After a heavy siege, Mariupol faces a possible outbreak of cholera

Mariupol is once again one of the most worrying points in the war in Ukraine. After months of constant shelling and a heavy siege, the city on the Azov Sea is facing another major setback caused by months of war: an outbreak of cholera.

Petro Andryushchenko, advisor to the mayor of Mariupol, told a programme on Ukrainian channel 1+1 that the city's drinking water is contaminated by rubbish and rotting corpses, increasing the risk of a cholera outbreak. Andryushchenko explained that local authorities had received information that a Russian town near the border was already preparing units to treat infectious diseases in case a cholera outbreak could affect Russian troops in the Ukrainian town.

"This threat is recognised not only by the World Health Organisation and by us, but also by the occupants," Andryushchenko stressed. "The risk of cholera is very high," he added to ABC News.

The mayor's aide also said Russian forces in control of the port city are closing off Mariupol and imposing a quarantine. Because of the seriousness of the situation, Andryushchenko has expressed hope that the Russian authorities will allow international or Ukrainian epidemiologists into Mariupol to control the disease. 

In late May, the mayor himself, Vadym Boycheno, warned that the devastated city of Mariupol was at risk of experiencing a surge in infectious diseases such as cholera and dysentery that could kill thousands of people by the end of the year, the city council said via Telegram.

The Ukrainian authorities' claims have been backed by the World Health Organisation (WHO). Last month, Dorit Nitzan, the WHO's health emergencies coordinator for Europe, said Mariupol was among the occupied areas at risk of cholera.

The organisation's spokeswoman, Margaret Harris, has pointed to the quality of the city's water as the main cause of the outbreak. "In Mariupol, due to significant damage to the water supply system, the water has been mixed with sewage," she said in a statement.

To address the potential outbreak, WHO has provided Ukraine with guidance on prevention, preparedness, case definitions, detection, including sewage monitoring, standards of care and case management, Harris told ABC News. WHO has also offered medical supplies, including cholera kits with rapid diagnostic tests, and is working with the Ukrainian Ministry of Health on prevention and treatment of the disease.

Harris also pointed out to the US media that "the psychological pressure" on the city's citizens is having "a serious effect on their immune systems, weakening them". "What is normally just a mild infection for me is a much more serious infection in someone in those conditions," she adds. 

Regarding the possibility of entering Mariupol to monitor the problem first-hand, the doctor acknowledged that entering the city "is a problem", so they are "looking for opportunities through partners on the ground".

A report by the WHO's Health Cluster Ukraine agency, in addition to delving into the threat posed by water contamination, warns that with the hot summer weather, transmission of the disease is likely to increase. The agency also recalls that Ukraine was the last European country to declare a cholera epidemic in 2011, with 33 cases in Mariupol. 

Another challenge facing the city is the collapse of the health system, an aspect that will undoubtedly aggravate the cholera outbreak. The health situation in Mariupol, in Andryushchenko's words, is "catastrophic". "With this scenario, any infectious disease becomes a deadly epidemic," he said on his Telegram channel. 

The UK Ministry of Defence agrees. London warns that the chances of a major cholera outbreak in Mariupol are increasing due to the collapse of local medical services.