Harare/Nairobi/Geneva, 17 November 2023—The International Federation of Red Cross and Red Crescent Societies (IFRC) has launched an emergency appeal for 3 million Swiss Francs to support the Zimbabwe Red Cross Society (ZRCS). The health needs exceed available resources, meaning immediate action to is needed to mitigate the impact on affected communities. Zimbabwe is currently grappling with a severe cholera outbreak, placing immense strain on healthcare systems, and necessitating coordinated action. The outbreak has led to increased morbidity and mortality rates, posing a significant threat to public health and demanding immediate attention. The IFRC had previously allocated CHF 464,595 from its Disaster Response Emergency Fund (DREF) to support the relief efforts. The Emergency Appeal focuses on critical areas, including the prevention and control of the cholera spread, improved case management, and the enhancement of water and sanitation facilities. The appeal also underscores the importance of community engagement, accountability, and inclusivity in providing a holistic response to the diverse needs of affected communities. John Roche, IFRC Head of Delegation Country Cluster for Zimbabwe, Zambia and Malawi said: “Access to clean and portable water remain among the most urgent needs in the community. We are deeply concerned with the situation unfolding as before the rains cases have escalated. The IFRC and Zimbabwe Red Cross Society are seeking resources through the appeal that supports activities that can contribute to stopping the spread and transmission of Cholera which will deescalate the worrying trends.” Zimbabwe Red Cross Society staff and volunteers have been mobilised and continue to respond to the outbreak by increasing awareness on water, sanitation, and hygiene (WASH) practices, emphasising the importance of WASH education for healthier communities. This commencement of public health education is being done in collaboration with Zimbabwe’s Ministry of Health. Currently the new cases reported are increasing at a high level and rising at an accelerating pace. This has created an urgency to increase mitigation measures to curb further spread and reduce cross border transmission. More information For further details on our response to the Cholera outbreak in Zimbabwe, visit the Zimbabwe Red Cross Societywebsite or the IFRC appeal page. To request an interview, please contact: [email protected]     In Harare: (ZRCS)Kim Stambuli, +263 71 251 7264,[email protected] In Nairobi: Rita WANJIRU NYAGA, +254110837154, [email protected] In Geneva: Tommaso Della Longa, +41 79 708 4367, [email protected]

In the last two years, villages like Cheplewa in the southewestern county of Bomet have witnessed a significant increase in diseases such as Cholera and Hepatitis B — two diseases triggered by consumption of contaminated water. To ensure comprehensive protection of water sources, the Kenya Red Cross and the IFRC have mobilized to educate communities on measures they can take to protect natural springs from contamination and then ensure that they remain clean. Springs serve as the main source of water in this region but it’s common practice for animals to be taken to the springs to drink. Meanwhile, residents also come to the spring and scoop the same water for domestic use. Chebett, a community health worker trained by the Kenya Red Cross, believes the lack of springs in neighboring villages accelerated the increase in Cholera cases. In the previous months, those villages also experienced an outbreak of Hepatitis B. A massive checkup ”At the time of screening and sensitizing communities about Covid-19, and about the importance of getting vaccinated, some people were diagnosed with Hepatitis B”, Chebett said. “We reported this to the Ministry of Health and they called for a massive checkup”. That checkup included community-wide screenings for Hepatitus B as well as continued sensitization on sanitation practices. Those found to be negative for Hepatitus B were vaccinated, while positive cases were given drug treatments. After several months, medical personnel from the Cheplewa dispensary embarked on another massive screening and vaccination, with the aim of eradicating the Hepatitis B virus in the area. But complete eradication became difficult because the Hepatitis B vaccine is given in two doses. Some community members took the first dose, but did not return. It was not long before symptoms — such as non-stop talking or speaking incoherently — began to appear. Mass screening is still ongoing to hasten the identification of new cases. The efforts come as part of IFRC’s focus on working with communities to build their resilience and support to break the cycle of disaster impacts amidst the changing climate. In the Horn of Africa, the alternating weather patterns have continued to cause drought and flooding, impacting water sources, livelihoods and food security. All these factors leave people more vulnerable to infectious diseases. Erasing fear by engaging communities Chebett said that when speaking with community members, she tells them that springs must be protected and the area kept clean. To avoid contamination of the water, communities were encouraged to build underground water tanks to collect spring water. Water taps were then installed next to these tanks at a distance of 10 meters. Community members were involved in the construction of the underground tanks. Though the spring water flowing through the taps is now clean, families were encouraged to boil the water used for drinking and cooking and store it in clean containers, and to keep the containers closed. Water pans for animals to drink were also created. Improved hygiene through education Because this area is between two hills, rainwater flowing down the hills also carries debris. Those who drink the water before boiling it could suffer from Acute Water Diarrhhoea. This led some families and community members to claim that the water had been poisoned and so they stopped drinking water altogether. But, after receiving information from community health workers who were trained by the Kenya Red Cross, they started boiling water used for drinking and cooking, and washing their hands before and after eating. The hygiene standards have also generally improved. Every household was encouraged to build a toilet, and to wash their hands after using the toilet. “The education we give is bearing fruit,” Chebett said of the community engagement efforts, which were made possible through support by USAID funded Community Epidemic and Pandemic Preparedness (CP3) programme.

