From Outbreak to Preparedness: Protecting Rohingya Communities Against Cholera

When 14-year-old Asmaul Hosna fell ill with watery diarrhea, fear swept through her family’s small shelter in Camp 09.

“We were very scared. She was getting weak quickly and we didn’t know what to do at first,” Alomsair recalls. “Diarrhea spreads fast, and we did not know who would get sick next.”

By mid-2024, cholera had begun spreading across the Rohingya camps in Cox’s Bazar, the world’s largest refugee settlement. With over one million people living in crowded conditions and limited access to safe water and sanitation, the disease spread rapidly, putting the most vulnerable, especially children, at serious risk.

Between June 2024 and January 2025, 581 cholera cases were confirmed, nearly 40 % among children under five. Health workers worked tirelessly to treat patients and contain transmission.

Vaccination brings hope

In January 2025, hope returned. The World Health Organization (WHO), the Government of Bangladesh and other health partners, launched a mass Oral Cholera Vaccination (OCV) campaign for both Rohingya refugees and nearby host communities.

The campaign vaccinated 976,751 people, reaching 103.6% coverage, likely due to a refugee influx and denominator inaccuracies. Children made up 42% (410,235) of those vaccinated.

“I feel safe and protected now,” says Asmaul.

The success of the campaign was built on months of careful planning and coordination. WHO led technical preparations, trained vaccinators on safe delivery, data documentation, and cold-chain management, and ensured equitable coverage across all 33 camps. Volunteers went door to door, raising awareness and making sure no family was left behind.

By the end of January, confirmed cholera cases had dropped from 170 in December to just 32, a fivefold reduction signaling the end of the outbreak.

Lessons and strengthened preparedness

“The outbreak taught us that preparedness cannot wait,” says Dr Mohammadul Hoque, Civil Surgeon of Cox’s Bazar. “Working with WHO helped us strengthen systems that protect not only refugees but host communities too.”

The response revealed gaps in water chlorination, hygiene practices, and coordination between health and WASH sectors. WHO and partners transformed these lessons into a strengthened Cholera Preparedness and Response Plan, focusing on timely surveillance, community awareness, and integrated rapid response mechanisms.

Trend of culture-confirmed cholera cases (2019–2025), showing the largest outbreak in 2024 (black line) and a sharp decline in 2025 (red line) following the OCV campaign.
Source: WHO Early Warning, Alert and Response System (EWARS), 2025

In April 2025, WHO and partners conducted a second OCV round, reaching 177,222 children aged 1–5 years, the group most vulnerable to severe illness. Vaccination was combined with improved WASH services and ongoing surveillance, further strengthening Cox’s Bazar’s health system against cholera and other infectious threats.

Building on these gains, in May 2025 WHO and the Government of Bangladesh organized a cholera preparedness simulation exercise to test emergency response capacity and coordination. The exercise refined outbreak protocols and reinforced multisectoral collaboration, ensuring that both health and WASH partners are ready to respond quickly in future emergencies.

Health workers and WASH partners discuss response protocols during a WHO-led cholera preparedness simulation in Cox’s Bazar.
Photo Credit: WHO/Terence Ngwabe Che

Communities leading the way

Yet cholera prevention begins at home. Mothers like Alomsair now play an active role in promoting hygiene and safe water use.

 “We all have a role in keeping cholera away,” she says proudly.

Through community health volunteers, hygiene promotion campaigns, and door-to-door awareness, WHO and partners continue to empower families with life-saving knowledge, helping them protect children and reduce the spread of cholera.

A future of hope

From the fear of losing loved ones to the confidence that protection brings, families in Cox’s Bazar now look to the future with hope.

“By investing in preparedness today, we are saving lives tomorrow,” says Dr Jorge Martinez, Head of WHO Sub-Office, Cox’s Bazar. “The real success lies not only in reducing cases but in the trust and resilience built within communities.”

For Alomsair and her daughter, that change is deeply personal.

“Last year brought fear,” she says softly. “This year brings hope and health.

For further information about this publication, please contact Terence Ngwabe Che, External Communication Officer, WHO Bangladesh, Cox’s Bazar Sub Office, at chet@who.int