As of 31 August 2023, globally, a total of 28 countries reported AWD/cholera outbreaks. In the Eastern Mediterranean Region of WHO, 9 countries namely, Afghanistan, Iraq, the Islamic Republic of Iran, Lebanon, Pakistan, Somalia, Sudan, Syria, and Yemen have reported Acute Watery Diarrhea (AWD)/ suspected cholera cases in 2022 and 2023. In 2023, 8 out of these 9 countries continued to report AWD/ suspected cholera cases in 2023.

During the reporting period (epi week 33-34 2023), a total of 32,590 new AWD/suspected cholera cases – including 18 associated deaths- were reported from 6 Member States: Afghanistan (15,663 cases; 11 deaths), Iraq (92 cases; 1 death), Pakistan (7 confirmed cases; 0 death), Somalia (539 cases; 0 deaths), Sudan (113 cases; 5 death) and Syria (16,176 cases; 1 death).

During the period of 1 January to 31 August 2023, cumulatively, a total of 267,052 AWD/suspected cholera cases-including 123 associated deaths- were reported from 8 Member States: Afghanistan (144,543 cases; 73 deaths), Iraq (92 cases; 1 death), Lebanon (2,197 cases; 0 death), Pakistan (117 cases; 0 deaths) Somalia (12,681 cases; 30 deaths), Sudan (421 cases; 12 deaths), Syria (103,123 cases; 3 deaths), and Yemen (3,878 cases; 4 deaths).

While males and females are almost equally affected by AWD/ suspected cholera in the Region, most of the AWD/ suspected cholera cases in Afghanistan (57%), Somalia, and Syria (54%) are children under five years of age. In Lebanon and Yemen, children under five years represent 26% and 24% of the total suspected cases respectively. This indicates the need for further investigations to understand other possible pathogens that may cause diarrhea among children under five years of age and to strengthen the surveillance and laboratory systems in the Region.

There are many drivers contributing to the resurgence of cholera in the Region, including climate change, conflict and political instability, weak health systems, increased population movement, poor water and sanitation infrastructure, and low awareness among the public. With the support of WHO and other partners, all cholera-affected countries implemented multisectoral cholera response interventions, including coordination, water and sanitation, early warning surveillance, laboratory diagnosis, clinical management, risk communication and community engagement, and oral cholera vaccination.

Considering that many countries in the Region are facing natural disasters, political and economic instability, and armed conflicts, it’s critical to enhance the preparedness and response capacities for AWD/cholera in the region.

Therefore, the high-risk countries - with WHO support- need to work on strengthening coordination, building the HCWs’ capacities for detection, diagnosis, and management and prevention of AWD/cholera outbreaks, in addition to prepositioning of the required health supplies. Furthermore, enhancing and continuing the response activities for the ongoing AWD/cholera outbreaks in the Region is essential.

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* These cases were reported from 1 January 2022 to 30 June 2023.