Nigeria’s Borno State is currently experiencing a profound health emergency as a severe cholera outbreak rapidly spreads, posing a significant threat to communities already struggling with the long-term impacts of conflict, displacement, and poverty. The highly contagious bacterial infection, which began surfacing on May 1, 2026, has quickly escalated, affecting 16 Local Government Areas (LGAs) and overwhelming vulnerable populations. As of June 17, 2026, health authorities from the Borno State Public Health Emergency Operations Centre (BPHEOC) and the Ministry of Health have reported over 12,000 suspected cases and at least 95 fatalities. These alarming figures are expected to climb further as the region enters its intense rainy season, a period known to amplify the risks of waterborne diseases. ## Understanding the Cholera Threat Cholera is an acute diarrhoeal disease caused by the bacterium *Vibrio cholerae*, which infects the intestine. It is primarily transmitted through the ingestion of food or water contaminated with the faeces of an infected person. Once ingested, the bacteria produce a toxin that causes severe, watery diarrhoea and vomiting, leading to rapid and extreme dehydration. If left untreated, cholera can be fatal within hours, making swift medical intervention absolutely critical. The characteristic 'rice-water stool' is a hallmark symptom, indicating the severity of fluid loss. In regions like Borno State, the conditions are ripe for cholera to thrive and spread rapidly. Years of conflict have devastated essential infrastructure, including healthcare facilities and water and sanitation systems. This has resulted in overcrowded settlements for displaced persons, where clean drinking water is scarce, and proper sanitation facilities are often non-existent. Open defecation becomes common, further contaminating water sources. An underfunded public health sector struggles to cope, leaving communities with inadequate access to basic hygiene practices and life-saving medical care. These systemic vulnerabilities create a perfect storm for outbreaks like the one currently gripping Borno. ## Médecins du Monde's Rapid Emergency Response Recognizing the urgency of the situation, Médecins du Monde (MdM) swiftly mobilized its teams and resources to launch a comprehensive emergency response. Drawing upon valuable experience from previous cholera outbreaks, including a significant one in Maiduguri Metropolitan Council (MMC) and Jere LGAs in 2024, MdM is strategically deploying interventions to save lives and contain the spread. Their rapid action demonstrates the critical role humanitarian organizations play in mitigating health crises in fragile settings. In a collaborative effort with Médecins Sans Frontières Belgium (MSF-B), MdM has established two crucial Cholera Treatment Units (CTUs) to provide immediate, life-saving care. These dedicated facilities are designed to manage moderate to severe cases of cholera, offering specialized medical attention. One CTU, equipped with a 15-bed capacity, has been set up at the Abbaganaram Primary Health Care Centre, while another larger unit with 32 beds is operational at the Dalaram Primary Health Care Centre. These units are vital hubs for patient management, isolation, and treatment, preventing further community transmission. ## Safeguarding Health: Infection Control and Supplies Ensuring the safety of both patients and healthcare workers is paramount in any infectious disease outbreak. MdM has implemented stringent Infection Prevention and Control (IPC) measures within these treatment facilities. This includes the use of specialized cholera beds designed for easy cleaning and waste management, strategically placed handwashing stations to promote hygiene, and the consistent application of chlorine solutions and disinfectants to decontaminate surfaces and prevent environmental contamination. These measures are fundamental to breaking the chain of transmission within the healthcare setting. To fully support the medical response, MdM has also distributed a wide array of essential medical and non-medical supplies. This includes crucial medical treatments such as Oral Rehydration Salts (ORS) – a simple yet highly effective solution for mild to moderate dehydration – and intravenous fluids like Ringer's Lactate for severe dehydration. Antibiotics such as azithromycin and doxycycline are also provided to help reduce the duration and severity of the illness. Beyond medication, essential protective equipment like disposable gloves, gowns, and footwear protect staff, while items such as IV cannulas, knapsack sprayers for disinfection, and patient registration materials ensure smooth and organized operations. ## Training and Community Engagement The effectiveness of any health response hinges on the competency of its staff. All medical personnel involved in MdM's cholera response have undergone rigorous formal training in cholera preparedness and case management. This foundational knowledge is further reinforced through ongoing formal and on-the-job training sessions for both MdM staff and local healthcare workers in supported facilities. Training modules comprehensively cover cholera case definitions, understanding the causes and transmission pathways, accurate assessment and management of dehydration, robust infection prevention measures, and effective outbreak control strategies. This continuous education ensures that frontline workers are well-equipped to handle the evolving challenges of the outbreak. Beyond the main CTUs, MdM has strategically established two Oral Rehydration Points (ORPs) at the Gwange 1 and Gamboru health facilities within MMC LGA. These ORPs serve a critical dual purpose: they offer immediate rehydration services for patients experiencing mild dehydration, preventing their condition from worsening, and they act as crucial early detection points. Patients with more severe symptoms can be swiftly identified and referred to the CTUs in Abbaganaram, Dalaram, or the MSF-B-supported facility in Nganaram, ensuring they receive advanced care without delay. ## Reaching the Hard-to-Reach: Damboa LGA Efforts have also been intensified in Damboa LGA, a challenging region located south of Maiduguri, known for its insecurity and high levels of poverty. These factors make humanitarian access difficult and communities particularly vulnerable. So far, 16 suspected cholera cases and two deaths have been reported in Damboa. While no patients are currently admitted to a CTU there, all suspected cases are being managed at the General Hospital Damboa according to established referral protocols. In a proactive move to prepare for a potential surge, MdM has bolstered preparedness measures across Damboa LGA. Twenty cholera beds have been pre-positioned, and a CTU stands ready for immediate operationalization should the epidemiological situation deteriorate. Under this preparedness plan, MdM will oversee clinical case management, while the International Medical Corps (IMC) will provide vital support for Water, Sanitation, and Hygiene (WASH) interventions, recognizing the interconnectedness of these efforts in cholera control. Furthermore, MdM plans to establish additional ORPs in Damboa to facilitate early rehydration, raise community awareness, and ensure timely referral of suspected cases. ## Prevention Through Education and Surveillance Beyond direct treatment and preparedness, MdM continues to prioritize cholera prevention through extensive community sensitization and health education. These crucial sessions are conducted both within health facilities and directly within communities, reaching a wider audience. Key messages focus on fundamental public health practices: emphasizing proper hand hygiene, promoting safe water practices (such as boiling or treating water), ensuring food safety, maintaining environmental sanitation, recognizing early cholera symptoms, and encouraging prompt healthcare-seeking behavior. Educating communities empowers individuals to take proactive steps to protect themselves and their families. MdM also plays a vital role in strengthening cholera surveillance activities. This involves close collaboration with health authorities and other humanitarian partners to ensure the timely detection, accurate reporting, efficient referral, and swift response to all suspected cases. Robust surveillance systems are the backbone of outbreak control, allowing health responders to track the disease, identify hotspots, and deploy resources effectively. ## A Call for Sustained Investment As the rainy season continues to intensify, the risk of further cholera transmission in Borno State remains alarmingly high. Médecins du Monde strongly reiterates the urgent need for sustained, long-term investments in essential health and WASH services. Protecting vulnerable populations from recurrent outbreaks requires more than just emergency responses; it demands resilient infrastructure, accessible healthcare, and consistent public health programs. Only through such comprehensive and sustained efforts can communities in Borno State truly build resilience against cholera and other preventable diseases, ensuring a healthier future for all.