Communities and displaced populations living in congested camps with poor hygiene and sanitation are at high risk of contracting cholera in South Sudan. Since the beginning of July this year, Médecins Sans Frontières (MSF) teams in Upper Nile State have treated over 904 patients for cholera. The teams have set up two cholera treatment centres in Malakal and Wau Shilluk where, they are treating cholera patients from affected areas.

“Cholera is a treatable disease that can be fatal if not diagnosed and treated promptly. It causes severe dehydration that can lead to death in a matter of hours,” says Llanos Ortiz, MSF Medical Emergency Manager for South Sudan. Only three weeks into the MSF intervention, 19 people have lost their lives to cholera, making the situation a humanitarian concern that needs rapid response to contain. The vulnerability of populations in these areas has been exacerbated by the conflict that started in December last year, which has forced people to move into crowded internally displaced persons (IDP) camps and protection of civilians (PoC) camps with poor living conditions favourable for the spread of the disease.

The prevalent food insecurity situation in Upper Nile and resultant malnutrition makes the population even more susceptible to infectious diseases such as cholera as their immunities are weak and they can easily succumb to death. To date, MSF teams have admitted over 3, 195 people, mostly children to its therapeutic feeding programs in Malakal, Wau Shilluk, Kodok and Lul in Upper Nile State. The on-going rainy season makes it impossible for the population to plough their lands and means that malaria and other diseases characteristic of the season are to be expected in the near future.Lack of clean and safe drinking water is a common problem in the area. In Wau Shilluk, an area with an estimated population of 50, 000 people, IDPs have been forced to use unprotected surface water and most people undertake open defecation given the extremely low number of latrines. The ongoing heavy rains wash the faeces into drinking water sources, thus completing the oral-faecal transmission and allowing communicable diseases like cholera to spread. Aid agencies in the area are working to ensure that more latrines are constructed and sanitation standards maintained, to help improve the population’s ability to break this oral-faecal transmission. Since conflict broke out in South Sudan on 15 December 2013, different areas of Upper Nile including Malakal, the state capital, have faced violent attacks. Civilians are paying the price of these attacks and the violence in general. Continual insecurity in the state is barring people from seeking medical help in good time as they are living in fear. It is imperative therefore that all parties involved in the conflict ensure that security is restored and people feel safe to access healthcare.

The upsurge of cholera cases and the need to prevent further spread of the disease has prompted MSF to mobilise its teams from different parts of South Sudan and the world to Upper Nile to help respond to this outbreak. Together with community health workers affiliated to the Ministry of Health and other organisations present in Upper Nile, MSF is creating awareness on the causes, spread and prevention of the disease. However, with an already precarious health situation and a vulnerable population, there is still need for more medical personnel on the ground to ensure better preparedness in tackling such outbreaks to ensure that they are contained and spread of the disease in curbed.

Since April this year, a total number of 4,765 cases of cholera have been reported in South Sudan. 109 people have died of the disease, 19 of them from Upper Nile State. MSF has set up cholera treatment centres in different parts of South Sudan, including Torit and Juba. The organisation is also supporting the Juba teaching hospital with water and sanitation activities.