the cholera epidemic in Yemen was already quite serious but still within manageable bounds, with over 35,000 suspected cases and 361 total deaths. Since that point, the cholera epidemic has reached runaway proportions as the world’s fastest moving and deadliest infectious disease outbreak.

The country has averaged over 5,600 new cases and almost 20 deaths every single day. As of Aug. 13, there were 503,484 suspected cases and 1,975 confirmed deaths, with no end in sight. Yemen’s total population is a little more than double that of Guinea’s, but the rate of disease transmission remains highly alarming. Compared to Ebola, controlling cholera should be straightforward. There wasn’t a vaccine at all for Ebola, for instance, during the 2013 outbreak. Ebola treatment also calls for stringent quarantine procedures and measures to protect health workers that go well beyond the requirements of cholera.

Given that cholera is a bacterial infection associated with contaminated drinking water and poor sanitation, basic handwashing, access to clean water and timely medical treatment can halt the formation and spread of the disease. More than 99 percent of people sick with suspected cholera and who are able access health services are now surviving, according to a July 26 statement from UNICEF, WHO and the World Food Programme.

As simple as these steps may be, they still require security for health workers and sufficient medical resources, both of which are in short supply in Yemen. Direct Relief continues to supply partners in Yemen with cholera treatment kits that enable care for hundreds of patients. The kits were designed using WHO guidelines for cholera treatment and prevention. The next Direct Relief shipment is scheduled to arrive in the coming weeks, and is being coordinated with the World Food Programme.

The risks can’t be overstated. At the same time, the cost of inaction is steep. If the global health community is not able to act soon, Yemen could find its place among history’s worst infectious outbreaks.

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