Sandra Mwayera wailed as her older brother sat next to her in the backseat of a car – he had died of cholera while waiting for treatment alongside dozens of others outside a hospital in Zimbabwe’s capital, Harare.

“My brother! My brother! Why did you leave me?” she pleaded. “Please come back. Come back!”

In neighboring Zambia, at the capital Lusaka’s 60,000-seat National Heroes Stadium, rows of gray cots lined the rooms of a makeshift treatment center where 24-year-old Memory Musonda died. Her family said they were not informed until four days later – the government had buried her and her grave had not yet been located.

Ms Musonda’s uncle, Stanley Mwamba Kafula, said the family was “troubled” and “heartbroken”.

Active outbreaks of cholera, a waterborne bacterial disease, are currently raging in five countries in central and southern Africa, ranging from the Democratic Republic of Congo to Mozambique.

The epidemic has spread over the past two years, infecting more than 220,000 people and killing more than 4,000 in seven countries. That is the deadliest regional outbreak in terms of cases and deaths that will plague Africa for at least a decade, Dr. Patrick Otim, who oversees cholera control for the World Health Organization in Africa. Public health workers in Africa say it is rare to have so many cases in so many countries at the same time.

Cholera cases in Africa have actually been declining and reached a low point in 2020, he said. But then there was a surge in West Africa in 2021, followed by the current outbreak in the southern part of the continent.

Two countries – Zambia and Malawi – have reported their largest ever cholera outbreaks, while Zimbabwe has its second highest number of cases on record. Of the 19 African Union countries that reported deaths and cases last year, nearly three-quarters of the cases came from southern Africa. according to the Africa Centers for Disease Control and Prevention.

“The cholera situation in southern Africa – particularly Zimbabwe and Zambia – is dire,” said Dr. Mounia Amrani, head of the Southern Africa medical team at Médecins Sans Frontières.

Public health experts said the devastation was linked to increasingly severe storms, a lack of vaccines and poor water and wastewater infrastructure.

Representatives from 15 nations in the Southern African Development Community have agreed to a collective mobilization that includes investments in the production and distribution of vaccines, cooperation in cross-border surveillance of the disease and the development of reliable water and sanitation systems.

Zambia is the hardest hit by the disease and is experiencing its deadliest outbreak on record. Since October More than 650 people have died and more than 18,500 have been infected, although the number of cases and deaths have fallen since their peak in January. Five deaths were reported in the 24 hours leading up to Monday, compared to the more than 15 deaths recorded daily last month. Schools reopened on Monday after a delay of about a month.

Still, there are worrying signs. The outbreak was initially limited to the capital, Lusaka, but has since intensified expanded to nine additional provinces. At 3.5 percent, the mortality rate is well above the 1 percent rate considered typical by health experts. Dr. Otim said about half of Zambia’s deaths occurred at home rather than in health centers, an indication that people were either in denial or unaware that they had cholera.

Médecins Sans Frontières has deployed 50 health workers to Zambia and 30 to Zimbabwe to help manage the outbreaks.

Even as public health and government officials struggle to combat the outbreaks, the CDC warns of a potentially difficult situation for Africa: Above-average precipitation is forecast across much of the region this month, weather that floods communities and destroys infrastructure and increases the Risk of cholera transmission.

People typically become infected with cholera when they drink water contaminated by human waste. Public health experts say the safest way to prevent the disease is to keep water sources for drinking and washing separate from wastewater.

Many communities in southern Africa suffer from poor water and sanitation infrastructure. For toilets, residents often rely on latrines in shallow pits and use streams or lakes for drinking and washing in the absence of tap water. This poses a significant risk of cross-contamination, particularly during heavy rains and floods.

One of the key commitments of Southern African Development Community leaders was to invest more in developing resilient water and sanitation systems.

“If we do not address the water, hygiene and sanitation issues, we will not stop the cholera outbreak,” said Dr. Otim from WHO.

Vaccination is also a big topic. A surge in cholera outbreaks worldwide in 2021 and 2022 has depleted vaccine supplies, Dr. Otim, and that’s all there is a manufacturer who produces the cholera vaccine on a global scale. About 37 million doses were produced last year, although demand was about 60 million, he said.

Dr. Amrani said cholera received less attention from the pharmaceutical industry than other diseases, which also contributed to the vaccine shortage.

While longer-term solutions such as creating better water infrastructure and increasing vaccine production may take time, organizations such as Doctors Without Borders and the WHO are helping countries across the region address the immediate problem of treating suffering patients. They provide fluid treatments, medical staff and supplies.

At a treatment facility set up at a school in a densely populated suburb of Harare, nurses wearing latex gloves tended to patients splayed on cots. There were moans and screams, and some patients leaned uncomfortably on benches waiting to be treated.

“I’m dying! Please, I’m dying!” A woman at the school screamed as nurses tried to put intravenous tubes in her hands to give her fluids for hydration. “What should my children do? Who should take care of them care about them?”

One morning at Sally Mugabe Central Hospital in Harare, where Ms. Mwayera’s brother had died in the car outside, a nurse delivered bad news to members of another family waiting in a hallway. Jethro Nguweni, 52, had lost his battle against cholera.

“What should I do?” His wife Melia Nguweni sobbed, took off her headscarf and threw it down. “My husband is gone. He left me.”

Collins Chilumba Sampa contributed reporting from Lusaka, Zambia.