On cyclone-hit Mayotte, antibiotic-resistant cholera poses a new danger. Here's what we know

A little over a week ago, Mayotte, an overseas French department in the Indian Ocean, was devastated by Cyclone Chido.

The worst to hit the region in nearly a century, the tropical cyclone has led to a dire situation for its population. Much of the islands' infrastructure was destroyed by 225 km/h winds, with fallen powerlines and impassable roads making communication and the movement of emergency supplies almost impossible.

To make matters worse, concerns are now being raised about sanitary conditions.

Experts believe there’s a risk cholera could surge again mere months after the end of a previous epidemic which saw five deaths and over 200 people infected.

"There is no reason today to think that cholera might be present, but it remains a concern," Geneviève Darrieussecq, the French outgoing Health Minister, told French media.

The renewed threat of cholera on Mayotte is being taken even more seriously after a study published on December 11 found a new antibiotic-resistant strain has been identified on the islands. Here’s what we know.

What is cholera?

Cholera is an infection caused by bacteria usually found in contaminated food or water, according to the World Health Organization (WHO). 

In around 80 per cent of cases, sufferers experience diarrhoea, but symptoms can also include vomiting and dehydration. 

When untreated, the most severe cases can lead to death quickly, especially among children, the elderly, and the vulnerable.

The treatment usually includes rehydration, which is provided orally or intravenously. 

In some cases, antibiotics can be prescribed "to reduce the duration of the infection and break the chains of transmission as quickly as possible," according to the Institut Pasteur.

However, a strain resistant to two of the three WHO-recommended antibiotics for the treatment of cholera had been identified by researchers in a study published in the New England Journal of Medicine earlier this month.

First discovered in Yemen, the strain was identified in Mayotte at the beginning of the epidemic that occurred between March and July 2024 this year, according to the study, "initially from patients coming from Tanzania or Comoros and subsequently from patients infected locally".

Therefore, a new surge of cholera - whether bio-resistant or not - is a "concern" for French authorities which are making plans to store vaccines and distribute chlorine tablets to purify water.

Mayotte's health services are in a dire situation

Already stretched thin, hospitals on the island chain are overwhelmed with patients suffering not only from cyclone-related injuries but also from dehydration, malnutrition, and disease.

At Mayotte’s main hospital in the capital, Mamoudzou, doctors faced a cascade of crises.

"We lost 40 per cent of patient rooms, about 50 to 60 beds," said Dr Roger Serhal, chief of the obstetrics and gynaecology department. 

"There are so many patients coming to the hospital, and we don’t have space to admit them".

As Chido battered the archipelago, Serhal and his team delivered three babies, including by cesarean section.

The hospital’s structural damage has forced staff to triage patients, prioritising the most severe cases. 

Though the official death toll remains 35, according to the French Interior Ministry on Saturday, the number of seriously injured has risen to 78, with 2,432 others sustaining minor injuries. 

Darrieussecq has warned that any estimates are likely major undercounts "compared to the scale of the disaster," with the storm having devastated entire neighbourhoods.

More than 500,000 tonnes of waste have accumulated in Mayotte since the cyclone hit.

Doctors fear that the lack of clean water and electricity, compounded by overcrowded living conditions is setting the stage for a health crisis, including a resurgence of cholera. 

"Patients are coming because their illnesses are untreated, there’s no water, and no electricity. We’re concerned about epidemics," said Dr Vincent Gilles, the hospital’s emergency medical director.

The hospital staff continues to work tirelessly, but resources are running dangerously low. 

"If we have rain it will be catastrophic," Serhal said.