In collaboration with health and WASH partners, the World Health Organization (WHO) and the Government of Bangladesh conducted a multisectoral tabletop simulation exercise on 6 May 2025 in Cox’s Bazar to assess and enhance cholera preparedness and response in Rohingya camps and host communities.
The exercise convened frontline professionals, including health managers, epidemiologists, medical coordinators, and Water, Sanitation, and Hygiene (WASH) experts, to assess the Acute Watery Diarrhoea/Cholera Preparedness and Response Plan, identify operational gaps, and strengthen intersectoral coordination. The simulation also integrated the 2024/25 Cholera Action Plan and the Joint Assessment and Response Team (JART) components to ensure alignment with global standards.
The urgency of this exercise was underscored by the most recent and severe cholera outbreak in the camps, which occurred between June 2024 and January 2025, resulting in 581 confirmed cases, and nearly 40% of which were in children under five. While rapid interventions, including enhanced surveillance, use of rapid diagnostic tests (RDTs), laboratory confirmation, case management, Risk Communication and Community Engagement (RCCE), water treatment, hygiene promotion, and a reactive Oral Cholera Vaccination (OCV) campaign, were instrumental in containing the outbreak, several critical gaps were identified. These included inconsistent water chlorination, inadequate sanitation, insufficient screening of new arrivals, limited community engagement, weak coordination between WASH and Health sectors, and inconsistent sharing of water quality surveillance data. “This exercise reinforced the complementary role of WASH in preventing and containing cholera outbreaks,” said Shejeda Begum, UNICEF’s WASH Officer in Cox’s Bazar. “It allowed us to revisit coordination protocols, clarify roles, and apply practical solutions to real-world challenges.”
“This simulation is a vital step toward closing the gaps we saw during the last outbreak,” said Dr Mohammadul Hoque, Civil Surgeon of Cox’s Bazar. “Preparedness must be continuous, coordinated, and community driven.”
The exercise guided participants through a simulated emergency outbreak scenario, beginning with a sudden spike in diarrheal cases leading to the confirmation of cholera. It walked participants through the full lifecycle of an emergency response, encompassing case detection and reporting through early warning systems, clinical management at health facilities, WASH interventions to ensure access to safe water and sanitation, risk communication to inform and engage communities, and logistics management to support effective resource mobilisation.
The simulation also included a dedicated segment on oral cholera vaccination (OCV), covering all steps from vaccine request to the execution mass vaccination campaigns. “Preparedness plans and procedures on paper are not enough, we need systems that work in real-world emergencies,” said Dr David Otieno, WHO Epidemiology and Surveillance Team Lead in Cox’s Bazar and the Lead Facilitator of the exercise. “This exercise helps us test and improve those systems, plans and procedures, ensuring that every actor is ready to respond effectively when it matters most.” The event brought together key stakeholders, Directorate of General Health Services (DGHS)-CDC, the Cox’s Bazar Civil Surgeon’s Office, the Refugee Relief and Repatriation Commissioner (RRRC), Health and WASH Sector partners, and WHO Bangladesh Country Office colleagues. This collaboration efforts highlighted a shared commitment to public health preparedness and multisectoral cooperation for sustainable outbreak prevention. “This simulation comes at a pivotal moment,” noted Dr Jorge Martinez, Head of WHO’s Sub Office in Cox’s Bazar. “With the monsoon season on the horizon, we must shift from reactive to anticipatory action. Strengthening tested coordination of preparedness to cholera outbreaks now means we are better equipped to save lives, build resilience, and uphold the dignity of the Rohingya and host communities when the next emergency strikes.” As cholera and other waterborne diseases continue to pose a significant threat in crisis-affected areas, WHO’s leadership in simulation-based preparedness is playing a pivotal role in paving the way for a safer, healthier future, one where crises are not only managed more effectively but, where possible, prevented altogether.
For more information about this publication, please get in touch with Terence Ngwabe Che, External Communication Officer, Cox’s Bazar Sub Office, WHO Bangladesh, at chet@who.int