The pilgrims come in droves. They come by foot, by vehicle and by air to the many churches and monasteries scattered around the once ancient Christian kingdom of Ethiopia. They seek piety in their communing, but it is in the very density of their shared pilgrimage that dangerous diseases like cholera tend to thrive.

Chief among the pilgrimages is the feast of the archangel Gabriel, celebrated in July and December by followers of the Ethiopian Orthodox Church. Along with festivities in individual churches, the major celebration ignites the small town of Kulubi, in the eastern Hararghe Zone of Oromia Region, where tens of thousands of pilgrims from within the country and abroad descend on Kulubi St Gabriel church.

Such a large gathering in Kulubi creates a favourable environment for cholera transmission, especially because ensuring good hygiene in such a context is an enormous challenge. This sensitivity of a situation is compounded where there is an ongoing outbreak, such as the one Ethiopia is currently experiencing. A case of cholera was first reported on 25 April 2019 in the Amhara Region, in the north-western part of the country. Since then, six other regions have reported cholera outbreaks, with most of the cases (985) reported from Amhara, Oromia and Afar regions and in the capital, Addis Ababa.

To accommodate the massive volume of people visiting the town for varying lengths of time, the Oromia Regional Health Bureau and the Ethiopian Public Health Institute with support from World Health Organization (WHO) and partner agencies, recently installed latrines with hand washing stations, set up cholera treatment centres and emergency clinics and dug pits for the safe disposal of solid waste. With the use of an advocacy van, mobile education teams spread hygiene messages on safe food preparation and handling as well as cholera prevention and control.

The WHO efforts on cholera control and elimination during an outbreak includes assisting regional health and water bureaus and partners for inspecting and monitoring water quality. Where cholera treatment centres have been established, WHO specialists in water, sanitation and hygiene also provide technical guidance to regional health workers on preparing different strengths of chlorine solution and ensuring that there are adequate sanitation facilities and shower rooms available.

Dr Aggrey Bategereza, WHO Representative a.i. for Ethiopia, emphasized the importance of joint efforts in preventing the spread of cholera. “This collaborative work in addressing prevention during religious festivals, and especially with the support of the religious leaders, gives us a fighting chance to control and possibly even eliminate cholera from Ethiopia.”