Sudan: Cholera Outbreak Emergency Plan of Action (EPoA) DREF Operation n° MDRSD027

Situation analysis

Description of the disaster

On 8th September 2019, Sudan’s Federal Ministry of Health (FMoH) confirmed four (4) cases of cholera in the Blue Nile State. Further on 19th September, an additional 124 suspected cholera cases were reported with seven (7) deaths: 6 in the Blue Nile and 1 in the Sennar States. The Ministry of Health (MoH) identified the White Nile, Gedaref, Sennar, Kassala and Khartoum as States that have the highest risks of cholera outbreak. On 22nd September the number of suspected cholera cases reached 1583 and continued to rise reaching on 25th September 187 cases, including eight (8) deaths reported in the Blue Nile and Sennar States.

Since the declaration of the outbreak on 8th September all relevant health bodies started monitoring the situation. Lifesaving activities started been implemented both by MoH and stakeholders. Inter-agency coordination meetings and Water Hygiene and Sanitation (WASH) and Health cluster meetings started being organized both at National and State levels. Clearer information and indications on the cholera outbreak situation and its potential development started being provided on 19th September in occasion of WASH & Health cluster meetings lead by the World Health Organization (WHO) and the MoH. Needs and gaps were communicated to partners, which were called upon to contribute with response and prevention actions to contain the current outbreak and avoid its expansion. Localities of intervention started being defined between partners, along with activities to implement, in order to ensure the coverage of the most affected areas, as well as complementarity of actions and no duplication of efforts. Although a complete 4W Matrix with main activities has not been disseminated, WHO and MoH guarantee a constant overview on the positioning of partners in the field and on their activities and provide updates in occasion of weekly coordination meetings. The SRCS, as actor responding to the cholera outbreak, is actively engaged in the coordination mechanisms in place and ensure its representation both at national and state levels. So far only an overview of actors engaged in chlorination activities was shared at Emergency Response Committee, organizes on 27th September.

To note as the main cause of this outbreak, 16 states across Sudan were affected by heavy rains and flash floods in August. The water levels of River Nile increased significantly, impacting the states along the river path, especially Khartoum state, resulting in the destruction of 41,514 homes, damaging another 27,242, and displacing approximately 350,000 people. The main affected states are While Nile, Kassala, Khartoum, Gazeera, and North Kordofan. Furthermore, 51 areas in the states of Gazeera, Sennar and White Nile were surrounded with water and became inaccessible.

The floods destroyed around 11,000 latrines resulting in contamination of drinking water sources. In the same way, the increased turbidity of water has rendered standard chlorination measures and procedures ineffective, exposing the population to high risk of waterborne diseases. In addition to that, stagnant water offers a breeding ground for mosquitoes, increasing the incident rate of Malaria cases and posing a risk for vector borne diseases. Concentrations of mosquito larva has reached its highest in While Nile, Khartoum, North and Southern Kordofan states.

The Sudanese Red Crescent Society (SRCS) and the FMoH are working together to strengthen disease surveillance, provide medical treatment for patients, distribute laboratory supplies, monitor water quality and chlorinate public water supplies, as well as promote health education and hygiene among affected and at-risk communities6. Two Cholera Treatment Centres (CTC) are serving patients in the Blue Nile state, and two dedicated Isolation centres have been established for cholera case management in the Blue Nile State.

The response efforts conducted by Government authorities, United Nations (UN) agencies, International NonGovernmental Organizations (INGOs), NGOs and other stakeholders present gaps, resulting in lack of assistance to people in need. Specifically, in the White Nile, Sennar, Khartoum and Gedaref states an estimated 36,000 people are still in need of WASH assistance. In the White Nile, Sennar and Gazeera states around 107,000 people are in need of health assistance. In the White Nile, Khartoum, Sennar and Kassala states an estimated 45,000 people are lacking Emergency Shelters and basic Household (HH) items . There has in general been limited education assistance provided. Moreover, as more and more areas become accessible as the water dries up, the number of affected people in need of assistance increases.