A. Situation analysis
Description of the disaster
On 12 February 2022, the Director of the Department of Vector Control at the Ministry of Health (MoH) of Gedaref State, released an appeal statement of emergency to control the alarming increase of Visceral Leishmaniasis (Kala-Azar) cases. The report indicated a continuous increase of cases throughout 2022 with 302 cases and 8 deaths only for January compared to the previous year’s showing cumulative data of 2,973 cases with 69 deaths registered in 2021: 2,137 cases with 38 deaths in 2020 and 2,098 cases with 29 death in 2019. Especially for children, there has been an alarming increase of cases with an average increase of 130% of cases and death. 24% of the reported cases were children since 2019. The report did not differentiate the type of leishmaniasis infections for the moment, which have 3 variants include Kal-Azar (the visceral mortal one), Cutaneous, and Mucocutaneous. Based on the level of mortality, health diagnostic, mortality increase can find their origin in the increase of the worst variant, the Kal-Azar one. The risk for population and the humanitarian emergency on the spread of this disease become then an emergency scaled-up by local authorities and Sudan Red Crescent Society (SRCS).
Historically, Kala-azar (visceral leishmaniasis) is a significant major health problem in Sudan and particularly in Eastern Sudan. Gedaref state has a total population of 1.4 million, spread over 75,000 km. 495,680 individuals in 245 villages are identified to be more at risk. The most endemic localities are Quraysha, Eastern and Western Qalabat, Basunda, Al-Rahad, Anahal, and are located along the Atbarah and Rahad river basins and villages in Sinnar close to the border with Gedaref.
The risk of contamination concerned Gedaref localities where cases have been already diagnosticated during the past 3 years and mainly during 2022 and the villages all around Gedaref which remain at higher risk due to continuous commercial, migration, and other exchanges including population displacement.
From the MoH report and available information, it was highlighted that the spread of the disease is attributed to a natural condition that represents the appropriate conducive environment for Sandfly (vector) survival. Cracked clay soil, Acacia trees, and Heglig trees, which are common in the area, present a haven for sandflies. In addition to the presence of farmers, fishermen, and smelters whose work coincides with the period of activity of the female sandfly. In addition to the instability of the support granted by organizations working in the fight and their focus on treatment rather than the preventive aspect, the situation has worsened due to the exit of some organizations that were working in the state and the increase of refugees during the past 2 years coming from other countries experiencing Visceral Leishmaniasis cases (Ethiopia and South Sudan).
In addition, the SRCS and International Federation of Red Cross and Red Crescent Societies (IFRC) reached out to various stakeholders, including World Health Organization (WHO), Medecins Sans Frontieres (MSF) to triangulate the information on identified cases and collect information on the assistance provided to date.
Leishmania parasites are transmitted through the bites of infected phlebotomine sandflies. If left untreated, Kala-azar fatality is over 95%, generally within two years. The symptoms of the disease are fever, weight loss, swelling of the spleen and liver (hepatosplenomegaly), and anemia, especially among children. For global understanding, Sandflies (class: Insecta; order: Diptera, family: Psychodidae) are important hematophagous insects that transmit the pathogens responsible for leishmaniasis, bartonellosis, sandfly fever, and vesicular stomatitis [1, 2]. The most important of these diseases is leishmaniasis, a multi-spectrum neglected tropical disease that manifests as long-lasting cutaneous ulcers (cutaneous leishmaniasis, CL), mucocutaneous lesions (mucocutaneous leishmaniasis, MCL), or visceral infection (visceral leishmaniasis, VL). Leishmaniasis has a wide global distribution with over one billion people at risk of infection in 98 countries . VL, caused by members of the L. donovani complex, is considered to be the most serious form of leishmaniasis. In absence of timely diagnosis and treatment, VL has a fatal outcome. There are an estimated 50,000–200,000 cases of VL annually with 5–10% mortality. Visceral leishmaniasis has a wide distribution in Latin America, Africa, Europe, and Asia, with 90% of cases occurring in India, Sudan, South Sudan Brazil, Ethiopia, Kenya, and Somalia.