Death rates from major cholera outbreaks in Sudan and Nigeria have surged to up to three times the global average putting thousands of children at risk as cases continue to rise as conflict and flooding hamper access to treatment, said Save the Children.

In Sudan, latest data shows a Case Fatality Rate (CFR) of 3.1 deaths per 100 confirmed cases – far above the 1 death per 100 confirmed cases (or 1%) considered the minimum standard. The outbreak in Nigeria has a fatality rate of 2.9% [1], also nearly three times the minimum standard.

About 16 countries in West, Central and East Africa including Sudan and Nigeria have suffered unprecedented flooding in recent months due to the growing impact of climate change. UN data shows that floods have affected more than 4.4 million people in West and Central Africa so far in 2024 and more than 2 million In Eastern Africa [2]. 

Flooding, contaminated water and inadequate sewage treatment has led to a spike in cases of cholera that can be treated successfully with appropriate access and quality of care which has not been available in parts of Sudan and Nigeria, driving up fatality rates with children aged under five disproportionately affected.

In Sudan, between 22 July and 29 September, over 17,600 cholera cases and 546 associated deaths were reported across 60 localities in 10 states, according to the Federal Ministry of Health and the WHO. The deadly combination of nearly 18 months of violence decimating health facilities, floods, and water contamination has fuelled the outbreak, with at least 80% of hospitals in Sudan are now out of service and those operational lacking the most basic medical supplies. 

In September, Save the Children teams in El Damer in River Nile State and in Gedarif in Gedarif State, reported a huge spike in cholera cases among children under five, who account for 15% of the confirmed cases and deaths across the country [3].   

In Nigeria, the outbreak is linked to massive displacement triggered by widespread floods that has impacted 29 of the country’s 36 states, mostly in the northern areas. By 1 October,  more than 450 cases were confirmed in Nigeria including 32 deaths [4], with children accounting for  37% of the confirmed cases. The situation was expected to worsen as rains continue in northern Nigeria in October, causing more flooding and displacement.

Mohamed Abdiladif, Interim Country Director for Save the Children in Sudan, said:

“A lack of vital medicines, combined with hunger and malnutrition is putting millions of children at risk of diseases and possible death. Our health teams across the country are telling us that most of the child cholera deaths are from other complications due to weakened immune systems due to malnutrition.

“For children, the collapsing healthcare system is not only depriving them of emergency medical care, but also disrupting their access to essential routine services, including lifesaving vaccinations for children under five and maternity care for pregnant mothers. Cases of cholera, measles and dengue fever have risen exponentially in recent months, and now hundreds of people are losing their lives to entirely preventable causes.” 

Duncan Harvey, Country Director of Save the Children in Nigeria, said:

"Cholera outbreaks are preventable with proper infrastructure and hygiene practices. But the flooding in Nigeria is making life worse for the most vulnerable, especially the children in northeast Nigeria. The situation is putting food and clean water out of reach and malnutrition and disease are already rife among children. We call on governments and donor agencies to speed up actions to save the lives of children. We urge the public to take precautions and seek medical attention immediately if symptoms arise”. 

In Sudan, Save the Children is testing water quality, monitoring and chlorination at 35 water sources in the Sawakin locality, Red Sea state, and has disposed of 125 tons of solid waste. In Gedaref state, Save the Children is treating cholera cases and providing safe drinking water to cholera treatment centres. The aid agency is also providing cash assistance to families for basics such as food, water.

In Nigeria, Save the Children is providing relief items and distributing household items to displaced people, including medical supplies, drugs, and cholera kits in most affected states of Adamawa and Yobe. We are trucking water to flood-displaced communities, conducting hygiene promotion campaigns, and disinfecting water sources to improve access to safe drinking water among other interventions.