A cholera infection doesn’t have to be deadly, but it can be, especially in conflict zones such as in Sudan.
A year into an ongoing outbreak, Sudan has recorded more than 65,000 cholera cases — about 32,000 of those in 2025 alone — and about 1,700 deaths (426 in 2025).
“In Sudan, the conflict has severely disrupted access to safe water, sanitation and health care — the very systems that prevent and contain cholera,” Joe English, an emergency communication specialist at the United Nations Children’s Fund, wrote in an email to DW.
Data published by the World Health Organization (WHO) in 2024 suggested that global infections of cholera had increased by 13% in the previous year, and that 38% of reported cases were among children younger than 5.
This month, UNICEF reported that 25% of cholera cases in Sudan’s North Darfur region were among children under 5 years of age.
“Children are especially vulnerable,” English said. “Their immune systems are less developed, and the rapid dehydration caused by cholera can become life-threatening far more quickly in [their] young bodies.”
What is cholera?
Cholera is an intestinal infection that leads to severe diarrhea — also known as acute watery diarrhea. It is caused by Vibrio cholerae bacteria.
Other Vibrio bacteria can cause an illness known as vibriosis.
Vibriosis and the sickness caused by Vibrio cholerae have similar symptoms, and both can be fatal. The main difference is that cholera is caused by one specific strain of Vibrio cholerae, known as serotype O1 (or O139).
“Vibrio cholerae serotype O1 causes severe, dehydrating, watery diarrhea and can kill a patient within 24 hours,” David Sack, an expert in cholera and professor in the Department of International Health at Johns Hopkins Bloomberg School of Public Health, wrote in an email to DW.
Vibriosis, on the other hand, is considered a seasonal disease, caused by a range of related bacteria that live in brackish, warm, low-salinity coastal waters, including the Baltic Sea, North Sea and Black Sea. These bacteria thrive there in warmer months, and scientists believe that may be exacerbated by climate change.
Symptoms of cholera
Cholera symptoms can start within a few hours of infection, but may take about five days to show. Symptoms include:
- Vomiting and very watery diarrhea (like “rice water”)
- Dehydration
- Shock
- Weakness and fatigue
- Sunken eyes
- Decreased skin elasticity
Many people infected with the bacteria do not show any symptoms; some people who get cholera don’t get sick.
Does cholera spread from person to person?
No, cholera does not spread directly from person to person, but it does spread indirectly from person to person “when the feces of infected people contaminate drinking water or food,” Sack wrote.
Cholera infections spread when people drink contaminated water or eat contaminated food.
In a paper published in The Journal of Infectious Diseases, Sack and co-authors described how Vibrio cholerae bacteria may also “naturally inhabit environmental waters” in Bangladesh and thrive among plankton. If people drink unfiltered water containing plankton from those waters, they risk contracting cholera, the researchers wrote in 2021.
In Angola, cholera appears to be present in river basins and waterways and is “proving very difficult to contain” as a result, Edo Lihic of Malteser International, a humanitarian aid organization, wrote in an email to DW.
In February 2025, Malteser International led an Infection Prevention and Control Special Care Team in Angola.
Lihic, who was part of the team, said cholera had a “high degree of mobility” — meaning that it moves well along those waterways and poses a challenge in Angola because of the country’s “wide geographic spread.” This was causing recurrent transmissions, Lihic said.
Is there a cholera vaccine?
Yes, there is a cholera vaccine, known as Oral Cholera Vaccine. But, as of June 2025, the average stockpile of OCV had fallen below the emergency threshold of 5 million doses, according to the WHO. The average stockpile was down to 2.9 million doses; one month earlier it was at 5.7 million.
In addition, conflict in some of the worst-hit regions is allowing cholera to spread in an uncontrolled way and preventing people from getting vaccinated.
“Fleeing refugees, some of whom may be carrying the bacteria, spread it to others who cannot find safe water nor ways to purify the water,” Sack said. “Cholera deaths can be prevented if treated quickly with rehydration and antibiotics, but effective treatment may not be available in the conflict zone and without treatment about half of the severe cases may die.”
Can cholera be killed by boiling water?
Yes, boiling water for at least one minute can make it safe to drink. But, if you are in an area at risk, you must make sure that you then store the water in a clean tightly sealed container to prevent recontamination.
The WHO says you can also physically remove pathogens by filtering water, and you should do that if the water looks cloudy or dirty.
Use a commercial filter or a clean cloth, paper towel or coffee filter. You can use a mixture of charcoal, sand and gravel as a makeshift filter. But none of these methods is perfect — and you will still need to boil or disinfect the water after you have filtered it.
If you have access to household water-treatment chemicals, use them as recommended by the manufacturer. As an alternative, the WHO advises adding three to five drops of chlorine (such as 5-9% unscented household bleach) to 1 liter or quart of water, and waiting at least 30 minutes before use.
Water from regularly monitored and maintained household pipes into your home is usually safe to drink. But if, for example, your area has been hit by flooding or a similar natural catastrophe and clean water and sanitation become scarce, try to drink and wash in bottled water.
Edited by: Derrick Williams
