Nigeria has been hit by a surge in cholera cases in recent weeks, focused on the country’s north and adding to a public health crisis accompanied by a rise in COVID-19 cases.

“In the last two weeks we had new and resurgence cases,” Dr Bashir Lawan Muhammad, the state epidemiologist and deputy director of public health for northern economic hub Kano State, told Reuters.

He said the rainy season was making it worse, while insecurity in the north, where the authorities have been battling militants and armed criminals, was also hindering the authorities’ ability to respond.

Twenty-two of Nigeria’s 36 states, as well as the federal capital territory Abuja, have suspected cases of cholera, according to the Nigeria Centre for Disease Control, (NCDC). The illness, which is caused by contaminated water, can kill within hours if not treated.

The surge has been focused in the north of the country, where health systems are least prepared.

At least 186 people had died in Kano of cholera since March, Muhammad said. The state accounts for the biggest share of the 653 cholera deaths recorded in the country as a whole by the NCDC.

Nearby northern states Bauchi and Jigawa are also among the hardest hit, according to the NCDC.

Lagos-based consultancy SBM Intelligence said the states with the most fatalities showed a strong correlation with those that performed poorly in its health preparedness index published in May.

The cholera surge comes as daily COVID-19 cases hit their highest since March, raising fear of the third wave of the pandemic in Africa’s most populous nation.

Putting states under red alert

Nigeria put six states on red alert in mid-July after seeing a “worrisome” rise in COVID-19 infections, a government official said, urging people to curb gatherings and hold prayers outside mosques during this week’s Muslim festival Eid-el-Kabir.

Nigeria, Africa’s most populous nation, is like most parts of the continent now facing a COVID-19 third wave after detecting the more transmissible Delta variant.

The head of the presidential steering committee on COVID-19, Boss Mustapha, said Lagos, Oyo, Rivers, Kaduna, Kano, Plateau and the Federal Capital Territory had been placed on red alert as part of preventive measures against the pandemic.

A red alert allows authorities in the states to restrict celebrations and gatherings to a minimum.

“These steps are critical as we begin to see worrisome early signs of increasing cases in Nigeria,” Mustapha said in a statement.