Since 1 January 2022 till 15 April 2023, a total of 774 925 acute watery diarrhoea (AWD)/suspected cholera cases, including 7722 laboratory-confirmed cases, were reported from 8 countries in the Eastern Mediterranean Region (EMR). A total of 427 suspected AWD/cholera associated deaths were also reported during the same duration from these 8 countries.

In 2022, Lebanon and Syria reported cholera outbreaks for the first time in almost two decades for Syria and three decades for Lebanon. This is alarming for the whole Region, as both countries are not cholera-endemic.

As of 15 April 2023, the highest number of suspected AWD/cholera cases in the Region were reported from Pakistan (335 105, CFR 0.01%),* followed by Afghanistan (277 275, CFR 0.04%), Syria (100 959, CFR 0.12%), Yemen (23 160, CFR 0.10%), Somalia (19 667, CFR 0.49%), Iraq (11 097, CFR 0.23%), Lebanon (7300, CFR 0.36%), and Islamic Republic of Iran (360, CFR 1.67%).

Males and females are almost equally affected by AWD/suspected cholera in the Region. Meanwhile, most of the suspected AWD/cholera cases in Afghanistan (55%), Somalia (65%) and Syria (45%) are children under five years of age. On the other hand, the suspected AWD/cholera cases for children under five years of age in Lebanon is 26% and in Yemen is 24%. This indicates the need for further investigations to understand other possible pathogens that may cause diarrhoea among children under five years of age and to strengthen the surveillance and laboratories 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 general 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.

Preparedness for the next season

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 and other emerging infectious diseases.

Therefore, working on the preparedness and readiness plans for the next season and prepositioning the required supplies and resources for diagnosis, management and prevention of AWD/cholera outbreaks is necessary. In addition, enhancing and continuing the response activities for the ongoing AWD/cholera outbreaks in the Region is essential. Hence, the WHO regional office continues to support countries of the Region to prepare and respond to the outbreaks.

*Pakistan revised the number of suspected cholera cases and the updated number of cases is 335 105

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