Excellencies, Ladies and gentlemen, distinguished guests, colleagues and friends, I’m so pleased to be here in vibrant Nairobi. You have always extended such warmth and enthusiasm every time I visit Africa. Thank you for your unmatched hospitality. I am grateful to Kenya Red Cross for hosting Pan African conference of the IFRC. IFRC Vice President Elder Bolaji Akpan Anani, Chair of the PAC. Governor Korir of the Kenya Red Cross. Governing Board members, Commission and Committee chairs of the IFRC, of the Standing Commission, Africa governance group, Vice President of ICRC (continuing our proud history to invite ICRC to IFRC statutory meetings because we can be successful when we work together as a Movement), National Society and youth leaders, staff and volunteers and the entire IFRC secretariat team. I want to particularly recognize the Africa team led by our Regional Director Mohammed Mukhier for working tirelessly to support the organization of the conference. I pay tribute to all of you for your immense contributions to the IFRC network, today and always. Your dedication to the communities we serve is unparalleled, especially through the recent growing complex crises across Africa. Let me join in solidarity with Morocco and Libya as they work hard to recover from two terrible disasters. As we gather here today, I am struck by the rich tapestry of Africa’s history, cultures, and the extraordinary resilience and spirit of its people. Yet, this comes with its own set of opportunities and challenges. A continent of immense beauty and diversity, Africa presents us with a complex humanitarian landscape. Africa is a place of paradoxes, where soaring aspirations uncomfortably co-exist with profound inequalities. Humanitarian needs are growing each day, stretching the bounds of lives, livelihoods, and human dignity. Poverty, inequality, and political instability compound these humanitarian needs. Economic challenges including high unemployment rates, limited industrialization, and a heavy reliance on primary commodities for export make many African nations vulnerable to fluctuations in global markets. We continue to witness alarming hunger levels across the continent, with 167 million facing acute food insecurity in Sub-Saharan Africa, a 14% increase from 2022. The impact of El Niño in 2023/2024, forecasts a 90% probability of flooding in Kenya, Somalia, and Ethiopia, alongside reduced rainfall in Southern Africa. We know this will further exacerbate food insecurity in the coming years, as African food systems are very vulnerable to climate extremes and shifts in weather patterns. Disease and epidemics are on the rise as a result. Last year, 96 disease outbreaks were officially reported in 36 countries, with cholera, measles, and yellow fever being the most common. As climate disasters worsen, 7.5 million people were displaced in Africa, the highest annual figure ever reported for the region. And with the cascading effects of political instability in a number of countries, the number of people on the move have begun to climb as well, with 9 million people torn from their homes in 2022. We cannot forget that behind these distressing statistics are actual people –women, men, and children with increasing needs and less resilience to cope. These are the challenges that exist in a continent which is full of young and dynamic population full of unparalleled vibrancy and dynamism. It also has many beautiful tourist destinations. This is a continent full of natural resources - minerals, oil and gas, timber, agricultural land, fisheries, renewable energy, gemstones, water resources, forestry products. Almost everything you can think of. It makes me wonder how come a continent so full of resources is also facing so many challenges. How can we contribute to addressing these humanitarian gaps? Please allow me to share just three fundamental approaches that could help us to make a meaningful contribution to the people and communities in Africa. First is Solidarity – Working together in partnerships: We are bound together in our journey in search of a brighter future. The expanding humanitarian needs push us to the brink, but our unwavering solidarity pulls us back and drives us forward. Solidarity and commitment to our Strategy 2030 and Agenda for Renewal allows us to respond to multiple crises and disasters, build community resilience and strengthen localization in this region. Just last month, I visited Gambia and Egypt to better understand the migration situation. My conversations with volunteers, National Society and government leaders were eye opening. When it comes to migration, Africa is a continent on the move. This comes with positive benefits too—In Gambia migrants contribute to 20% of the country’s GDP. To