Nigeria?s cholera crisis is deepening as flooding and other factors spread the deadly disease to 34 states, killing 86 people and infecting over 3,000 by June. With 80,000 children at risk and water prices soaring, millions are forced to drink contaminated water, perpetuating a vicious cycle of poverty and preventable death.

At least 15 million Nigerians face high flooding risks as the country enters its most dangerous weather period. Nigeria?s rainy season typically spans from April to October, with August marking the wettest and most hazardous month.

The devastating link between flooding and disease outbreaks has been repeatedly demonstrated. Reporting on the 2022 devastating flooding in Nigeria, the United Nations Children?s Fund (UNICEF) noted, ?Cases of diarrhoea and water-borne diseases, respiratory infection, and skin diseases have already been on the rise. In the north-eastern states of Borno, Adamawa and Yobe alone, a total of 7,485 cases of cholera and 319 associated deaths were reported as of 12 October, 2022.?

This year?s flooding has already claimed hundreds of lives across multiple states. In May, catastrophic flooding in Mokwa, Niger State, killed over 150 people and displaced thousands. Rivers State recorded at least 25 deaths following landslides and flash floods in Okrika, whilst severe flooding has battered Ogun and Gombe states.

The crisis has spread nationwide, affecting Anambra, Delta, Lagos, Plateau, Taraba, Zamfara, Bauchi, Katsina, Kano, and Kebbi states, creating a perfect storm for cholera transmission across Nigeria?s most vulnerable communities.

The Nigeria Centre for Disease Prevention and Control (NCDC) recently sounded the alarm over surging cholera cases nationwide. Latest data from Epidemiological Week 26 (June 23?29, 2025) shows all 34 states reporting infections, with Zamfara State bearing the heaviest burden at 32 per cent of suspected cases.

By the end of June, Nigeria had recorded 3,109 suspected cases and 86 deaths across these states, making it the second-worst affected country in West and Central Africa, according to the United Nations Children?s Fund.

The outbreak poses regional risks, with UNICEF warning that active cholera transmission in both Nigeria and the Democratic Republic of Congo threatens cross-border spread to neighbouring countries. An estimated 80,000 children face heightened infection risk as the rainy season intensifies across the region.

On Thursday, M?decins Sans Fronti?res (MSF) sounded the alarm over Zamfara State?s escalating outbreak, reporting more than 1,500 cases from three Ministry of Health medical facilities under its support.

The current crisis builds on Nigeria?s already dire cholera record?the NCDC documented over 10,000 suspected cases and more than 350 deaths in 2024 alone.

Compounding the health emergency, the Nigerian Meteorological Agency (NiMet) has issued impact-based weather forecasts warning of heightened flooding and flash flood risks across several states.

Such flooding creates a deadly cascade, the NCDC cautioned, triggering large-scale displacement, disrupting livelihoods, and dramatically increasing infectious disease outbreaks, particularly waterborne and vector-borne illnesses.

NCDC Director General Dr Jide Idris explained how floodwaters become vehicles of contamination, washing pathogens from soil, animal waste, and overwhelmed sewage systems into rivers, lakes, and drinking water supplies. This contamination creates ideal breeding conditions for cholera, caused by the bacterium Vibrio cholerae.

Though cholera has plagued Nigeria for decades, outbreaks peak between April and October when seasonal flooding accelerates disease transmission in areas with poor sanitation.

The disease strikes both children and adults, with symptoms appearing 12 hours to five days after exposure. Without treatment, death can occur within hours.

Following the 2024 flooding in Maiduguri, Borno State, Binta Saidu arrived at Gubio IDP Camp with her five children. She offered harrowing insight into the crisis? human toll. Recalling her sudden onset of symptoms, Binta told workers at the UNICEF-supported Cholera Treatment Unit (CTU), ?I was vomiting and stooling at the same time. I was fine a few hours earlier, and suddenly I became weak. Despite taking some medications, I did not feel any relief. In a matter of minutes, I became so weak that I could not even sit up.?

Nigeria?s water crisis provides fertile ground for the outbreak. Data from the Nigerian Institute of Water Engineers shows 179 million Nigerians lack access to safely managed drinking water services.

