A vivid and harsh image of extreme drunkenness serves as a warning of the destructive, unavoidable punishment awaiting the nations. They are forced to drink from a cup of wrath, a symbol of the heavy subjugation and deep sorrow that will soon overcome them [מצודת דוד, ביאור שטיינזלץ].
The prophecy outlines a gradual deterioration in their condition. It begins with the command to drink and become entirely intoxicated. While a person might normally consume wine without losing control, here the drunkenness will be absolute. Following this, the nations will be driven to severe physical illness from their excessive consumption [רש״י, מצודת ציון]. Even those with strong constitutions, who typically withstand such effects, will be pushed to this breaking point [מלבי״ם].
This illness carries a deeper meaning. It represents the nations' desperate attempts to rebel and throw off the oppressive yoke of Babylon. However, this very struggle to reject their subjugation will only drain their strength and ultimately lead to their complete ruin [מלבי״ם].
The imagery reaches its climax when the nations fall, unable to rise again. In ordinary circumstances, a person who becomes ill from drinking often experiences a moment of relief afterward, regaining enough sense to stand back up. In this case, however, the decree is final. There will be no recovery and no return to their feet [רד״ק, מלבי״ם]. This permanent collapse is brought about by the sword, representing the chaos and violence of war [רש״י]. God will send this conflict among them, sparking a brutal internal war where nations will turn against one another until every last one of them falls [מלבי״ם].