the rest of the world, the migration of Africans is often framed around their movement beyond Africa’s borders. Yet the story of the millions of refugees and internally displaced people being hosted within Africa, which is more than 85%, is not acknowledged. Through the IFRC’s Global Route-based Migration programme and humanitarian service points we witness how Africans are overwhelmingly supporting fellow Africans on the move. Africans standing shoulder-to-shoulder with fellow Africans, is a testament to our capacity to overcome adversity. As we address urgent crises before us, it's our combined strength that forms our bedrock of hope. Internal solidarity sometimes can be challenging. Let us not doubt ourselves in our commitment to solidarity. Let us foster trust and belief among ourselves. Second is Solutions to scale- think big, act big: Across Africa much progress has been made and the vast opportunities lie ahead. 34 countries, representing approximately 72% of Africa’s population, have demonstrated significant progress in governance over the last two decades, especially in the areas of rule of law, the protection of rights, and growth of civil society. Africa’s great untapped potential is more visible than ever, with economic growth and investment in public services contributing to the improvement of millions of lives and transformation of societies. The theme of this 10th Pan African Conference is renewing investment in Africa. I suggest that we make this investment people centric. You may want to consider calling it "renewing people-centric investment in Africa". I encourage every one of us to consider how investments in National Societies, and especially in their young volunteers, can harness Africa’s agility and innovation that empowers people to address the needs when they come and continue to work to reduce humanitarian needs by building long term resilience in the communities. For this, our Agenda for Renewal guides the IFRC to work for and with National Societies in everything we do. We have invested in scaling up digitalization, risk management, new funding models for greater agility, accountability, and impact to reach the communities. We foster learning and strengthen National Society capacities, so that we become leaders in the humanitarian field, not just in response but in resilience building, data, influence, collaboration, and innovation. In 2020-2021, during the COVID-19 pandemic, African National Societies came together with the IFRC secretariat to reach 450 million people with humanitarian services. The REACH initiative between Africa CDC, the African Union and the IFRC comes with an ambition to scale up the community health workforce by two million and strengthening National Society capacity across the continent to address health needs. These are solutions that are tailored to African communities, that reflect African needs and that can be measured by the outcomes we achieve for the people. Let’s not play small. Let’s think big, let’s act big. Because that’s what it is needed now. Third is Leadership – listen, learn and lead. Our humanitarian action must make a positive difference in people’s lives. In this era of fast paced change and shifting political divides, our leadership has never been more crucial. Leadership to partner with others along equal and mutually reinforcing terms, Leadership to position our National Societies as unparalleled community partner, with unmatched local intelligence and reach, Leadership to engage in internal transformation, Leadership to embody our Fundamental Principles, Leadership to invest in young people--Africa’s most abundant and greatest resource--harness their skills, give them opportunities to lead us to a more just and equitable future. Leadership to build trust, internally and externally, to be bold at communicating good news as well as challenges, to bring about collective energy and hope. Leadership that doesn’t accept business as usual. Leadership that strives for excellence in everything we do. There will be ups and downs, but we will persist. This is what leadership is all about. In our pursuit of a brighter future for Africa, let us hold ourselves to lead with accountability, not just to the challenges of today but also to the aspirations of tomorrow. Let every action we take, every initiative we launch, and every partnership we forge be a testament to our unwavering commitment to the people. I wish you a very productive Pan-African Conference. And please allow me to conclude by sharing a quote from Nelson Mandela – «one of the things I learned when I was negotiating that until I changed myself, I couldn’t change others». Let this conference give us the inspiration to be the real agent of change for the people of Africa. Thank you.

