Thousands of suspected cholera cases have been reported in Sudan’s Khartoum state since mid-April, and nearly 500 cases were recorded in a single day on May 21.
Doctors Without Borders/Médecins Sans Frontières (MSF) currently supports seven cholera treatment units in Khartoum state and several oral rehydration points. Our cholera response teams are working in affected areas and we are running community-based water and sanitation activities.
Here, Slaymen Ammar, MSF medical coordinator in Khartoum, explains how the ongoing war in Sudan has compromised basic infrastructure, leading to this surge of cholera cases.
How concerned are you about the current cholera outbreak in Khartoum?
This is not the first time that Sudan or Khartoum has been affected by cholera, but the conflict has clearly compromised basic infrastructure, and this upsurge of cholera cases is definitely one of the consequences of the war.
There are several reasons for the ongoing cholera outbreak, but for sure the difficulty of access to safe drinkable water is one of them. Due to drone attacks on power plants in Omdurman, water treatment stations no longer have electricity and cannot provide clean water from the Nile. People in other parts of the city, such as southern Khartoum and Jabal Awliya locality, are deprived of access to drinkable water and electricity. That might explain why these are some of the heavily affected areas.
Secondly, access to essential health care has been severely hindered in many parts of the capital, making it either unavailable or unaffordable. In certain areas like south Khartoum, a significant number of the health facilities were damaged in one way or another and many of the remaining health workers had no choice but to leave because of the intensity of fight. In the absence of essential care and without the preventive measures that were there before, the epidemic has become widespread among the vulnerable population.
Now cholera cases are coming from everywhere in the state and the facilities supported by MSF are overwhelmed.
What are the main challenges?
Part of what we are doing with health authorities is to reinforce the epidemic surveillance system to have a better understanding of where most of the patients come from, what the main problems are, and how we could improve our support. In a context like this, with very few operational health facilities, we need to quickly address the needs of patients to prevent them from progressing to a severe form of the disease.
Cholera can be fatal, but it is easy to treat if care is available and patients are treated early enough, which is not the case everywhere. Additionally, rehabilitating the water treatment system will take time, so it’s crucial to reinforce all activities related to improving hygiene.
What is MSF currently doing?
In Khartoum, we have just resumed our activities in support of the Bashair Teaching Hospital, including its cholera treatment center, where we have increased bed capacity from 20 to 50. MSF is working closely with the Ministry of Health to reinforce its efforts and respond to the outbreak.
Thirteen cholera treatment units are currently operating in Khartoum State, and MSF is supporting seven of these to ensure they are fully functional and can scale up according to need. In Omdurman, MSF is supporting two cholera treatment centers to handle the influx of cases, where more than 570 patients were treated from May 17 to 21.
In addition, we are implementing a variety of preventive activities within the community. These include setting up rehydration points and improving water and sanitation facilities. One of our strategies for tackling cholera is to reach out to the population through mobile clinics. These allow us to reinforce community-based surveillance and function as an entry point for identifying, diagnosing, and treating other health issues, such as dengue or malaria.
Cholera can be fatal, but it is easy to treat if care is available and patients are treated early enough, which is not the case everywhere.
Slaymen Ammar, MSF medical coordinator in Khartoum
During their mobile clinics each day, medical teams provide primary health care and refer patients with acute diarrhea to dedicated treatment centers. The conflict has had a particularly negative impact on children, who are among the most vulnerable and affected of those being treated. Some of them are also suffering from malnutrition.
We are also seeing numerous cases of mosquito-borne diseases, which can be fatal without access to medicine, due to the absence of preventive protection measures (few mosquito nets are available and there is no indoor spraying to prevent mosquitoes). We are constantly looking for ways to extend our support and improve access to care for the population of Khartoum.
MSF urges donors, UN agencies, INGOs and their funders to urgently scale up water, sanitation, and hygiene promotion efforts in Khartoum to curb the outbreak. With no city power, fuel is critical to run generators for water stations and hospitals.