South Sudan: Urgent action needed to address growing cholera outbreak

Juba, 13 November 2024: Médecins Sans Frontières (MSF) has set up a 20-bed cholera treatment unit (CTU) at the Renk Civil Hospital in South Sudan, in response to a cholera outbreak declared by the Ministry of Health (MoH) on 28 October. We call on all organisations in Upper Nile state to help prevent the spread of the disease within Upper Nile State and beyond.

The MSF-supported CTU has so far received and treated 45 cholera cases, and recorded among them two deaths. Most of the patients are people arriving from the war in Sudan, where a cholera outbreak was declared in August 2024. However, the MSF teams have also received patients from the local population of Renk. Contaminated water sources, open defecation, and overcrowded living conditions due to new arrivals from Sudan pose a significant threat to both refugees and the local community.

“Given the inadequate, overcrowded living conditions and continued influx of refugees and returnees from Sudan into [the cities of] Renk and Malakal, there is an imminent urgent need for a response to improving the water, sanitation and hygiene situation to prevent further spread of the disease,” says Emanuele Montobbio, MSF’s field coordinator for Renk emergency programme. “In the past weeks, an average of up to 800 people are entering Renk daily from Sudan, fleeing from the war in the country.”

Cholera response in Malakal

In Malakal, less than 300km away from Renk, MSF teams have observed a sharp rise in cholera cases. This is an onward travel destination for many returnees and refugees coming from Renk after fleeing Sudan, some of whom stay in Malakal but many other proceed with further travel to other parts of the country.

The observed rise in cholera cases in Malakal prompted the establishment of a cholera treatment unit at MSF’s Malakal Town Hospital. As of 12 November, in less than a week 65 patients have been admitted to the facility. In parallel, MSF is conducting health education initiatives to help curb the further spread of the disease.

Given the increasing number of patients, MSF has established a Cholera Treatment Center (CTC) in Assosa, less than 10km away from Malakal Town Hospital, with capacity of up to 100 beds. MSF teams are treating cholera patients from Malakal’s protection of civilians (PoC) site, which hosts thousands of people in close proximity, heightening the risk of rapid spread. MSF urges other organisations to quickly establish treatment facilities within the PoC to prevent loss of life.

Risk of spread

With people moving across Upper Nile State and other parts of South Sudan, the cholera outbreak poses a risk of spreading beyond Renk and Malakal.

“The current response in Upper Nile does not match the urgency of the situation. We're calling for stronger, collaborative efforts from all organisations in Renk, and beyond particularly in Malakal, to manage the spread and prevent a further and a wider crisis, as soon as possible,” says Montobbio. “An immediate reactive vaccination campaign is crucial.”