As the cholera outbreak in Malawi escalates, the number of cases more than doubled in January with 1,142 cumulative cases recorded and 39 deaths - and the number continues to rise.

Exacerbated by poor sanitation and rainy season floods, the outbreak started in the capital, Lilongwe, on November 17, quickly spreading to two of the capital's densely-populated slums where there is no running water. The disease has now spread to more than 30 percent of the districts in the country, with the highest concentration remaining in and around Lilongwe.

“Thirty-nine people have died from cholera with more than 1,000 cases recorded," said Dr. Moses Massaquoi, Medical Coordinator in Malawi for Médecins Sans Frontières (MSF). "It’s extremely worrying as the disease continues to spread and numbers mount.

"Every day, the rain pounds down and people with no access to safe water resort to drinking untreated water from swamps or from unprotected wells in slums. As one of the poorest countries in the world, water and sanitation levels are extremely low. On top of this, the floods cause latrines to overflow and sewage then mixes with drinking water.”

MSF teams are helping to set up special isolation units in the most affected areas in Lilongwe and also installing latrines and donating special cholera beds and plastic sheeting to help with the response.

“Authorities here are doing their utmost to try and contain the spread, but it is a real struggle," said Dr. Massaquoi, "At the best of times, the country has an acute shortage of healthcare workers so, when cholera breaks out, it puts an unbearable strain on an already creaking health system and overworked medical staff.”

While cholera is endemic in Malawi, it has been eight years since the country’s worst outbreak, which killed almost 1,000 people, so much of the ‘memory’ of how to respond to cholera is lost. As a result, MSF medical staff are carrying out intensive bedside training and mentoring for national Malawian nurses and assisting them in handling cases to increase their capacity to respond to and contain this outbreak.

“People have forgotten about the disease so it spreads faster," said Dr. Massaquoi. "Right now, there aren’t enough health staff in Malawi with the training or experience needed to respond to a serious cholera outbreak. Time is life in a cholera outbreak so it’s essential to act fast, but people are going to clinics too late. Cultural practices are also contributing to the worrying increase in cases as people continue to wash dead bodies before burial, look after and visit the sick, and eat together during funerals.”