Recurrent outbreaks of cholera in Nigeria: a narrative review on the role of conflict and climate change

ABSTRACT Cholera remains a major public health problem in Nigeria, with recurrent outbreaks linked to weak water and sanitation services. We conducted a narrative review of published studies and reports and examined how conflict and climate variability contribute to cholera risk and how these drivers interact. Evidence shows that conflict increases cholera transmission mainly through population displacement, overcrowding, and the breakdown of water, sanitation and hygiene (WASH) systems, surveillance, and health services. Climate hazards, especially heavy rainfall, flooding, and drought, increase exposure to contaminated water and disrupt sanitation infrastructure, creating conditions that support the persistence and spread of Vibrio cholerae. The interaction of insecurity and climate shocks is most evident in high-risk settings such as internally displaced persons camps and flood-prone communities, where outbreaks are harder to detect and control. We recommend conflict-sensitive and climate-adaptive cholera control, including strengthened WASH services, earlier warning and surveillance, pre-positioned outbreak supplies and oral cholera vaccines, and coordinated response plans for high-risk regions.