Sudan: Cholera Outbreak in Kosti, White Nile State - Flash Update No. 01 (As of 25 February 2025)

HIGHLIGHTS

• Sudan’s Ministry of Health reports a surge in cholera cases, with 1,640 cases recorded in White Nile State over the past week.
• The outbreak is believed to be connected to riverine water, as communities are resorting to collecting water from the White Nile River, due to the breakdown of the main water supply in Kosti town.
• Local health authorities have advised against such practice and are working towards reinforcing the chlorination in the water distribution system.
• To respond to the outbreak, a 6-day cholera vaccination campaign was launched in Kosti and Rabak localities, targeting 1 million people with oral cholera vaccines.
• Health partners are coordinating with health authorities to fast-track the delivery of life-saving cholera supplies and response activities.

SITUATION OVERVIEW

On 23 February, a total of 1,640 cases, including 63 related deaths, were reported in White Nile State, according to the Federal Ministry of Health (FMoH). This includes 289 cases, and five related deaths, on 23 February alone.

According to partners on the ground, the outbreak is believed to be connected to riverine water as communities have been collecting water from the White Nile River after the power supply facility was damaged during recent clashes causing a major power outage that affected the main water supply in the town.

The current cholera outbreak in Sudan started in July 2024, spreading to White Nile State by September. The number of new cases reported from White Nile peaked from 4-10 November 2024 and had been on the decline until 10 February 2025, according to the General Directorate of Health Emergencies and Epidemics Control at the FMoH.

HUMANITARIAN IMPACT AND NEEDS

This recent surge in cases has put a strain on the capacity of the cholera treatment centre (CTC) in the Kosti Teaching Hospital. The CTC has run out of space and patients are being admitted in an open area and treated on the floor as there are not enough beds, reports Médecins Sans Frontières (MSF). If the surge continues, medical supplies to treat acute dehydration will run out and medical teams will be completely overwhelmed. Medical staff from the Rabak Hospital have arrived in Kosti to support the response, but more assistance is needed. Water, sanitation and hygiene (WASH) partners report that the main needs in Kosti are access to safe drinking water and sanitation, while immediate WASH interventions are key, as well as support for surveillance, case management, and the establishment of Oral Rehydration Points (ORP).

Funding is needed to improve the water supply in the town, in particular to procure fuel for the generators used to operate the main water treatment plant. The fuel consumption of the generators is about 40 barrels of diesel a day, of which the government provides 30 per cent. Funding is also needed to support rapid response teams and chlorinators; latrine desludging; cleaning campaigns; vector control activities and replenishment of supplies.

HUMANITARIAN RESPONSE

On 21 February, the World Health Organization (WHO), the UN Children’s Agency (UNICEF) and the FMoH launched a 6-day cholera vaccination campaign in Kosti and Rabak localities with plans to reach 1 million people with oral cholera vaccines. The State Ministry of Health and Social Development in White Nile reported in the media on 23 February that more than 1,000 people had been treated at the CTC in Kosti Hospital and were sent home after treatment.

Local health authorities have banned collecting water from the river and have requested reinforcing the chlorination in the water distribution system. The city market and most restaurants are closed.

WASH partners are supporting the government’s Water and Environmental Sanitation Department (WES) with fuel for the generators used to operate the main water treatment plant. They have also activated a Cholera Task Force to coordinate the response.

The Health Cluster is coordinating with health authorities and partners to fast-track the delivery of life-saving cholera supplies; enhancing surveillance; providing technical support to case management; supporting WASH interventions; and engaging communities on hygiene and prevention. Health partners are also transporting medical supplies from Kassala, and more supplies will be dispatched from Port Sudan. The set-up of 17 ORPs in Kosti is ongoing.

The WASH Cluster has distributed chlorine to all state localities for water disinfection and will support the operation of the Kosti water station for three days. The organization has also trained and will provide incentives for 32 volunteers to carry out donkey car water chlorination for two weeks. Social and behaviour change (SBC) staff have been deployed to carry out health promotion activities.

The Sudanese Red Crescent Society (SRCS) has provided 100 first aid volunteers to support MSF at the Kosti Hospital. In addition, SRCS has deployed five teams to assist in the response, which includes health education and cholera prevention awareness.

Finally, a cholera response plan is under finalization, to best support response efforts.

Challenges facing response activities
Humanitarians are facing challenges in responding to the cholera outbreak, including the limited supplies of intravenous (IV) fluids; overcrowding in the CTC; the high costs of fuel needed to sustain the main water station; and delays in travel permits for staff to support response in Kosti.

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