World Health Organization (WHO), the Health Sector lead agency, is collaborating with the WASH sector to tackle the cholera outbreak in the Rohingya camps through the Joint Assessment and Response Team (JART). Cholera is a significant threat in refugee settings and among migrant populations because of overcrowding, insufficient access to clean water, and poor sanitation and hygiene (WASH) services.
Globally, cholera affects around 2.9 million people annually, resulting in approximately 95,000 deathsi . Between June and July 2024, there has been a significant resurgence of cholera cases worldwide. WHO has reported nearly 195,000 cases and over 1,900 deaths across 24 countries since the beginning of the year 2024. The highest number of cases has been in the WHO Eastern Mediterranean Region, followed by the African Region, the Americas, Southeast Asia, and European regionii.
Cholera has been endemic in Bangladesh for decades, with peaks occurring before and after the monsoon seasons. It has been a major health concern in the Rohingya refugee camps since the influx in 2017. The weekly trends of acute watery diarrhoea cases in 2024 from syndromic surveillance data are consistent with the previous six years’ trends. However, the number of culture-confirmed cases has decreased since 2019 which recorded the largest outbreak (283 culture-confirmed cases), and in 2021 (136 confirmed cases) which was the second largest. There was a drop in annual cases in 2022 (70 cases) and 2023 (81 cases) following a successful reactive Oral Cholera Vaccine (OCV) campaign between October and November 2021, which achieved a population coverage of 86%.
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Fig. 1: Trends of culture-confirmed Cholera cases reported by laboratories from 2019 to 2024
Current Situation in Rohingya Camps
Since June 23, 2024, a total of 77 cholera cases have been reported. Among these, 65 cases were confirmed through culture tests, while 12 RDT-positive cases are awaiting culture confirmation. These cases are spread across 16 camps as of July 23, 2024. There have been no cholera-related deaths (CFR-0%), and the severity rate stands at 32% as of July 23, 2024.
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Fig. 2: Geographic distribution of RDT Positive/Culture-Confirmed cases in Epi weeks 26-28, from 23 June to 13 July 2024 (EW26-28)
Response Efforts
Despite the curfew and internet blackout emanating due to protests and unrest across the country, the WHO Epidemiology and Surveillance team persistently collected data from multiple sources including EWARS, laboratory culture confirmations, and clinical health facility records. Cases are spread across sixteen camps, with the majority in Camps 1E and 14. Epidemiological investigations revealed minimal travel history among cases, with some clusters linked to shared water sources and family-level latrines. WHO has activated the local Incident Management System (IMS) for cholera, coordinating with health and WASH sectors. The WHO-led health sector is managing a scenario-based approach and overall coordination. WHO warehouses currently hold over 20,000 Cholera Rapid Diagnostic Test (RDT) kits and a central cholera treatment module capable of treating 100 severe cases.
The JART is enhancing WASH interventions by scaling up activities such as water quality surveillance, distributing Aqua tabs, cleaning water containers, and disinfecting WASH facilities.
Community Engagement
Community Health Workers (CHWs) have reached more than 180,000 households, delivering essential information on preventing and responding to Acute Watery Diarrhoea (AWD) and Cholera. Additionally, CHWs are directing individuals with diarrhoea-like symptoms to the nearest health facilities.
The WHO Epidemiological and Surveillance team, in collaboration with the WASH sector, has carried out a rapid risk assessment to comprehend the context and factors driving transmission in the hardest-hit camps. WHO has initiated an Incident Management System (IMS) and a Cholera Response Action Plan, working together with the Ministry of Health and other sectors to control the spread and mitigate the impact of the disease.
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JART members testing water chlorine levels, used for drinking water disinfection, Rohingya Camps, July 2024.
©WHO/Terence Ngwabe Che
The Oral Cholera Vaccine (OCV) is under consideration for inclusion in the immunization stockpile for populations. It is essential to investigate further and improve community behaviours that elevate the risk of household water contamination, and to maintain WASH infrastructure per SPHERE standards (globally accepted standards for humanitarian response). For more information about this publication please contact Terence Ngwabe Che External Communications Officer Cox’s Bazar Sub Office, at chet@who.int
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