/ 2 February 2024

WaterAid warns of regional cholera epidemic as cases spread across Southern Africa

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Kariba REDD+ Project members fetching water from the borehole to irrigate their garden in Hurungwe RDC, Zimbabwe.

Focus required to fix root causes: lack of access to clean water and sanitation

As Zambia fights to contain its worst cholera outbreak since 2017, cases are already being reported in other countries in the region, including Zimbabwe, Malawi, Mozambique and South Africa. 

Zambia is recording more than 400 new cases of cholera a day, with young people especially impacted. Schools and colleges remain closed and one of the main football stadiums in the capital Lusaka has been turned into a treatment centre. International NGO WaterAid is supporting a government-led coalition to try to further contain the spread. 

WaterAid has warned that, without addressing the root cause of cholera — a lack of clean water and sanitation (WASH) — there may be a further rise in cases across the region. While it is important to deal with the current emergency, the NGO is urging leaders to allocate adequate financial and human resources to address the longer-term infrastructure issues. 

WaterAid Regional Director, Robert Kampala, said: “Cholera reflects deep inequality in society and the inadequacy of sustainable water, sanitation and hygiene access, especially among poorer communities. Across the region, in recent years — particularly in Zambia, Malawi and Mozambique — we are seeing the devastating consequences of slow progress in water and sanitation funding, as lives are lost and livelihoods needlessly destroyed. 

“These frequent cholera emergencies affect not only people and communities. They also undermine economies, productivity and economic growth.  

Mozambican children learn about hygiene in a WaterAid initiative.

“We urgently need to see investment in water and sanitation increased, at pace — this will save lives, safeguard livelihoods and equip the region to deal with the disease in a sustainable way to ensure that it becomes a thing of the past. 

“By taking a proactive stance, national governments will be able to save precious resources and boost economic development.”  

The statistics show the Southern Africa Development Community (SADC) suffers inadequate access to WASH, leading to higher vulnerability to cholera and other pandemics.  

UNICEF data indicates that, since the first known case in Zambia in October 2023, more than 200 000 cases and over 3 000 deaths have been reported. In Mozambique, basic access to hygiene at household level is very low, at around 26%.

In schools, it is estimated at 15% and in healthcare facilities at 40%. The proportion of the population practising open defecation is estimated at 20.7%.  

Short-term solutions

 For the short-term, WaterAid urges national governments to:  

  • Provide adequate resources and increase capacities of public institutions to deal with and arrest the on-going outbreak;  
  • Step up public awareness education and information dissemination on cholera, especially among marginalised and poorer communities that have limited access to clean water, sanitation and good hygiene;  
  • Provide the required toolkits such as clean water, hand-washing soap, hand-washing stations and chlorine tablets, among others, to ensure that those that are directly affected can better cope with the outbreak;  
  • Support and strengthen the capacities of health workers who may be overwhelmed with the ongoing situation.  
Wateraid People Spostcodelottery Mariomacilau
Access to clean water saves lives — and money. (Photo: Mario Macilau)

Longer-term solutions

For the medium- to long-term, WaterAid urges SADC member states, that in line with the SADC Regional Hygiene Strategy and the Ngor Commitments, to ensure universal access to resilient, inclusive and sustainable WASH and address the root causes by:  

  • Allocating adequate financial, human and technical resources to address current limited WASH facilities and infrastructure  by progressively allocating a minimum of 0.5% of annual GDP;
  • Focusing on the poorest, most marginalised and unserved, aimed at progressively eliminating inequalities in access and use and implement national and local strategies with an emphasis on equity and sustainability;   
  • Enabling and engaging the private sector in developing innovative sanitation and hygiene products and services, especially for the marginalised and unserved.

About WaterAid

WaterAid is an international not-for-profit determined to make clean water, decent toilets and good hygiene normal for everyone, everywhere within a generation. We work alongside communities in 22 countries to secure these three essentials that transform people’s lives. Since 1981, WaterAid has reached 28 million people with clean water and nearly 29 million people with decent toilets.  

For more information, visit the website wateraid.org/uk


  • 703 million people in the world – almost one in 10 – don’t have clean water close to home.
  • 2.2 billion people in the world – more than one in four – don’t have safe water.
  • 1.5 billion people in the world – almost one in five – don’t have a decent toilet of their own.
  • Almost 400 000 children under five die every year due to diseases caused by unsafe water, sanitation and hygiene. That’s more than 1 000 children a day, or almost one child every one-and-a-half minutes.
  • Investing in safely managed water, sanitation and hygiene services provides up to 21 times more value than it costs.