The International Federation of Red Cross and Red Crescent Societies (IFRC) Disaster Response Emergency Fund (DREF) has allocated CHF 219,904 for implementing anticipatory actions to reduce and mitigate the impact of cholera in Somalia. This simplified early action protocol includes CHF 135,958 allocated to preposition supplies and conduct annual readiness activities for early actions when triggers are met. The protocol covers four districts: Borama and Burao in Somaliland, and Garowe and Bosaso in Puntland. The Somali Red Crescent Society (SRCS) is implementing this EAP with technical support from IFRC and the Norwegian Red Cross. Pre-identified early actions can reach up to 24,700 people across these four districts, with a pre-activation lead time of 10 days for cholera response.

Cholera continues to be endemic in Somalia, with persistent transmission since 2016 and major outbreaks occurring during droughts, floods, and rainy seasons (Gu and Deyr). In 2017, Somalia recorded approximately 78,000 cases and 1,159 deaths (Case Fatality Rate 1.5%). By 2023, over 18,000 cases were reported, and in 2024 the disease spread to more than 30 districts, with children under five representing nearly 60% of cases. The sEAP seeks to decrease morbidity and mortality from Acute Watery Diarrhoea (AWD)/cholera by activating early actions based on environmental triggers (floods, drought, heavy rains, increasing malnutrition) and surveillance data, including Community-Based Surveillance (CBS) alerts.

Key priority impacts include:
• Reducing cholera-related illness and death, especially among children under five years old.

Key early actions at the community level include:
• Risk Communication and Community Engagement (RCCE): Community awareness initiatives, hygiene promotion, rumor management, and accountability mechanisms.
o Mobile outreach Oral Rehydration Therapy (ORT) at household and village levels.
• Emergency Water, Sanitation, and Hygiene (WASH) Interventions:
o Distribution of aqua tabs and hygiene kits.
• Branch Outbreak Response Teams (BORT/Community Action Teams Intervention): Rapid outbreak response to interrupt transmission pathways in partnership with health authorities.

Readiness activities involve enhancing SRCS volunteer capacity and expanding CBS coverage in hotspot districts. The period from epidemiological trigger activation to early action implementation is approximately 10 days. A phased trigger mechanism allows for initial activation of low-cost preparedness measures, followed by comprehensive early response actions when surveillance thresholds are surpassed. Through timely anticipatory action, enhanced surveillance, and targeted WASH and health interventions, the cholera sEAP seeks to prevent outbreak escalation, decrease fatalities, and safeguard the most vulnerable populations in Somalia’s high-risk districts.