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We are at home with Sandra Nyendwa in Lusaka, the capital of Zambia.

She boils water for an electrolyte solution.

Because she has a serious case of diarrhea - the water here made her sick.

Sandra Nyendwa, cholera survivor:

»I didn't believe I would come back from the hospital alive, it was very bad.

I can only thank God and the nurses.

I didn’t expect to be in my house at that time because I was in terrible shape.”

She was sick with cholera.

The bacteria are transmitted via contaminated water or food, for example when there are inadequate sanitation and sewage systems.

Nyendwa's son also became infected.

Sandra Nyendwa, cholera survivor:

»My child kept complaining of stomach pain until he turned pale and started vomiting.

When we saw that the situation was getting worse, we rushed to the clinic.

They are not the only ones: Cholera has been spreading across the African continent for months.

Zambia is particularly affected: the country's national stadium has been converted into a central treatment center for cholera sufferers.

More than 19,000 cases have been reported in the country since October and there are said to be at least 685 deaths.

In addition, twelve other countries in eastern and southern Africa are affected by a severe cholera outbreak, with more than 200,000 cases and 3,000 deaths estimated by the children's aid organization "Unicef".

Just over half of those affected are children under the age of five.

High numbers of cholera cases are also reported in Afghanistan and Syria.

Vaccines can help, but there are too few.

The global emergency supply of cholera vaccines is empty.

All available doses for this month have already been allocated, the World Health Organization and Unicef ​​told the Reuters news agency.

At least 50 million vaccine doses could be missing this year as the number of cases continues to rise worldwide.

The biologist and climate impact researcher Veronika Huber at the Ludwig Maximilian University of Munich comes to the conclusion that climate change has an influence on cholera outbreaks.

The study situation is clear.

Veronika Huber, LMU Munich:

“Well, there are these cholera epidemics in many countries in the Global South.

There are studies from Latin America, from Asia, from Africa and they looked, for example: when do these peaks occur in this epidemic and then they found, for example, that this is linked to this El Niño / La Niña - System, i.e. this ENSO climate system, which is actually a global climate fluctuation, so to speak, and where you can see that these cholera epidemics are climatically sensitive.

And we know, for example, that once such an epidemic has broken out, the dynamics of this epidemic are, so to speak, driven by rainfall patterns.

I was also involved in a study in which we didn't really look at all of these individual climatic variables, such as rainfall or ENSO in this case, but we simply looked at what the direct temperature effect was.

And there is also evidence that simply at elevated temperatures there is a higher risk of a cholera outbreak.”

Global climatic changes are revealing the weak points of public health systems, says Siegbert Rieg, Professor of Clinical Infectiology at the University Hospital of Freiburg.

It will be particularly difficult for low- and middle-income countries to compensate for these developments.

Siegbert Rieg, Freiburg University Hospital:

“There is less precipitation, but in very short periods of time and the extreme water accumulation leads to a collapse of the sanitary systems.

All of this will mean that we see these diseases more often.

And it doesn't just apply to cholera, it will also apply to other fecal-oral pathogens.

And caring for these patients will then become increasingly difficult in these countries and with it, unfortunately, the burden of disease.”

Cholera should actually be eradicated by 2030.

In 2017, the World Health Organization drew up an action plan for this.

Among other things, it says that people everywhere should have access to clean drinking water and those affected should receive new vaccines more quickly.

But due to climate change, this plan is now in danger of failing.

Climate changes are increasing existing inequalities.

Extreme weather events such as drought and floods make access to clean water difficult.

However, the consequences are also noticeable in Europe.

Siegbert Rieg, Freiburg University Hospital:

“This is about mosquitoes, mosquitoes, whose distribution area will change significantly.

And that ultimately also affects southern and central Europe.

This means that there are diseases such as dengue fever or chikungunya, West Nile fever.

We are seeing these diseases in areas, in geographical regions, that we did not know before.

But there are also other examples, for example Vibrio diseases, which can cause serious skin soft tissue infections, which can now be observed in the Baltic Sea in the summer months because the bacteria can grow there due to the warmer water temperatures and then trigger infections.

The experts agree: Climate change requires a rethink in the healthcare system and global strategies on how infectious diseases can be combated in the future and possible new pandemics can be prevented.

An important component is scientific research into the new risks - and providing information to the affected populations.

Then maybe Sandra Nyendwa could have prevented something worse from happening.

Sandra Nyendwa, cholera survivor:

»We didn't know that the disease had broken out, but now we know.

We never chlorinated, we just drank straight from the tank and there was never any real cleaning.”

In particular, people like Sandra Nyendwa, who live in precarious conditions, are additionally threatened by climate change.

And the cholera outbreak in Zambia is not over yet.