Soaring sachet water prices are worsening the situation, forcing families towards dangerous alternatives. ?Pure water? bags now cost between N400 and N500, with single sachets selling at N50?price increases that push vulnerable households towards contaminated sources health experts warn pose serious risks.

Multiple factors fuel cholera?s spread: inadequate clean water access, poor sanitation, insufficient waste management, open defecation practices, flooding, and unsafe water sources.

However, health experts stress the disease remains conquerable through targeted investment in clean water infrastructure, improved sanitation, enhanced hygiene practices, and community-level behaviour change.

Economic Impact

According to a 2022 report by the Stop Cholera initiative, which features the work of investigators at Johns Hopkins University, based on estimates an Infectious Disease Cost Calculator from the University of Pittsburgh Center for Health Security, ?the global cost for cholera in 2010 was $3.11 billion. These costs include $221 million for health care, $211 million in lost productivity from missed work by the patient and/or caregivers, and $2.68 billion in ?death costs.? ?The disease costs Bangladesh $122 million a year, India over $1 billion, and Nigeria $271 million (approximately over N414 billion today). For each country, the death cost constitutes the largest component, but health care and productivity costs are also major contributors.?

The report emphasises that assessing cholera?s true impact requires examining its comprehensive economic burden on the nation. Cholera patients face immediate ?direct? medical expenses encompassing medication costs, intravenous treatments, hospital transport, and admission fees. Beyond these upfront costs lie significant ?indirect? financial consequences, including reduced economic output when both patients and their carers are unable to work. Most critically, fatalities represent a profound economic loss through what economists term the ?death cost??the permanent loss of an individual?s lifetime economic contribution.

Understanding both the immediate healthcare expenditure and the broader economic losses from reduced productivity and premature death is crucial not only for health ministry officials but equally for economic and finance policymakers. Finance officials have particular reason to prioritise cholera prevention, as the disease?s entirely preventable nature means these substantial economic losses are both unnecessary and completely avoidable through proper intervention.

What experts say Dr Chukwuebuka Ugwu, a research scientist at Zankli Research Centre, Bingham University, Karu, Nasarawa State, expressed frustration that cholera continues claiming lives and draining resources annually despite being both preventable and treatable. Speaking with The Guardian, he emphasised that the disease flourishes where basic water, sanitation, and hygiene (WASH) infrastructure remains inadequate.

Statistics underscore Nigeria?s vulnerability: only 10 per cent of citizens access safe potable water, while nearly 50 per cent practise open defecation. Recurrent rainy season flooding compounds the crisis by spreading bacteria into wells and rivers.

Ugwu described how each rainy season brings ?the familiar but deadly shadow of cholera??an acute diarrhoeal disease caused by the bacterium Vibrio cholerae that spreads through contaminated food or water.

Decades of infrastructure neglect have left millions vulnerable, he noted, with many communities lacking safe piped water and proper sewage systems even in urban centres.

He said, ?Cholera imposes a heavy cost on Nigeria?s economy. The World Health Organisation estimates that cholera costs African countries hundreds of millions of dollars annually in lost productivity, healthcare expenses, and trade disruptions. In Nigeria, conservative estimates suggest billions of naira are lost each year, money that could be invested in education, infrastructure, or job creation.?

Ugwu highlighted the devastating link between poverty and cholera, explaining that poor households typically lack safe water, proper toilets, and prompt medical care access.

The disease perpetuates poverty, he argued, as families lose income through illness or death, exhaust savings on treatment, and see children miss school. ?This creates a cycle that is hard to break without systemic change.? He attributed current case spikes to weak outbreak response systems?where delayed detection accelerates spread?and climate variability that extends cholera?s reach through intensified rains and flooding.

He said, ?Several factors contribute to seasonal spikes in cholera cases: contaminated water sources due to flooding and overflowing latrines, poor hygiene practices such as open defecation, inadequate handwashing, and inconsistent water supply forcing people to store water in unsafe containers.?

The disease?s lethality stems from severe dehydration caused by rapid fluid loss through profuse diarrhoea, Ugwu explained. In extreme cases, patients can lose up to one litre of fluids and electrolytes within an hour. He added that without quick rehydration, either with oral rehydration salts (ORS) or intravenous fluids, death can occur within hours.

