The protracted humanitarian crisis since 2013 has increased the risk of outbreaks for diseases like cholera. The crisis has left nearly 2 million internally displaced persons that are living in congested camps with barely adequate access to safe water and sanitation. The crisis has also weakened the health system thus curtailing its capacities to detect, investigate and effectively respond to emerging disease outbreaks. South Sudan has a total of 1,392 functional health facilities including 51 hospitals, 326 PHCCs, and 1015 PHCUs. The health system has been devastated by the protracted crisis with many health facilities looted and destroyed and health workers displaced.
The 2010 South Sudan household survey showed that 69% of households had access to improved water sources though only 6% households were using appropriate water treatment methods. In the survey, the use of improved sanitation facilities was very low and estimated at 7%. During the crisis that started 2013, these indicators worsened thus aggravating the risk of cholera among the IDPs and host communities.
1.2 CHOLERA IN SOUTH SUDAN
Cholera is endemic in South Sudan and its neighboring countries where recurrent outbreaks continue to be reported with both local and cross-border spread. Since the 2013 crisis, three cholera outbreaks have been reported in South Sudan in 2014, 2015, and 2016 (Figure 1, table 1). The outbreaks have typically occurred during the rainy season in states along the big rivers (Figure 2). Internally displaced persons, refugees and other areas with high concentrations of people have a higher risk of suffering cholera outbreaks and have reported cholera cases during this period.