Cholera grips Sudan as MSF calls for quick response

A cholera outbreak in central and eastern Sudan is bringing yet more risk, death, and misery to people already bruised by the country’s devastating war. Emergency teams from Doctors Without Borders/Médecins Sans Frontières (MSF) are treating patients as well as providing water and sanitation services to people affected by the war.

In August, Sudanese authorities declared a cholera outbreak, which is currently heavily affecting the states of Kassala, Gedaref, River Nile, Al Jazirah, and Khartoum. According to the Ministry of Health, over 5,000 cases of cholera and 191 deaths have been reported. In the second half of August, weekly cases of the disease increased fourfold.

People are dying from cholera right now, and we plead with the UN and international organizations to fund and scale up activities, particularly water and sanitation services, which are crucial to stop the lethal spread.
Frank Ross Katambula, MSF medical coordinator

Cholera cases are not uncommon in Sudan, but the current outbreak is taking place in a country torn by 17 months of war, making it more difficult to prevent cholera and provide lifesaving care.

A patient receives IV hydration in a cholera treatment center. — Cholera can rapidly become fatal within hours if not treated, but fortunately it is very simple to treat—rehydration is key. | Sudan 2024 © MSF

Immediate need for unrestricted rapid access for staff and supplies

“People are dying from cholera right now, and we plead with the UN and international organizations to fund and scale up activities, particularly water and sanitation services, which are crucial to stop the lethal spread,” says Frank Ross Katambula, MSF medical coordinator.

After nearly 17 months of challenges and obstructions of the provision of humanitarian assistance in Sudan, MSF also calls on warring parties to allow unhindered access of medical staff and supplies to all areas in need across Sudan in order to enable a quick, coordinated response and prevent avoidable deaths.

“There is a risk of running out of essential supplies such as cholera kits in a moment when scaling up the response is urgently needed,” says Katambula. “We call on the authorities to fast-track and facilitate the delivery of supplies and drugs, as bureaucratic obstacles remain a major challenge.”

MSF’s cholera treatment center in Kassala, Sudan. — MSF is supporting the a 200-bed cholera treatment center at the Teaching Hospital in Kassala, helping with case management and oral rehydration points. | Sudan 2024 © MSF

Case management and water and sanitation

Cholera is a waterborne intestinal infection, and is transmitted through contaminated food or water, or through contact with fecal matter or vomit from infected people. Cholera can cause severe diarrhea and vomiting, and can rapidly become fatal within hours if not treated. But cholera is very simple to treat—rehydration is key.

MSF teams in Khartoum, River Nile, Kassala, and Gedaref have mobilized to support the Ministry of Health’s response by setting up and running cholera treatment centers and units , and providing support to existing overwhelmed treatment facilities in some of the most affected areas and in hard-to-reach places where cases are surging.

MSF response in Sudan

In Tanedba, Gedaref state, MSF runs a 50-bed cholera treatment unit in its Tanedba Hospital and supports three primary health care centers in hard-hit villages, that provide water chlorination and distribution. We also make donations to support their work.
MSF built a 30-bed cholera treatment unit in Gedaref city close to a camp for displaced people, which provides outpatient treatment for mild cases through oral rehydration points in the community. We have constructed emergency latrines, provide potable water, distribute soap, and handle patient referrals.
MSF is providing support to set up and run a 100-bed cholera treatment center in Atbarah, the most affected town in River Nile state.
MSF is setting up 4 oral rehydration points in Kassala state, building and desludging 62 latrines. We have distributed non-food items for 500 families, provided drinking water, and created washing points in three displacement camps.
In Kassala, we are supporting the 200-bed cholera treatment center at the Teaching Hospital, helping with case management and oral rehydration points.
In Wad El Hilu, MSF is helping a rural hospital cope with a surge of cases in the southern part of the district.

Between the end of August and September 9, we treated 2,165 patients in facilities we support.

In Darfur, where no cases have yet been registered, MSF teams are helping to improve preparedness.

“The menacing mix of heavy flooding and torrential downpours with woeful living conditions and inadequate access to drinking water that millions face today, particularly in crowded camps for displaced people, have created the perfect storm for the spread of this often-deadly disease,” says Esperanza Santos, MSF emergency coordinator for Sudan.

The menacing mix of heavy flooding and torrential downpours with woeful living conditions and inadequate access to drinking water that millions face today, particularly in crowded camps for displaced people, have created the perfect storm for the spread of this often-deadly disease.
Esperanza Santos, MSF emergency coordinator for Sudan

In Kassala, heavy rains and flooding rivers have destroyed water and sanitation infrastructure and put both internally displaced communities and Eritrean and Ethiopian refugees in even more appalling living conditions.

Cholera adds yet another challenge to the crisis in Sudan and to its decimated health system, which is already struggling with increasing child malnutrition, high numbers of war-wounded patients and regular cases of preventable diseases. The humanitarian response is regularly obstructed by both warring parties, and remains far short of what is needed.

A cholera treatment center in Atbarah city, Sudan. — MSF is setting up and managing a 100-bed cholera treatment center in Atbarah city, which has recorded the highest number of cholera cases in the state. | Sudan 2024 © MSF

“One man was unconscious [upon arrival to the facility],” recalls Angela Giacomazzi, a human resources coordinator in Tanedba, about a patient who fortunately survived. “Dehydration causes the body to go into shock. When the body reaches that point after a few minutes, it’s already too late. Doctors were resuscitating him, squeezing liters of fluids in his veins for about five minutes. His face and his breathing were really showing so much panic.”

MSF teams are setting up oral rehydration points, trucking in drinking water, constructing handwashing points and latrines, distributing hygiene kits, and doing health promotion in the affected communities.