When the Kakhovka Dam in southern Ukraine collapsed in June, a torrent of water poured over downstream towns and farmlands, reducing homes to rubble and leading to the tragic loss of many lives. The flood swept up everything in its path, washing farm animals, unexploded mines, hazardous chemicals and dangerous bacteria—such as salmonella, E. coli, and cholera—down toward the Dnipro-Buh Delta on the Black Sea. The Ukraine Red Cross Society’s (URCS) response to the dam disaster was swift. From the moment the dam collapsed, their volunteers began evacuating people from flooded areas and distributing essentials such as food, hygiene products and water purification equipment. Psychosocial support specialists were also on hand to help people cope during those difficult first days. But recovering from a disaster like this doesn’t happen overnight. Three months on, URCS teams remain firmly by the side of communities to help them get their lives back on track. “People's needs have changed but have not disappeared," says Serhiy Moroz, a URCS volunteer. "In many populated areas, people are attempting to return to their previous lives in damaged housing and amidst disruptions in centralized water supply services. Often, water systems are simply non-existent, leaving people to suffer from a lack of clean water. This creates significant household challenges as well as risks to public health." The IFRC recently deployed an Emergency Response Unit or 'ERU'—a team of specialized personnel and equipment from across the IFRC network—to Kropyvnytskyi city to support the Ukraine Red Crescent Society’s work restoring access to safe water. Marco Skodak, the ERU team leader, details their efforts: "We're launching Water, Sanitation, and Hygiene (WASH) activities in response to the dam's destruction. URCS volunteers are undergoing training to provide assistance, and, working alongside our specialists, they are already on the ground conducting needs assessments and establishing crucial water purification systems and pipelines." By training up the Ukraine Red Cross Society in this way, the IFRC network is ensuring that communities get the long-term assistance they need to recover, and that volunteers have an even greater ability to respond should a similar disaster ever occur in future. -- Click here to learn about how the IFRC is supporting local humanitarian action, including the different types of ERUs we can deploy. And click here to learn more about the IFRC’s work in Water, Sanitation and Hygiene.

Cholera is a bacterial disease, usually spread through contaminated water, that causes severe diarrhoea and dehydration. It can kill, and thrives in poor or overcrowded conditions where access to safe water, sanitation and hygiene are compromised.

The world is facing an upsurge in cholera, even touching countries that have not had the disease in decades. Years of progress against this age-old disease have disappeared. While the situation is unprecedented, the lesson to draw is not a new one: safe drinking water, sanitation and hygiene are the only long-term and sustainable solutions to ending this cholera emergency and preventing future ones. The global cholera situation is concerning, but as we mark World Water Day today, and the historic United Nations Water Conference begins in New York, the Global Task Force for Cholera Control (GTFCC) is appealing to countries and the international community to channel that concern towards concrete action. First, to prevent future outbreaks, countries need strong public health surveillance systems to quickly identify and confirm cholera cases, allowing for immediate action. Countries with ongoing widespread outbreaks need immediate support to track and tackle the current crisis. We can’t solve a problem we can’t see. Second, stop the cycle that takes us from emergency to emergency by investing in water, sanitation, and hygiene (WASH). When there is a cholera outbreak, responders rush in soap and chlorine tablets, bring in safe water in trucks, and build temporary latrines to prevent the outbreak from spreading. While these actions are undoubtedly life-saving, longer-term investments in WASH infrastructure can prevent outbreaks in the first place. Wherever in the world cholera has been eliminated, it has been thanks to improvements in basic water, sanitation and hygiene – access to these is an internationally recognized human right. Moving from an emergency response to long-term improvements is more effective, because although cholera is a health issue, first and foremost, it is a development issue. Third, focus efforts on cholera hotspots. Fighting cholera requires a targeted approach centred on hotspots–health zones or districts–where cholera cases are concentrated. Focusing on cholera hotpots more than doubles the return on investments in safe water, sanitation and hygiene: from US$4.30 to US$10 for every US$1 invested. Fourth, support the development and implementation of national cholera