MSF Responds To Hepatitis E Outbreak In South Sudan Refugee Camps

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An epidemic of hepatitis E is escalating across refugee camps in South Sudan’s Maban County. To date, Doctors Without Borders/Médecins Sans Frontières (MSF) has treated 3,991 patients in its health facilities in the camps and has recorded 88 deaths, including 15 pregnant women.

Hepatitis E is a virus that causes liver disease and can lead to acute liver failure and death. It is particularly dangerous for pregnant women. Like cholera, the virus spreads in environments with poor sanitation and contaminated water. There is no cure, but its symptoms are treatable.

“We have been doing everything we can to care for people with hepatitis E, but there is no treatment for the disease,” says Dr. José-Luis Dvorzak, MSF Medical Coordinator in Maban County. “We suspect this outbreak is far from over, and many more people will die.”

The first cases appeared in June 2012. Three camps—Jamam, then Gendrassa and Batil—have seen the most cases so far. Numbers still have not peaked in Batil camp, where death rates have steadily risen from one or two per week in November, to ten per week in January.

Over the past two weeks, MSF has identified a further 41 suspected hepatitis E cases in Doro camp, two of whom have died, meaning that none of the camps in Maban County is free of the virus.

This hepatitis E outbreak was able to take hold because of poor water and sanitation conditions—such as inadequate distribution of clean water, limited access to functioning latrines, and too few hand-washing points—in the Maban refugee camps, which host more than 110,000 Sudanese refugees.

“The refugee camps should not only be a place of safety from conflict, but also a place where refugees can stay alive and are safe from preventable diseases and outbreaks,” said Laurence Sailly, MSF Emergency Coordinator in Doro camp.

Because of Maban County’s geographical location, it is a flood plain in the rainy season and a parched wasteland in the dry season. The refugees in these camps are completely reliant on humanitarian assistance for the food, water, and health care they need to survive.

While continuing to concentrate on the extremely heavy medical workload of caring for hepatitis E patients and treating all the other patients with other pathologies who present in our field hospitals, MSF teams are also carrying out emergency gap-filling activities, such as pumping, treating, and distributing around 2.5 million liters of water per week in Doro camp.

MSF has been working in Maban County since November 2011, and is the main health care provider across the four refugee camps, running three field hospitals and seven outreach health posts.

Dr Maarten Dekker does rounds in the Hepatitis E ward at MSF's hospital in Batil refugee camp, Maban County, South Sudan. All four camps in Maban County are now affected by the Hepatitis E outbreak, which began in June 2012. Hepatitis-E is a virus that is spread via fecal-oral transmission and that causes liver disease and can lead to acute liver failure and death. There is no cure, and medics can only try to alleviate the symptoms to assist the patient to recover. It is known to be particularly dangerous for pregnant women.
South Sudan 2013 © Corinne Baker/MSF