Since July 2025, eastern Chad has been grappling with a cholera epidemic, exposing the vulnerabilities of fragile water supply and sanitation systems. As of 26 September, over 2,475 cases and 141 deaths had been reported. Overcrowded Sudanese refugee camps and impoverished host communities provide conditions conducive to the rapid spread of the disease, which is transmitted through contaminated water or food. Cholera causes severe diarrhoea that can lead to death from dehydration in just a few hours if treatment is not administered promptly. Médecins Sans Frontières (MSF), in collaboration with Chad’s Ministry of Public Health and other organizations, has been implementing both preventive and curative measures to limit the epidemic and protect communities.
One of the main challenges in fighting cholera is the late arrival of patients at healthcare facilities. Many people, like 65-year-old Khamis Ahmat Ali, seek care only when severely dehydrated, sometimes in shock. This delay is often caused by limited knowledge about the disease and inadequate health infrastructure, particularly during the rainy season. Nearly half of all cholera-related deaths occur outside healthcare facilities, with mortality rates six times higher than when proper treatment is available. MSF treatment centers and hospitals focus on rehydration therapy, sometimes supplemented with antibiotics, to save lives. Khamis emphasizes the importance of community awareness and communication to ensure timely access to care.
Preventive measures are critical in curbing cholera transmission. MSF and the Ministry of Public Health have strengthened medical facilities, trained community health workers, and conducted awareness campaigns in camps, markets, and border areas. Vaccination campaigns targeting over one million people were launched in August 2025 across seven health districts, with MSF supporting cold chain management and administering vaccines to more than 630,000 people in refugee camps and host communities. Vaccination efforts continue along key routes, particularly near the Sudanese border, to prevent further spread.
In addition to treatment and vaccination, MSF has taken steps to improve hygiene and water access. More than 550,000 bars of soap have been distributed, benefiting nearly 200,000 people in Adré. Water systems have been rehabilitated in districts like Hadjer Hadid, providing 75,000 litres of water to residents previously lacking access. In refugee camps such as Iridimi in Wadi Fira, long-term improvements to water access are underway to support new arrivals from Sudan.
Eastern Chad’s epidemic is exacerbated by the influx of over 877,000 Sudanese refugees since April 2023, concentrated mainly in the province of Ouaddaï. Limited access to safe water, inadequate sanitation facilities, and overcrowded living conditions increase the risk of cholera outbreaks, especially during the rainy season. In Adré, there is only one latrine for every 160 people, far below the emergency standard of one per 50 people, forcing open defecation and raising transmission risks. The epidemic has spread to Guéra and Sila provinces, prompting MSF to deploy additional response teams. Effective prevention and control will require coordinated access to safe drinking water, improved sanitation, and sustained national and international support.
