UNICEF South Sudan Flash Update (Cholera) - 05 November 2024

Flash Update: Cholera outbreak in Renk County, Upper Nile State, South Sudan

Key Highlights

• On 28 October 2024, the National Ministry of Health declared a cholera outbreak in Renk County, Upper Nile State, and the National Incident Management System for a coordinated response has been activated.

• As of 3 November, 69 suspected and confirmed cholera cases have been reported in Renk county, with 44 cases by RDT confirmed positive and 16 confirmed by culture at the National Public Health Laboratory, according to Ministry of Health data.

• UNICEF has reinforced its Renk sub-office team, started expanding its WASH activities beyond the current Sudan crisis response, initiated risk communication and community engagement (RCCE) activities through the recruitment of 60 community mobilizers and distribution of information, communication and education (IEC) materials for cholera prevention, and coordinates with others through participation in the WHO-led cholera task force.

Background / Situation Update

Renk County in Upper Nile has been the main transit point for people fleeing the conflict in Sudan into South Sudan. According to UNHCR data, out of more than 850,000 returnees and refugees who crossed into South Sudan since the beginning of the crisis in April 2023, approximately 680,000 did so through Joda crossing in Renk county. Sudan itself has recorded about 28,400 suspected cholera cases and 836 suspected deaths as of 3 November, including about 1,800 suspected cases in White Nile State bordering Renk county, according to OCHA.

The first suspected cholera case from Renk County was reported on 28 September. On 28 October, after 6 samples tested positive for culture, the National Ministry of Health declared a cholera outbreak in Renk County, Upper Nile State, and the National Incident Management System for a coordinated response was activated. As of 3 November, 69 suspected and confirmed cholera cases have been reported in Renk county, with 44 cases by RDT confirmed positive and 16 confirmed by culture at the National Public Health Laboratory, according to Ministry of Health data.

The high population density and challenges linked to access to water, sanitation (including open defecation) and hygiene practices at Transit Centers (TCs) and in the host community make Renk highly susceptible to both imported cases and local transmission. Given that Renk is primarily a transit point for most returnees and refugees fleeing Sudan, there is a risk that the outbreak could extend to other parts of South Sudan.

UNICEF response

UNICEF Renk sub-office and Malakal field office teams are mobilized to contribute to ongoing assessments of needs and gaps, initial response and prevention actions, with support from Country and Regional offices. On coordination, UNICEF participates in the Cholera Task Force led by WHO in Renk and in the Public Health Emergencies Operations Center (PHEOC) meetings led by the national Ministry of Health in Juba. UNICEF is developing a cholera response plan for Renk and beyond, aligned on the upcoming Ministry-led plan. In the meantime, UNICEF is already taking the following actions:

Deployment of surge capacity

• An Emergency Specialist and a WASH Specialist from the country office in Juba were deployed to Renk last week and are currently on site.

• Deployments of a Social and Behavior Change (SBC) Specialist from the country office and a Health in Emergencies Specialist from UNICEF regional office in Nairobi are ongoing to further support coordination and response.

• A Health Specialist from the country office will arrive in Renk during the week of 11 November to ensure continuity of health response.

• Arrangements are also ongoing for the deployment of a longer-term surge cholera expert to support UNICEF’s country wide preparedness and response.

Water, sanitation and hygiene (WASH)

• UNICEF is scaling up its WASH response through expanded partnerships with World Vision International (WVI) and the local Urban Water Corporation to increase safe water availability, maintaining SWAT systems in critical locations and hand-washing facilities.

• Hygiene promotion activities are also being intensified through extensive public awareness and door-to-door outreach initiatives.

• To address the urgent hygiene and water needs, UNICEF is procuring and distributing essential items, including 1,000 buckets with taps and lids, 300 boxes of soap, PUR / Aquatab water purification chemicals, and filter cloths to hotspot areas.

• Training and deployment of hygiene promoters to cover affected and high-risk areas including Renk and Joda, promoting household water treatment and safe storage; handwashing with soap; personal hygiene; safe water and safe sanitation practices.

• Deployment of water quality monitors across Renk and Joda (household level, publics places, water sources,

etc), including private water tankers, donkey carts, etc., taking corrective action to chlorinate the water where the quality is compromised (shock chlorination).

In the coming weeks, depending on availability of new funding, UNICEF plans to strengthen its WASH response by expanding coverage (including to schools), expand sanitation activities and access to water in key areas, deploy rapid response teams to newly identified hotspot areas, while sustaining current interventions.

Social and Behaviour Change (SBC)

• Recruitment of 60 social mobilizers for risk communication and community engagement (RCCE) activities across Renk County is completed, with plans for an additional 20 to be recruited and deployed at Wunthou/Joda border crossing.

• Distribution of IEC materials completed for 13 partners working across critical locations (TCs, health facilities and public spaces).

• Ongoing capacity building of Boma Health Workers (BHWs), hygiene promoters and Community Network Volunteers (CNVs) through mobilization and trainings on RCCE, surveillance, contact tracing, complaints and feedback mechanisms and hygiene promotion.

In the coming weeks, depending on availability of new funding, UNICEF plans to further strengthen SBC/RCCE response through the expansion and intensification of the above activities, sensitization on mass-media (including to areas at risk), initiate school-based RCCE activities targeting children across Renk county and step up engagement of community and religious leaders on cholera prevention.