plans, including the budget allocated for WASH. These national plans lay out multisectoral actions needed for sustained cholera prevention and control, including the use of oral cholera vaccines, putting communities at the center. Poverty, conflict, and disasters continue to fuel cholera, now turbo-charged by climate change. The future presents multiple challenges, but at least for cholera, we have the answer: access to safe water, sanitation and hygiene in cholera hotspots. Urgent, targeted investments will get us there. Note to editors In the past months, the world has seen a resurgence of cholera. Last year, as many as 30 countries experienced outbreaks, and we continue to see a worrying geographic spread into 2023. Countries like Lebanon, South Africa and Syria are seeing their first outbreaks in decades. It is not just the number and spread of outbreaks which is concerning, but the severity with which they are striking. The average case fatality rate of the current outbreaks is double the target threshold of less than 1%. Many of these outbreaks have clear links with extreme climate events, which bring at times too much and at times too little water, both potent fuel for cholera as access to water supplies are disrupted, and people may be forced to move from their homes to more temporary—and at times crowded—settlements. Looking ahead, we can expect more frequent floods, droughts, storms and displacement. Other than climate change, modelling exercises show that population growth and urbanization alone could lead to a doubling of cholera cases over the next 20 years if we do not act now. For more information on the full multisector approach to cholera control and elimination, please see the GTFCC Steering Committee statement on the current cholera situation. Signed by the Steering Committee of the Global Task Force for Cholera Control (GTFCC) His Excellency Mr Hakainde Hichilema, President of the Republic of Zambia, and Global Cholera Control Champion Dr Frew Benson, Chair, GTFCC Steering Committee Dr Christopher J. Elias, President, Global Development, Bill & Melinda Gates Foundation Dr Howard Zucker, Deputy Director for Global Health, Centers for Disease Control and Prevention (CDC) Dr Seth Berkley, CEO, Gavi, the Vaccine Alliance Jagan Chapagain, Secretary General, International Federation of Red Cross and Red Crescent Societies (IFRC) Dr Christos Christou, International President, Médecins Sans Frontières Catherine Russell, Executive Director, UNICEF Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization Media Contacts Zambia National Public Health Institute Mazyanga Liwewe, [email protected] BMGF [email protected] CDC Erik M. Friedly, [email protected] Gavi, the Vaccine Alliance [email protected] IFRC Marie Claudet, [email protected] MSF Jean-Marc Jacobs, [email protected] UNICEF Sara Alhattab, +1 917 957 6536, [email protected] WHO [email protected]

This article was originally published on the BMJ website here. Once thought to be close to eradication, cholera is back—dehydrating and killing people within hours and ravaging communities across six continents. Despite the alarming numbers of cases and deaths over the past year, decision makers are averting their eyes, leaving people to die from a preventable and treatable disease. The healthcare community should sound the alarm for immediate actions. A strong and global emergency response is urgently needed, but it is only a first step. More than ever the world must invest in water and sanitation systems and prepare communities before outbreaks occur. Over the past 200 years, there have been seven cholera pandemics, and today’s surge is the largest in a decade. In 2022, 30 countries reported cholera outbreaks, including places that had been free of the disease for decades. In Haiti, where millions of people have been displaced by violence, cholera has killed hundreds of people in just a few months.Lebanon is experiencing its first outbreak since 1993, with more than 6000 recorded cases.After devastating floods, Nigeria had a major cholera outbreak.In Malawi, the worst outbreak in decades has left 620 people dead since March.Schools are now closed in an attempt to stop the surge of infections. The risk of cholera transmission multiplies when people live in poor or overcrowded conditions and lack access to safe water, proper sanitation, and hygiene facilities. A diarrhoeal disease caused by theVibrio choleraebacteria, cholera is commonly spread through contaminated food or water. Left untreated, it can cause severe dehydration and be deadly within hours. Almost half of the world's population—approximately 3.6 billion people—live without safely managed sanitation in their home, leaving them vulnerable to cholera outbreaks. The World Health Organization reports that at least two billion people consume water from sources contaminated with faeces. Overlapping crises The root causes behind the spate of recent cholera outbreaks are, however, complex