for handwashing. in sierra leone, some 21,500 cases, with 290 deaths reported in 2012. on august 21, 2013, the united states state department issued a security message warning u.s. citizens in or traveling to cuba about an outbreak of cholera in havana. it may be linked to a reported outbreak of cholera in eastern cuba. an ongoing cholera outbreak in ghana in 2014, hitting hard the capital accra, has claimed some 100 lives and over 11,000 cases by september. it did not gain much notice because of being overshadowed by ebola news in nearby countries. in 2011 and 2012 ghana had cholera epidemics combined that totaled 16,000 cases and 130 deaths. september 2015: ongoing cholera epidemic in tanzania resulting in 13 deaths and almost 1000 cases so far—mainly in dar es salaam, but also in morogoro and iringa, caused by the o1 ogawa strain. there had been an earlier outbreak in the lake tanganyika area, starting in the refugee population who had fled from burundi. 30 deaths and 4400 cases were reported in may 2015. somalia, 2017: an ongoing outbreak started in january 2017 in somalia. by the end of may, there were more than 50,000 cases, associated with 880 deaths; the case fatality rate is 1.7% (2.1% in children). sixteen of the country's eighteen regions are involved, with the worst affected being bay and togdheer. in april 2017, an outbreak resurged in yemen (it had started in october 2016). unicef and the world health organization (who) estimated that, by 24 june 2017, the total cases in the country exceeded 200,000, with 1,300 deaths. unicef and who attributed the outbreak to malnutrition, disrupted sanitation, and interrupted access to clean water due to the country's ongoing civil war. the effects of the outbreak were exacerbated by the collapse of yemeni health services; many health workers have remained unpaid for months. the outbreak occurred ten days after the sewerage systems in the yemeni capital of sana'a stopped working on 17 april. approximately half of the cases, and a quarter of the deaths, were among children. on 14 august, who stated that about 500,000 people in yemen were affected by cholera. who called it "the worst cholera outbreak in the world". in august 2018, the algerian ministry of health announced that 56 cases of cholera were confirmed in the regions of the capital algiers and surrounding provinces of tipaza, blida, bouira, medea and ain defla, with reports of 2 deaths as a result of this epidemic. a water source in the town of hamr el-ain, tipaza was found to have been the origin of cholera contamination. the access to the water source was restricted. on september 6, 2018, a cholera outbreak was declared in zimbabwe. the government declared a state of emergency on september 11, 2018. the outbreak has so far killed 48 people, and there are at least 98 confirmed cases as of september 27, 2018. 2020s an ongoing cholera outbreak was reported in several regions of niger in august 2021. as of august 23, there were 1,770 cases of cholera reported with 68 deaths. between october 2021 and 30 january 2023, there were 15,220 reported cases of cholera in cameroon, with 306 deaths. between january 2022 and 5 february 2022, there were 24,263 cases and 612 cholera deaths reported in nigeria. between january 2022 and 8 february 2023, there were 21,885 cases and 301 cholera deaths reported in the democratic republic of the congo. between march 2022 and 13 february 2023, there were 42,957 cases and 1,399 cholera deaths reported in malawi. in june 2022 an outbreak in mariupol, ukraine during the russian invasion of ukraine, was announced by mayor boychenko. following the june 2022 afghanistan earthquake, the united nations warned of a possible outbreak in the affected areas. in august 2022, over 400 cases were reported, and eight people died. between august 2022 and 10 february 2023 there were 1,131 cases of cholera reported in ethiopia, with 28 deaths. in september 2022, a cholera outbreak believed to be linked to irrigation of crops using contaminated water broke out in several regions in syria. the united nations said it presented a "serious threat to people in syria and the region". twenty-nine people died and a total of 338 cases were recorded. in october, 2022 lebanon recorded two cholera cases in akkar province, bordering syria. between 14 september 2022 and 19 february 2023, there were 5,237 cases and 37 cholera deaths reported in mozambique. in october 2022, haiti experienced a cholera outbreak. between october 2022 and 14 february 2023, there were 4,821 reported cases of cholera in kenya, with 85 deaths. between january 2023 and 13 february 2023, there were 122 reported cases of cholera in zambia, with two deaths. during the same time period there were 122 cases reported in burundi, with one death. in the first quarter of 2023, south africa announced one cholera death, with five cases confirmed in the country. on 28 february 2023, the syrian opposition said that two people had died from a cholera outbreak in the northwestern region of the country, following the 2023 turkey–syria earthquake. false reports main article: chicago 1885 cholera epidemic myth a persistent urban myth states 90,000 people died in chicago of cholera and typhoid fever in 1885, but this story has no factual basis. in 1885, a torrential rainstorm flushed the chicago river and its attendant pollutants into lake michigan far enough that the city's water supply was contaminated. but, as cholera was not present in the city, there were no cholera-related deaths. as a result of the pollution, the city made changes to improve its treatment of sewage and avoid similar events. in popular culture unlike tuberculosis ("consumption"), which in literature and the arts was often romanticized as a disease of denizens of the demimondaine or those with an artistic temperament, cholera is a disease that today almost entirely affects the lower-classes living in filth and poverty. this, and the unpleasant course of the disease – which includes voluminous "rice-water" diarrhea, the hemorrhaging of liquids from the mouth, and violent muscle contractions which continue even after death – has discouraged the disease being romanticized. it is seldom presented at all in popular culture. the 1889 novel mastro-don gesualdo by giovanni verga presents the course of a cholera epidemic across the island of sicily, but does not show the suffering of the victims. in thomas mann's novella death in venice, first published in 1912 as der tod in venedig, mann "presented the disease as emblematic of the final 'bestial degradation' of the sexually transgressive author gustav von aschenbach." contrary to the facts of how violently cholera kills, mann has his protagonist die peacefully on a beach in a deck chair. luchino visconti's 1971 film version also hid from the audience the graphic course of the disease. mann's novella was also adapted as an opera by benjamin britten in 1973, his last one; and as a ballet by john neumeier for his hamburg ballet company, in december 2003.* w. somerset maugham's novel the painted veil (1925), explores a british couple's marriage against the work of the husband as a doctor in china during a 20th-century cholera epidemic. it was most recently adapted as a film of the same name (2006), starring edward norton and naomi watts. it did show people suffering the physical effects of the disease. earlier adaptations in 1934 and 1957 kept the disease out of sight. in gabriel garcia márquez's 1985 novel love in the time of cholera, cholera is "a looming background presence rather than a central figure requiring vile description." the novel was adapted in 2007 for the film of the same name directed by mike newell. the 1995 film the horseman on the roof (le hussard sur le toit) by jean giono is about a cholera epidemic in the south of france. the 1997 american television film contagious is about people dying in los angeles from a cholera outbreak.