Water, Hygiene and Inequality: Keys to Understanding and Combating the Current Cholera Epidemic in the Democratic Republic of Congo-A Narrative Review.

Background and Aim: The Democratic Republic of the Congo (DRC) is among the countries most affected by cholera in the world. Since the 1970s, endemic foci have persisted in the eastern lake provinces, where chronic armed conflict, massive population displacement, and extreme socioeconomic inequalities create particularly favorable conditions for transmission. Despite a national elimination plan involving more than 22 ministries, the epidemic continues: 46,800 cases and 1362 deaths were recorded as of August 2025. This review synthesizes recent data on the structural determinants, public health responses, and persistent barriers that characterize cholera in the DRC. Methods: The PubMed, Web of Science, and Google Scholar databases were searched for publications from 2015 to 2025. Grey literature from WHO, UNICEF, MSF, Africa CDC, and the DRC Ministry of Health was also considered. Main themes were defined a priori. Results: Cholera transmission is facilitated by insufficient access to safe drinking water, poor sanitation, and socioeconomic fragility exacerbated by conflict and population displacement. Case fatality rates vary considerably from one province to another, reaching 11.1% in some areas. The collapse of the health system, community mistrust, and vaccine hesitancy further compromise the effectiveness of interventions. Vaccination campaigns and water, sanitation, and hygiene (WASH) interventions have demonstrated a measurable impact but remain insufficient when implemented in isolation. Conclusion: The sustainable fight against cholera in the DRC requires an integrated approach combining long-term investments in WASH, health system strengthening, community engagement, and equity-oriented policies in order to break the cycle of transmission in this particularly complex context.