Cholera Claiming Lives in Upper Nile State, South Sudan

Nick Owen/MSF

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, Doctors Without Borders/Médecins Sans Frontières (MSF) teams in Upper Nile State have treated more than 904 patients for cholera. The teams have set up two cholera treatment centersin Malakal and Wau Shillukwhere 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’s 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 favorable for the spread of the disease.

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 have turned to open defecation, given the extremely low number of latrines. The ongoing heavy rains wash the feces into drinking water sources, thus completing the oral-fecal 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-fecal transmission.

Since conflict broke out in South Sudan on December 15, 2013, different areas of Upper Nile including Malakal, the state capital, have faced violent attacks. Civilians are paying the price of these attacks and of 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 health care.

The prevalent food insecurity situation in Upper Nile and resultant malnutrition makes the population even more susceptible to infectious diseases such as cholera since their immunities are weak and they can easily succumb to death. To date, MSF teams have admitted more than 3,195 people, mostly children, to its therapeutic feeding programs in Malakal, Wau Shilluk, Kodok, and Lul in Upper Nile State. The ongoing rainy season makes it impossible for the population to plow their lands and means that malaria and other diseases characteristic of the season are to be expected in the near future.

The upsurge of cholera cases and the need to prevent further spread of the disease has prompted MSF to mobilize its teams from different parts of South Sudan and projects around the world to Upper Nile to help respond to this outbreak. Together with community health workers affiliated with the Ministry of Health and other organizations 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 is curbed.

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

Kiden Margaret, 31, is the mother of two-year-old John Mukaya. "When I arrived this morning, we were directed to the observation room to register. My son was very weak, now we are here and he is put on drip and given oral rehydration solutions. I hope my son will get better." Since the South Sudanese Ministry of Health declared a cholera outbreak in Juba, the countryÕs capital, on 15 May 2014, more than 1,306 patients have been treated for the disease, and 29 people have died as at 05 June 2014. MSF has set up a CTC in the district of Gudele 2, and two smaller CTCs in the two IDP camps in UN bases. There are several MSF Oral Rehydration points close to the affected areas of Juba, and support id provided to the MoH in the Juba Teaching Hospital.
Nick Owen/MSF