and multifaceted. Overlapping humanitarian crises around the world, such as migration, conflicts, poverty, and social injustice are forcing people to live in unsanitary conditions, and this is fuelling the spread of this infectious disease. In the aftermath of the covid-19 pandemic, the number of people living in extreme poverty increased for the first time in a generation. And now, rising inflation and the repercussions of the conflict in Ukraine could worsen an already dire situation. Climate change plays a part in contributing to the spread of cholera. More frequent and intense extreme weather events, such as hurricanes and floods, have resulted in major disruption to water treatment processes and damaged sanitary infrastructure in many parts of the world. The combination of higher temperatures and extreme precipitation leads to a higher incidence of waterborne infections like cholera. Factors such as food insecurity also exacerbate the vulnerability of communities to the spread of cholera. Malnourishment weakens the immune system, increasing a person’s risk of severe symptoms and death. As global events drive up food prices, the number of malnourished people has also risen. An estimated 140 million people in Africa face severe food insecurity. Cholera can be treated through a simple method called oral rehydration treatment, but many people cannot access this lifesaving tool—an estimated 56% of children with diarrhoea are not able to receive this treatment. Cholera can also be prevented through the oral cholera vaccine, but supply cannot meet current needs. By the end of 2022, 11 countries experiencing cholera outbreaks had requested 61 million doses of the vaccine—far more than the 36 million doses that were expected to be produced. The shortage of vaccines has recently forced the International Coordinating Group, of which the International Federation of Red Cross and Red Crescent Societies (IFRC) is a part, to switch from a two dose to a single dose strategy so that coverage can be expanded. Morally unacceptable In places such as Malawi and Haiti, the mortality rate from cholera tripled in 2022. Nobody should die from a preventable and treatable disease. This level of suffering is morally unacceptable. The IFRC has launched a time sensitive emergency response in 20 countries, where trained Red Cross and Red Crescent volunteers track transmission routes while also ensuring that sanitation facilities are working and that safe water supplies are available. At the community level, teams treat people by administering oral rehydration treatment and referring those most severely affected to hospital. In Malawi, where the number of infections is increasing daily, the Red Cross has established 14 oral rehydration points across the country and is reaching more than 753 000 people with health and hygiene campaigns. Volunteers also play a major part in cholera vaccination campaigns. The Lebanese Red Cross, for example, has contributed considerably to the rollout of the national cholera vaccination campaign. Through door-to-door visits of households, institutions, and organisations, the Lebanese Red Cross vaccinated more than 260 000 people in only 39 days across 151 municipalities. In countries where cholera is endemic, we are implementing sustainable long term water systems, sanitation, and hygiene programmes. For instance, in the countries where we are operating, we built and rehabilitated 1300 water systems, more than 7000 sanitation facilities in households, schools, and health centres, and close to 6000 handwashing stations, improving the lives of more than three million people around the world. Red Cross and Red Crescent staff and volunteers are on the frontlines of this public health emergency, but we are not able to do this alone. The resurgence of cholera around the world despite decades of eradication efforts suggest that cholera control, prevention, and response mechanisms must be rapidly amplified. To prevent outbreaks, reduce transmission, and save lives, we need political commitment and greater financial resources. We must ensure access to safe water supplies and invest in proper sanitation infrastructure in the communities most at risk. We need to increase the production and distribution of oral cholera vaccines. Public health systems and cholera treatment centres must be better funded. Lastly, we need to build trust in communities. People are less likely to follow preventive measures if they do not trust their community leaders and health systems. But to really put an end to cholera, we cannot forget the humanitarian crises at root level. Governments, non-governmental organisations, and the private sector must finally mobilise and increase investments in infrastructure and health and social systems so that they can withstand the fallout from disasters, conflicts, and climate change. One of the most important lessons we learnt from the covid-19 pandemic is that no one is safe until everyone is safe. It is in everyone’s best interests to work together and ensure that no one is left behind. -- Visit our water, sanitation and hygiene (WASH) page for more information about cholera. And follow Petra on Twitter for more updates on the IFRC's work in health and care: @petra_khoury

