Fighting the Cholera Outbreak: A Race Against Time in South Sudan

Mayom/South Sudan - On October 28, 2024, the Ministry of Health of South Sudan declared a cholera outbreak in South Sudan. The first suspected case had been reported in Renk County on September 28, 2024, at the Wunthou point of entry. To date, 33, 320 cases have been identified in 40 counties across seven states and one administrative area.

Renk, a major entry point for displaced persons fleeing the conflict in Sudan, soon became the epicentre of a worsening health emergency. Returnees and the host community bore the brunt of the outbreak as cholera spread rapidly, fuelled by limited access to sanitation and overcrowded living conditions.

As the outbreak progressed, Unity State emerged as the hardest-hit region, accounting for 55% of the total cases nationwide. The situation in Mayom County was particularly alarming, with 2,501 cases confirmed for cholera and 70 deaths in early January 2025. Makeshift cholera treatment centres operated under dire conditions, with patients lying on the floors of schools repurposed as emergency treatment sites.

One of the major contributing factors to the rapid spread of cholera in Mayom was the poor access to water and sanitation services. Health facilities without access to adequate water sources forced the community to rely on contaminated sources. This not only increased the risk of infection among the population but also severely hindered the access of water for patients and health workers, which is essential to reduce mortality and infection rates. Additionally, lack of latrines forced many to practice open defecation, further worsening the spread of the disease.

Recognizing the urgency of the crisis and upon request by the Ministry of Health, IOM in South Sudan deployed a rapid response team to help contain the outbreak. A cholera treatment unit was established in Joknyang, and a cholera treatment centre was established at Mayom hospital, where in total, 565 patients were successfully treated and discharged. Mobile oral rehydration points were also mobilized to cater for communities in hard-to-reach areas. In addition, within six days over 138,000 people were reached through the oral cholera vaccination campaign conducted in five Payams across Mayom county.

As part of its WASH response, a community water source was rehabilitated, restoring access to clean water for thousands of affected individuals and key health facilities. Efforts were also made to provide safe and sufficient water access for cholera treatment centres. Sanitation facilities were also constructed, with a particular focus on cholera treatment centres and high-risk communities. Risk communication efforts were initiated to educate the community on cholera prevention, emphasizing handwashing, food safety, and hygiene.

"Thanks to the coordinated efforts of IOM and the local health authorities, we are witnessing a significant decline in cholera cases. The community is becoming more aware of health practices, and we are better equipped to handle such outbreaks in the future." — Dr. Koang-Koang Gatduel, Director of County Health Department.

“With continuous vomiting, diarrhea, and weakness, I was rushed to Joknyang CTC by my son. The journey was tough—crossing a river and losing the path in the dark—but I made it. Upon arrival, I received urgent medical care.” Said Chuol Deng*, one of the beneficiaries. My son had lost hope, but through medical support from IOM, I have fully recovered and regained my health” she adds.

Through close collaboration with the Ministry of Health and local authorities, hospital admissions dropped from 50 cases per day to an average of one per day. As part of its exit strategy following the deployment of the rapid response team, the CTU in Joknyang and the CTC at the Mayom hospital have been handed over to the county health department who will continue to oversee the operations of the facilities until a declaration to the end of the outbreak is made by the national ministry of health.

The cholera crisis in South Sudan underscores the devastating impact of displacement, poor access to water and sanitation, and fragile health systems. However, the swift response in the past few months, and close collaboration with the local health authorities, has outlined the importance of a timely and coordinated humanitarian response in the face of a public health emergency. Through continued collaboration, South Sudan is striving not only to recover but to build stronger public health and water security as a key defence against future epidemics.

IOM's activities to respond to the cholera outbreak is supported by The Foreign, Commonwealth and Development Office.