Cholera-Bentiu-12-2024-21 – MSF teams and patients are seen at the MSF-supported Cholera Treatment Center (CTC) in Bentiu State Hospital in Rubkona County of Unity State. (Photo: Gale Julius Dada/MSF).

Médecins Sans Frontières (MSF) urgently calls on the government and national and international humanitarian organizations to immediately scale-up response to the rapidly escalating cholera outbreak in South Sudan – especially in the camps for internally displaced people.

Persistent chronic gaps in healthcare, funding cuts, dire water and sanitation conditions and gaps in other essential services have created the perfect conditions for the disease to spread, the charity said.

In the camps in Unity and Central Equatoria states, MSF said it teams are witnessing an alarming and rapid increase in the number of suspected cholera cases, which are overwhelming the capacity to respond.

It underscored that tens of thousands of people displaced by conflict and flooding have sought refuge in Bentiu and Rubkona’s overcrowded camps for decades.

Those living in these camps have faced appalling conditions for many years, which have continued to deteriorate as donor funding has diminished, and the humanitarian system has increasingly come to accept these conditions as the norm, it said.

Beyond the camps, MSF narrated that the community is exposed to contaminated drinking water, with little or no access to latrines.

This, coupled with overwhelmed cholera treatment facilities, is reportedly driving the rapid spread of the disease, with 4007 cases reported in Rubkona County alone as of December 20, 2024.

“In just four weeks, MSF teams in Bentiu have treated over 1210 cholera patients, many of whom arrived in a critical condition due to severe dehydration, and tragically 92 lives have been lost in Unity State” says Albert Stern, MSF emergency response coordinator in South Sudan.

The cholera outbreak is also intensifying in Juba’s former Protection of Civilians (PoC) camps, where an estimated 63,000 people live, according to the aid group.

In the past weeks alone, MSF has treated over 1,700 suspected cases at its cholera treatment centres (CTC) in the camps, and at least 25 deaths have been reported in the community – amid a serious concern that the numbers will continue to rise due to the dire sanitation conditions.

“What we are witnessing is not just a cholera outbreak – it is the result of systemic neglect,” says Mamman Mustapha, MSF head of mission in South Sudan.

“The camps are overwhelmed with mountains of uncollected waste, latrines are broken and overflowing which has left people with no choice but to defecate out in the open, and raw sewage is running between people’s tents and between food kiosks.”

“As a result, drinking water has become contaminated, and patients are arriving at our cholera treatment centres in a critical condition—many are at death’s door. Without immediate action to address the dire conditions that people are living in, we expect cholera cases to skyrocket in the coming days and weeks.”

Nyaluak Kuol and her two-year-old son, Tesloach Manah, were treated in MSF’s cholera treatment centre in one of Juba’s camps.

“We live in an overcrowded camp where the situation keeps getting worse. For nearly three weeks, there has been a severe water shortage,” says Kuol. “Today, I’m relieved that my child is being discharged, but deep down, I fear we will be back. No matter how hard I try to keep my home clean, the entire camp is contaminated.”

Martha Nyachar Gatduel, from Mankuay village in Rubkona, reflects on the hardships her family has faced as cholera struck her region.

“Two of my kids got infected with cholera. For my four-year-old it was severe,” says Nyachar Gatduel. “We had to borrow a bed from a neighbour to lay him down and then carry him through the night to the main treatment centre in Rubkona. It was difficult. At home, we fetch water from the river, we just drink without boiling because we do not have firewood to boil water, and we do not have chlorine. There is no latrine at my home.”

The international aid group said the scale of the outbreak is too great for it to be able to contain it alone.

“We are urgently calling on donors to increase funding for the cholera response, and urging South Sudanese health authorities, as well as national and international humanitarian organisations, to scale up critical interventions without delay. These include enhancing case management capacities, improving water and sanitation infrastructure, and strengthening cholera surveillance in the most affected areas.”

MSF is also calling for the rapid roll-out of a nationwide vaccination campaign, adding that addressing logistical delays in vaccine delivery and increasing funding for the response and scaling up of community-based interventions, such as enhanced hygiene promotion, water and sanitation improvements, and targeted outreach to high-risk groups, are critical to ensuring an effective and timely humanitarian response.

First declared on October 28 in Upper Nile State, the outbreak has since spread to Unity, Northern Bahr el Ghazal, Jonglei, Lakes, Eastern and Central Equatoria states, reporting an estimated 6,617 cases across the country, according to The World Health Organization.

MSF is currently responding to the cholera outbreak in five out of the seven states affected by cholera in South Sudan.