Malawi, 25 January 2023—Malawi is currently facing its worst cholera outbreak in two decades, with over 29,000 cases reported and more than 900 people dead. The Malawi Red Cross, in partnership with the International Federation of Red Cross and Red Crescent Societies (IFRC) and in-country partners—Danish Red Cross-led consortium and Swiss Red Cross—is scaling up its cholera response to assist over two million people. Since the first recorded case in February 2022, cases have continued to spread, with all 29 districts affected. Cholera is now putting over 10 million people at risk, including more than five million children. “Malawi Red Cross Society is committed to continue supporting the Government of Malawi in responding to the cholera outbreak and other health emergencies. We are grateful to the IFRC and other Movement partners for continued finance and technical assistance to the MRCS Cholera response plan,” said McBain Kanongodza, Secretary General for the Malawi Red Cross Society. According to the Malawi Ministry of Health’s cholera update on 22 January 2023, over 29,364 cases and 960 fatalities were reported, leaving the fatality rate at 3.27 per cent, which is considerably higher than the acceptable rate of less than 1 per cent set by WHO. The Malawi Red Cross Society (MRCS) is already providing lifesaving treatment at the community level by administering Oral Rehydration Therapy. Volunteers ensure that water supplies are safe and that sanitation facilities are working. They also go door-to-door to raise awareness on preventing the disease from spreading. With the rainy season underway, it is crucial that people take precautions to protect themselves and their families. “We have been monitoring the developments on the ground since the first cases, and we are deeply concerned that this outbreak has taken a foothold in every corner of Malawi. We need to support the joint efforts of the MOH and Malawi Red Cross in their response to this devastating situation. As the outbreak worsens, partnerships are crucial to ensure lives are saved,” said John Roche, Head of IFRC’s Delegation for Malawi, Zambia and Zimbabwe. The IFRC and its membership are launching an Emergency Appeal seeking 5.2 million Swiss francs, which will help the Malawi Red Cross reach a further 1,385,391 people in need of assistance. Malawi Red Cross and its partners with the IFRC aim to target 15 affected districts, with the core objectives being to prevent and control the spread of the outbreak, reduce morbidity and mortality due to cholera and improve the availability of safe water and sanitation facilities, through continued support to communities and district health offices. For more information, please contact: In Lilongwe: Felix Washon, +265 999 95 57 21, [email protected] In Harare: Ella Mcsharry, +263 78 689 3350, [email protected] In Nairobi: Euloge Ishimwe, +254 731 688 613, [email protected] In Geneva: Marie Claudet, +1 202 999 8689, [email protected]

Geneva/New York, 19 October 2022 - A strained global supply of cholera vaccines has obliged the International Coordinating Group (ICG)—the body which manages emergency supplies of vaccines—to temporarily suspend the standard two-dose vaccination regimen in cholera outbreak response campaigns, using instead a single-dose approach. The pivot in strategy will allow for the doses to be used in more countries, at a time of unprecedented rise in cholera outbreaks worldwide. Since January this year, 29 countries have reported cholera cases, including Haiti, Malawi and Syria which are facing large outbreaks. In comparison, in the previous 5 years, fewer than 20 countries on average reported outbreaks. The global trend is moving towards more numerous, more widespread and more severe outbreaks, due to floods, droughts, conflict, population movements and other factors that limit access to clean water and raise the risk of cholera outbreaks. The one-dose strategy has proven to be effective to respond to outbreaks, even though evidence on the exact duration of protection is limited, and protection appears to be much lower in children. With a two-dose regimen, when the second dose is administrated within 6 months of the first, immunity against infection lasts for 3 years. The benefit of supplying one dose still outweighs no doses: although the temporary interruption of the two-dose strategy will lead to a reduction and shortening of immunity, this decision will allow more people to be vaccinated and provide them protection in the near term, should the global cholera situation continue deteriorating. The current supply of cholera vaccines is extremely limited. Its use for emergency response is coordinated by