Somalia: 2024 AWD/Cholera outbreak Flash Update No.1 (As of 22 January 2024)

This Flash Update is prepared by OCHA, in coordination with the Health and WASH Clusters in Somalia and covers the situation as of 22 January 2024. The next update will be issued as soon as additional information is available.

HIGHLIGHTS

  • At least nine people died of Acute Watery Diarrheoa (AWD)/cholera and 474 cases were reported during the second week of 2024, as the outbreak spreads in Somalia, according to the Health Cluster.

  • Most cases have been reported from Hiraan and Middle Shabelle regions, particularly Belet Weyne, Bulo Burto, Jalalaqsi and Jowhar districts. The current outbreak is a continuation from 2023 when over 18,300 cases were reported, including over 10,000 children below 5 years (55 per cent).

  • Partners and the Federal Ministry of Health have developed a six-month plan that requires US$5.6 million to scale up cholera response activities. A National Cholera Task Force has been activated.

  • Partners have scaled up the implementation of response activities to control outbreaks in districts that were affected by floods in October to December 2023. New treatment centres have been established in Belet Weyne, Bulo Burto and Daynile districts.

  • Risk communication and community education is ongoing including the distribution of awareness materials to all high- risk districts, deployment of community health workers and outreach teams, dissemination of radio preventive messages on safe water handling and hygiene practices.

KEY FIGURES

9
Deaths reported from 7 to 13 January 2024
474
Cases reported from 7 to 13 January 2024
18.3K
Cases reported across Somalia in 2023
US$5.6M
Funding required to scale up the cholera response
480K
People targeted for oral cholera vaccine

SITUATION OVERVIEW

Acute watery Diarrhoea (AWD)/cholera is spreading in Somalia with at least nine people dead and 474 cases reported from 7 to 13 January 2024, according to the Health and Water, Sanitation and Hygiene (WASH) Clusters. The deaths reflect a Case Fatality Ratio (CFR) of 1.9 per cent, which is above the World Health Organization (WHO) emergency threshold of ≥1 per cent. Most cases have been reported from Hirshabelle State, particularly from Belet Weyne, Bulo Burto, Jalalaqsi and Jowhar districts which suffered massive flooding in October to December 2023.

The outbreak in Belet Weyne was confirmed in November 2023 with 616 cases and nine deaths reported, while the outbreaks in Bulo Burto and Jalalaqsi and Jowhar were confirmed in early January. The outbreak spread to Bulo Burto, Jalalasi and Jowhar because the displaced communities are using contaminated water from River Shabelle. In addition, 352 confirmed cases were reported among displaced communities in Daynille in Banadir region since October 2023, including 19 cases since 1 January. In Somaliland, suspected cases are reported in Hargeysa and one confirmed case in Wajaale towns. Twenty five stool samples collected and tested in laboratories were positive for Vibrio Cholerae 0139 Ogawa.

Somalia has had uninterrupted AWD/cholera transmission since 2022 and in Banadir region since the drought of 2017, according to WHO. In 2023, more than 18,304 cumulative cases and 46 deaths were reported, including over 10,000 children aged below 5 years (55 per cent). This includes 499 cases, mostly children below 5 years, that were reported from 11 to 31 December from 30 districts that were affected by drought earlier in the year; an overall CFR of 0.3 per cent. The current cholera outbreak is attributed to limited access to safe water, proper sanitation, primary health care services and lowered immunity among children experiencing high levels of acute malnutrition which lowers their immunity to cholera infections.

Cholera is an acute intestinal infection that spreads through food and water contaminated with bacteria, often from faeces. While the triggers for outbreaks—like poverty and conflict—are enduring, extreme climate events like floods and droughts reduce access to clean water and create an ideal environment for cholera to thrive. While safe water and proper sanitation can prevent AWD/ cholera, 28 per cent of Somali families are estimated to lack a functional sanitation facility while 34 per cent practice open defecation and 80 per cent lack a handwashing facility.