In August, Sudanese authorities declared a cholera outbreak, which is currently heavily affecting the states of Kassala, Gedaref and River Nile, followed by 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 the weekly cases of the disease multiplied by four.
Cholera cases are not uncommon in Sudan, but this is the second year since the start of the war in April 2023 that the country is faced with outbreaks of the disease. For the past two years, our teams have been actively engaged in emergency responses to mitigate their impact.
“The menacing mix of heavy flooding and torrential downpours with woeful living conditions and inadequate access to drinking water that millions have 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.
In Kassala, for instance, heavy rains and river floods 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 the decimated health system, already struggling with increasing child malnutrition, high numbers of war wounded and regular cases of preventable diseases. Regularly obstructed by both warring parties, the humanitarian response remains far below what is needed.
MSF teams in Khartoum, River Nile, Kassala and Gedaref have mobilized to support the Ministry of Health to respond to the situation, by setting up and running cholera treatment centers and units (CTCs and CTUs) or providing support to existing overwhelmed treatment facilities in some of the most affected areas and in hard-to-reach places where cases are upsurging.
Between the end of August and 9 September, we treated 2,165 patients in our supported facilities.
Caused by a water-borne intestinal infection, cholera 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 rapidly prove fatal, within hours, if not treated. But cholera is very simple to treat – rehydration is key.
“One adult male was unconscious [upon arrival to the facility]. 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,” recalls Angela Giacomazzi, a Human Resource coordinator in Tanedba, about a patient who fortunately survived. “His face and his breathing were really showing so much panic.”
MSF teams are setting up oral rehydration points, trucking drinking water, constructing handwashing points and latrines, distributing hygiene kits and doing health promotion in the affected communities.
In Darfur, where no cases have yet been registered, MSF teams are helping to improve preparedness.
“People are dying from cholera right now; hence we plead on the UN and international organisations to fund and scale up activities, particularly water and sanitation (watsan) services, which are crucial to stop the lethal spread,” says Frank Ross Katambula, MSF medical coordinator.
After nearly 17 months of challenges and obstructions around the provision of humanitarian assistance in Sudan, MSF also calls on warring parties to allow unhindered access of medical staff and supplies to all the areas in need across Sudan to enable a quick and 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. We call on the authorities to fast-track and facilitate the delivery of supplies and drugs, as bureaucratic obstacles remain a major challenge,” says Katambula.
Gedaref state
-Tanedba: MSF runs a 50-bed CTU in its Tanedba hospital and supports three primary healthcare centers (PHCCs) in hard-to hit villages; water chlorination and distribution, donations. Helping to set up another 20-bed CTU. Emergency referral of patients.
-Gedaref city: we have built a 30-bed CTU close to a camp for displaced people. Outpatient treatment of mild cases in the community through oral rehydration points. Construction of emergency latrines, water trucking and distribution of soap. Referral of patients.
River Nile state
-Atbarah: support to set up and run a 100-bed CTC in the town, the most affected of the state.
Kassala state
Setting up 4 Oral rehydration points, building and desludging 62 latrines; distribution of non-food items for 500 families, cleaning of PHCC, provision of drinking water and creation of washing points in three IDP camps.
-Kassala: supporting the 200-bed CTC at the Teaching Hospital. Case management and oral rehydration points.
-Wad El Hilu: preparing to help the rural hospital cope with a surge of cases in the southern part of the district.
