Protecting communities and containing cholera: results and lessons from a CERF funded response in Amhara Region

Ethiopia's Amhara Region face public health challenges driven by recurrent disease outbreaks, conflict-related displacement, and limited access to safe water and sanitation. Among the most critical emergencies in recent years has been cholera, an acute diarrhoeal disease linked to unsafe water and poor hygiene practices.

With support from the United Nations Central Emergency Response Fund (CERF), the World Health Organization (WHO) and local health authorities worked together on a cholera response that focused on finding cases early, stopping the spread, and preventing new infections. It also demonstrated how rapid, community-centred action can save lives.

Before the intervention, the holy water site in the region was overcrowded, lacked basic sanitation facilities, and relied on untreated water sources. Pilgrims and surrounding communities had limited awareness of cholera transmission, and suspected cases were reported late due to weak surveillance. Following the CERF-supported response, visible improvements were observed: water treatment points were installed, handwashing stations introduced, hygiene messages displayed, and access to the site was temporarily restricted to reduce risk.

Key response activities included rapid assessments and real-time surveillance, deployment of trained Rapid Response Teams, distribution of water treatment chemicals, and hygiene promotion campaigns. Importantly, 31 community volunteers were trained and equipped to conduct cholera prevention activities, empowering communities to take ownership of their health.
Religious leaders, initially hesitant to restrict access to holy water sites, became advocates for public health after targeted dialogue and evidence-based risk communication. Their agreement to temporarily close high-risk sites marked a turning point in outbreak control.

Alemu, a 42-year-old pilgrim from Quara District, said, "After the training, I understood how cholera spreads. Now I treat my water at home and teach my children to wash their hands. We have not had sickness like before."

Despite these successes, the response faced challenges, including insecurity, damaged health facilities, mobile network disruptions and limited health workforce capacity in remote areas. These constraints delayed early detection and complicated data reporting. Nevertheless, the CERF-funded intervention demonstrated that preparedness, coordination, and trust-building can overcome even the most difficult operating environments.

Mr Belay Bezabih, Director General of the Amhara Public Health Institute, underscored the importance of collective action: "The cholera outbreak reminded us that preparedness and coordination are non-negotiable. By working together across sectors and with communities, we can build a resilient public health system capable of preventing future outbreaks."

Innocent Komakech, WHO Hub Coordinator and cholera response Incident Manager, highlighted the role of community leadership: "The success of this response was driven by strong government leadership and the active involvement of local communities and religious leaders."

The lessons learned led to longer-lasting solutions. In October 2025, health officials and faith leaders agreed on basic water, sanitation, and health standards for religious places, turning what they learned during the emergency into ongoing ways to prevent cholera, in line with the worldwide plan to end cholera by 2030.

These efforts led to a big drop in cholera cases, with no cases reported in the Amhara region by the end of 2025.
The CERF-funded cholera response in Amhara shows how quick funding, involving the community, and respecting local culture can turn a crisis into long-term health improvements, saving lives now and making communities stronger for the future.