the ICG which manages the global stockpile of oral cholera vaccines. Of the total 36 million doses forecast to be produced in 2022, 24 million have already been shipped for preventive (17%) and reactive (83%) campaigns and an additional 8 million doses were approved by the ICG for the second round for emergency vaccination in 4 countries, illustrating the dire shortage of the vaccine. As vaccine manufactures are producing at their maximum current capacity, there is no short-term solution to increase production. The temporary suspension of the two-dose strategy will allow the remaining doses to be redirected for any needs for the rest of the year. This is a short-term solution but to ease the problem in the longer term, urgent action is needed to increase global vaccine production. The ICG will continue to monitor the global epidemiological trends as well as the status of the cholera vaccine stockpile, and will review this decision regularly. About the ICG The ICG is an international group that manages and coordinates the provision of emergency vaccine supplies and antibiotics to countries during major disease outbreaks. It manages the global stockpile of the oral cholera vaccine. The group is composed of members of WHO, Médecins Sans Frontières, UNICEF and the International Federation of Red Cross and Red Crescent Societies. The ICG was established in 1997, following major outbreaks of meningitis in Africa, as a mechanism to manage and coordinate the provision of emergency vaccine supplies and antibiotics to countries during major outbreaks. Since the establishment of the cholera vaccine stockpile in 2013, 120 million doses of oral cholera vaccine doses have been shipped to 23 countries, of which 73 million (60%) has been approved for emergency response. Media contacts IFRC: Jenelle Eli +41 79 935 97 40 +1 202 603 6803 [email protected] MSF: Lukas Nef  +41792400790 +41443859457 [email protected] UNICEF: Tess Ingram +1 347 593 2593 [email protected] WHO: WHO Media inquiries Telephone: +41 22 791 2222 Email: [email protected]

A major 7.2-magnitude earthquake hit Haiti on 14 August 2021, killing more than 2,000 people and causing widespread destruction to people's homes and infrastructure. The Haiti Red Cross Society responded rapidly to provide immediate humanitarian assistance to those affected. More than one year on, this Emergency Appeal is supporting ongoing recovery and reconstruction efforts. And in December 2022, we revised the Appeal to also help the Haiti Red Cross Society control a Cholera outbreak in the country through water, sanitation and hygiene (WASH) and community engagement activities.

Beira/Nairobi/Geneva, 14 April 2019 – One month after the worst disaster in Mozambique’s recent history, signs of recovery are beginning to emerge as people return home and as the deadly cholera outbreak appears to be starting to abate. However, hundreds of thousands of people will need sustained support over the coming months if recovery is to take hold, says the International Federation of Red Cross and Red Crescent Societies (IFRC). Florent Del Pinto, Head of Emergency Operations for IFRC in Beira, said: “There is still a huge amount of work to do, but some of the immediate dangers are passing. “New cholera cases are declining. This is thanks in part to the work of Red Cross volunteers and staff who have provided clean water and sanitation, as well as treatment and care. But we cannot afford to be complacent – this work has to continue.” The disaster response operation, led by the Mozambique Red Cross with support from IFRC and other partners, has helped more than 38,000 survivors in the month since Cyclone Idai made landfall. Relief supplies have been distributed to some 19,000 people, 900 people have been treated at Red Cross field hospitals and clinics, and more than 250,000 litres of clean water have been produced and distributed. “This work has been effective, and we are now starting to see the initial green shoots of recovery in central Mozambique,” said Titus Queiroz dos Santos, Mozambique Red Cross Director of Programmes. “The survivors of this disaster are still suffering, but many are already determined to go home and rebuild their lives and livelihoods. The Red Cross will be there to support them at every step of the journey.” The Mozambique government has reported that the number of people still sheltering in relocation centres has dropped by half in recent days. The Mozambique Red Cross and partners are distributing relief supplies such as tarpaulins and shelter kits to people in need, and IFRC is deploying a dedicated team to plan a 24-month recovery programme focused on shelter, health, livelihoods and disaster risk reduction. Some 1.85 million people were affected by Cyclone Idai, which the World Bank estimates has caused 2 billion US dollars of damage in the affected countries. The Mozambique Red Cross and IFRC Emergency Appeal seeks 31 million Swiss francs to support 200,000 people.