Mortality rates tell a stark tale of healthcare access inequality: in remote communities or where treatment is delayed, death rates can reach 50 per cent. However, with adequate rehydration and treatment, mortality drops to just one per cent.

Drawing historical parallels, Ugwu recalled how cholera devastated European cities in the 19th century until governments invested in modern sanitation systems, clean piped water, and public health legislation.

If Europe conquered cholera with 19th-century science, Nigeria can and must achieve the same in the 21st century, he argued. He said, ?London?s famous physician John Snow traced an outbreak to a contaminated water pump in 1854, demonstrating the power of safe water in stopping cholera. Today, Europe rarely sees cholera, not because the bacteria disappeared, but because environments where it thrives have been eliminated.?

?Cholera in Nigeria is not inevitable. With political will, investment in clean water, and community-level behaviour change, the disease can be drastically reduced and eventually eliminated. Every Nigerian has a role to play: governments must lead, communities must act, and individuals must protect themselves and others.?

Government action remains critical for lasting change, Ugwu stressed, requiring investment in nationwide WASH infrastructure including piped water and sewage systems, strengthened disease surveillance for faster outbreak detection and response, and affordable healthcare access ensuring treatment is never delayed.

For individuals, he recommended frequent handwashing with soap, especially after toilet use and before eating; drinking safe water through boiling, filtering, or chlorinating; cooking food thoroughly; safe faeces disposal; avoiding open defecation; and seeking immediate treatment for diarrhoea, starting ORS without delay.

During epidemics, he noted the need to pre-emptively position vital IV fluids and medicines in known hotspots and scale up targeted mass vaccinations using oral cholera vaccine in at-risk communities.

Also speaking, the M?decins Sans Fronti?res (MSF) Medical Coordinator in Nigeria, Dr David Kizito, noted that cholera has remained a p?blic health concern in Nigeria due to poor sanitation, with open defecation persisting as a cultural practice.

He said, ?During the rainy season, rainwater carries faeces into water sources and contaminates them. When the population drinks this contaminated water, this brings issues like cholera, typhoid fever, diarrhoea, and other waterborne diseases. Hence, the use of latrines is more than important for the population, as well as respecting basic hygiene rules such as washing hands after using the toilet, before eating, and drinking clean or boiled water.?

Kizito explained that when people contract cholera, they lose a large amount of water from their bodies through liquid diarrhoea and vomiting, adding that this loss plunges them into severe dehydration and hypovolemic shock, which can lead to death.

He observed that under certain conditions, poverty prevents people from accessing safe water, hygiene, and sanitation, leaving them vulnerable to cholera.

?Access to drinking water prevents the population from drinking and using contaminated water, protecting them from waterborne diseases, including cholera.?

Kizito stated that the MSF is supporting case management in Zurmi General Hospital, Shinkafi General Hospital, and Talata Mafara General Hospital in Zamfara State, which currently have more than 160 cholera beds for Cholera Treatment Centres (CTCs).

He added that the organisation is also involved in WASH activities at the community level in these different local government areas, particularly in the areas where most cholera cases are originating and is advocating with health authorities and other humanitarian NGOs to address the WASH gaps still visible in these communities.

Kizito urged Nigerians to respect basic hygiene measures such as using toilets, drinking boiled water, washing hands with soap or ash after using the toilet and before eating, and eating hot food.

He called on the government to strengthen access to clean drinking water in at-risk areas and improve sanitation measures. On his part, a public health physician at the University of Nigeria, Nsukka (UNN), and honorary consultant at UNTH Enugu, Prof Emmanuel Aguwa, noted that cholera is a waterborne disease transmitted through drinking contaminated water or eating raw fruits and vegetables washed with contaminated water.

He lamented that poor communities in the country lack access to potable water and stressed that the disease can only be contained by improving hygiene, water, and sanitation.

Aguwa stated that the government?s role in curbing the cholera outbreak is both preventive and curative.

He said, ?Preventive roles include health education of the public through mass media, provision of accessible potable water to the public, and vaccination during cholera epidemic. Curative is to ensure that health facilities have the resources they need to treat patients, and these should be affordable and accessible to the public.? (The Guardian)

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