Cholera patients being treated at MSF-run hospital in Malakal in Upper Nile State. (Photo: MSF).

The Doctors Without Borders known by its French initials as Médecins Sans Frontières (MSF) said it is deeply concerned about a rapidly escalating cholera outbreak in Malakal of Upper Nile state where 737 cases have since been recorded.

MSF said the cases currently nearing the one thousand mark – were recorded from when the outbreak was declared on on 28th October to 3rd December, adding that the charity’s hospital in Malakal treated 646 of those patients.

“The situation in Malakal remains critical, and we are concerned that the outbreak is spreading to neighbouring areas such as Tonga and Kodok,” says Zakaria Mwatia, MSF head of mission in South Sudan.

“MSF urgently set up the 100-bed cholera treatment centre in Assosa and continues to provide critical medical care; however, significant gaps remain, especially in the number of functioning oral rehydration points and water and sanitation. We have been stretched thin in our response as we have had to expand our efforts to address critical gaps in the ongoing response.”

The medical aid group underscored that the outbreak, initially declared in Renk County north of Upper Nile state has spread to Malakal, Bentiu in Unity state, Aweil in Northern Bahr-el Ghazal state, and even South Sudan’s capital, Juba.

Renk is a major entry point for refugees and returnees from Sudan, and the relief organization stated that inadequate living and hygiene conditions have contributed to cholera’s spread.

Over 850,000 people have crossed from Sudan into South Sudan over the past 18 months, around 75 per cent of them through the Renk crossing into Upper Nile state.

MSF said the ongoing influx of refugees and returnees into South Sudan continues to pose risks to the already fragile situation and puts additional pressure on an already much overstretched health system.

It said this highlights the urgent need for a stronger response to not only curb the spread of cholera, but also strengthen the delivery of critical health services across the country.

In its report released on Friday, MSF said by 3rd December, a total of 1,526 suspected and confirmed cholera cases had been recorded in South Sudan, with the numbers continuing to rise rapidly.

“Of these, more than 880 were treated at MSF facilities. Hundreds of these patients are displaced people from neighbouring Sudan, where more than 37,000 cholera cases have been reported in the recent months,” it stated.

Although preparedness to address the potential spread to Malakal and other areas has been reportedly slow, the charity said it worked alongside the Ministry of Health and other partners to set up the cholera treatment centre in Malakal in just three days.

MSF said its teams are actively educating the community about cholera prevention and transmission and undertaking contact tracing to identify potential cases and refer them to the medical facility.

“We also provide technical support, medical supplies, and logistical assistance to other organisations and the Ministry of Health to cover gaps and ensure an effective response.”

MSF further said it has also deployed mobile teams outside Malakal to provide technical support to the Ministry of Health in setting up cholera treatment units.

Cholera is a deadly disease transmitted through the ingestion of contaminated food or water, leaving patients with severe acute watery diarrhea and it can kill within hours if left untreated, according to WHO.

Most people infected with V. cholerae do not develop any symptoms, although the bacteria are present in their feaces for 1–10 days after infection and are shed back into the environment, potentially infecting other people.

Among people who develop symptoms, the majority have mild or moderate symptoms and a minority of patients develop acute watery diarrhea with severe dehydration.

On December 1, the Ministry of Health, with support from the World Health Organization (WHO), has secured over 282,153 doses of oral cholera vaccine to initiate a vaccination campaigns in cholera transmission hotspots across the country.

The oral cholera vaccine (OCV) is supplied by the International Coordinating Group (ICG), which coordinates and manages the global stockpile of vaccines for countries during cholera outbreaks, WHO said in a statement.

It added that the drugs consignment will be used to implement a two-dose mass vaccination campaign in Renk and Malakal Counties of Upper Nile State.