Cholera in Ukraine: propagating disaster-disease myths

Author: Gina Charnley

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Since the beginning of the Russian invasion of Ukraine in February 2022, there has been widespread suffering felt by the Ukrainian people. Media reports have rightly presented the truly tragic situation in Ukraine, along with several accounts of the strength of the Ukrainian people to support each other and their country.

On 17th May, WHO Europe held a news briefing on the health situation in Ukraine, which was posted on Twitter. The 20-minute briefing covered a number of health topics, with a brief mention that the deteriorating sanitary conditions in Ukraine poses a risk of cholera and that provisions of oral cholera vaccines had been stockpiled. In early June 2022, several large newspapers and media outlets wrote articles in relation to this including NBC News, the Washington Post, and CNN, to name a few.

The articles all follow a similar narrative that an increasing number of corpses and sewage are contaminating drinking water in Ukraine which could lead to cholera outbreaks. These reports are problematic and, in some instances, scientifically flawed. The WHO briefing gives no mention to dead bodies causing disease and this disaster myth has been dispelled time and time again by those working in disaster research and medicine^1-3.

Diseases do not appear from nowhere and unless the deceased had an infectious disease at the time of death, the body will not contaminate the environment or cause a disease outbreak. Similarly, if sanitary conditions break down, disease will only spread if the sewage was from people who were infected or carrying a water-borne disease.

Cholera is not endemic in any European nation, due to the general widespread access to sanitation and hygiene and of the few cases that are reported, these are from travellers returning from endemic countries. For example, in 2016-18 there were 66 cases of cholera in EU/EEA countries, all of which had travel history to cholera-affected countries.

In 2011, Ukraine experienced a small cholera outbreak in Mariupol, which resulted in 33 reported cases and 26 carriers being identified. Despite this, the strain which caused the outbreak was most closely related to Haiti, Nepal, and India, with strong evidence suggesting the cause as an introduction from South Asia through associated travel. International travel to and from Ukraine is not something that Ukrainians are likely to do at the present time, therefore removing this risk.

Dissimilar to many other diseases, cholera predominantly infects humans. It does not have large animal reservoirs which can cause spill-over, and despite environmental reservoirs being possible (especially with brackish water and the presence of crustaceans), there is little evidence of a long-term environmental reservoir for cholera. Due to the characteristics of cholera, for an outbreak to occur, sustained environmental contamination is needed.

Major outbreaks have been reported in several conflict-affected countries in 2021 and 2022, including Afghanistan, the Democratic Republic of Congo, Ethiopia, and Nigeria. The difference though between these countries and Ukraine is that cholera was already endemic, and risk factors and vulnerabilities were worsened by the conflict, allowing the pathogen to spread. If cholera was to arise in Ukraine, an introduction would have to occur, which from previous outbreaks is most likely to come from international troops or humanitarians, not from Ukrainian fatalities of the war.

The most prominent example of this danger is arguably Haiti. In February 2010, a 7.0 magnitude earthquake hit Haiti and a cholera outbreak followed, which lasted nearly a decade. Haiti was a non-endemic country and many people were naive to the disease. Without any immunity, mortality was very high, and created one of the most deadly cholera outbreaks ever recorded, which could be the case if a Ukrainian outbreak was to happen. Despite the common narrative, the Haitian outbreak was not caused by the earthquake or dead bodies, but instead an introduction from UN peacekeepers which contaminated the local water sources. The truth took far too long to surface and compensation for this is still being sought by the Haitian people.

The hope, regardless of any report, is that the Ukrainian people do not suffer any more than they have already. The greatest tragedy in terms of corpses is the deprivation of the Ukrainian people to body identification and dignified burial of their loved-ones, and the importance of providing them with the basic human right of water, sanitation, and hygiene.

Propagating the dead body-disease disaster myth is dangerous, it shifts the responsibility of action and in some cases blame, naming it as an act of fate outside anyone’s control, instead of a risk that can be managed. Disease mitigation is important, including learning from previous mistakes (like those seen in Haiti) and planning for outbreaks (vaccine stockpiling). Writing reports on simple speculation though is not helpful and the focus should instead be on the current health threats affecting Ukrainians. Presently, sexual violence and mental health are serious threats in Ukraine and more needs to be done as the repercussions of these health crises will likely be felt for decades to come, increasing morbidity and straining the healthcare system as it tries to recover.

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Gina is a Research Postgraduate at Imperial College London and is funded by the Natural Environmental Research Council | g.charnley19@imperial.ac.uk

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1. Morgan O. Infectious disease risks from dead bodies following natural disasters. Revista panamericana de salud pública. 2004;15:307-12.
2. De Goyet CD. Stop propagating disaster myths. Disaster Prevention and Management: An International Journal. 2000.
3. Morgan O, Ville de Goyet CD. Dispelling disaster myths about dead bodies and disease: the role of scientific evidence and the media. Revista Panamericana de Salud Pú 2005;18:33-6.