ACUTE WATERY DIARRHEA OUTBREAK - EARLY RAINS

UNCLAS SECTION 01 OF 02 KHARTOUM 000741

SIPDIS

AIDAC
SIPDIS

STATE FOR AF/SPG, PRM, AND ALSO PASS USAID/W
USAID FOR DCHA SUDAN TEAM, AF/EA, DCHA
NAIROBI FOR USAID/DCHA/OFDA, USAID/REDSO, AND FAS
USMISSION UN ROME
GENEVA FOR NKYLOH
NAIROBI FOR SFO
NSC FOR JMELINE, TSHORTLEY
USUN FOR TMALY
BRUSSELS FOR PLERNER

E.O. 12958: N/A
TAGS: EAID PREF PGOV PHUM SOCI KAWC SU
SUBJECT: ACUTE WATERY DIARRHEA OUTBREAK - EARLY RAINS
INCREASE RISKS IN SOUTHERN SUDAN

REF: a) Khartoum 0478, b) Khartoum 0700

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Summary and Comment
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1. The outbreak of acute watery diarrhea (AWD) continues
in Southern Sudan. The U.N. World Health Organization
(WHO) has confirmed that the AWD outbreak derived from a
single strain of cholera. WHO reported that between
January 28 and March 22, 8,684 cases of AWD including 231
deaths had been reported throughout Southern Sudan.
According to WHO, although the illness originally spread
by road north and east of Juba, AWD cases are now being
reported in Ikotos along the southern road from Juba to
Uganda. On March 14, the Government of Southern Sudan
(GoSS) Under Secretary of Health announced that the AWD
outbreak in Yei had ended. WHO reported that as of March
19, 1,807 cases including 53 deaths had been reported in
Yei and 4,523 cases including 87 deaths had been reported
in Juba. Local health facilities report that the number
of cases has been steadily declining in these cities, but
new cases are being reported along major routes and in
villages surrounding major towns throughout Southern
Sudan. At least 1,651 new cases of AWD including 64
deaths had been reported in other areas of Southern Sudan
as of mid-March.


2. The onset of early rains in Juba and other parts of
central Equatoria has increased the risk of renewed
outbreaks in the area, especially in Juba and Yei, where
conditions are crowded, sanitation is poor, and many
shelters are flimsy and temporary. End summary and
comment.

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The Spread of AWD
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3. Although the number of cases of AWD appears to have
declined in Yei and Juba towns in recent weeks,
increasing reports of new cases of AWD from areas outside
of Juba pose a serious challenge to the ongoing response
efforts. New cases of AWD have now been reported at
health facilities throughout the south: 300 kilometers
(km) northeast of Juba in Pibor and surrounding villages
of Jonglei State; 250 km south of Juba in Kajo-Keji;
along a 200-km route north of Juba in Terekeka, Padak,
Bor, and villages west of Bor; 150 km northwest of Juba
along the route to Mundri in Rokon and Tijor villages;
500 km west of Yei in the villages surrounding Yambio;
and 800 km north of Juba in Malakal and Nyilwak in Upper
Nile State. WHO and USAID partner Adventist Development
and Relief Agency (ADRA) reported that barge passengers
have carried the illness north in at least once instance.


4. Of particular concern are reports from Lohutok
outside Torit town, where more than 700 cases have been
reported recently by the non-governmental organization
(NGO) Medecins sans Frontieres. In Malakal the number of
new cases has been increasing daily, reaching 80 cases as
of March 10, with unconfirmed reports of many more since
then. During the past three weeks, 363 cases including
18 deaths were reported in Torit town, 137 cases
including 3 deaths were reported in the Pibor area, and
109 cases including 10 deaths were reported in Bor, where
all cases are believed to be linked to Juba's Lologo
internally displaced person (IDP) camp.


5. In Yei the number of cases of AWD peaked between
February 1 and 7, just as the outbreak was beginning in
Juba. The number of cases peaked in Juba at an alarming
2,400 cases approximately two weeks later, at the same
time reports started arriving of the spread of AWD cases
to other areas of Southern Sudan. In week 10 of the
outbreak, reports indicated a steady increase in the
number of cases outside Juba and Yei.


6. Response efforts continue (Ref B) and include
coordination, surveillance, case management, and
environmental control measures on the part of the GoSS

KHARTOUM 00000741 002 OF 002


Ministry of Health (MOH),the U.N. Children's Fund, WHO,
and NGO partners. Nevertheless, the spread of the
illness has been quick and has posed a challenge for
agencies on the ground in terms of both treatment and
containment.

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Early Onset of Rains and Lologo IDP Camp
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7. Three torrential rainstorms swamped Juba between
March 7 and March 12, nearly a month earlier than
expected. Health professionals are concerned that the
early onset of heavy rains may lead to a resurgence of
new cases in Juba. Many households in Juba do not have
access to latrines, and the combination of heavy rain,
surface defecation, and AWD could yield a wave of new
cases. Population movements throughout the south
compound the risk.


8. Lologo camp on the outskirts of Juba hosts
approximately 3,000 IDPs, mostly Bor Dinka, living in
temporary shelters of plastic sheeting suspended on
makeshift wooden frames. USAID staff visited the camp
the morning of March 13, after heavy rains drenched the
area. The shelters were completely inundated and
families had spent the night sleeping in mud. All
household belongings, including food rations, were
soaked, and women reported fevers and coughs among the
children. The camp was a quagmire, with large pools of
standing water all around, providing excellent breeding
grounds for disease and mosquitoes. On March 17, the
U.N. Children's Fund (UNICEF) reported that the rains had
destroyed some of the camp's shelters, although the exact
number was unknown.


9. Although health workers at the Lologo clinic reported
that cases of AWD had declined in the camp during the
previous week, they were concerned that cases could spike
again with the early rains. Through a U.N. program,
Lologo IDPs were scheduled to be returned to Bor by barge
the end of the dry season, but transportation was halted
after the AWD outbreak began in Yei and Juba. No IDPs
have returned to Bor since early February. Now with the
early rains, the potential for a renewed AWD outbreak,
and the possibility of spreading additional illnesses
such as as typhoid and meningitis, it is probable that
these IDPs will be stranded in Lologo camp until the next
dry season.


10. As most men have moved ahead to Bor with their
cattle, Lologo camp residents are predominantly women,
children, and the elderly. These populations are most
vulnerable to diseases that spike during the rainy
season. Currently one camp health center, run by USAID
partner ADRA, sees more than 120 patients daily. The
camp has only one borehole. The only other water
available in the camp is Nile River water trucked in and
stored in bladders.


11. A joint U.N., MOH, and NGO coordination group for
Lologo has discussed relocating IDPs from Lologo to
another camp near Juba, but these plans have stalled.
Although there is tremendous political pressure against
making any permanent additions or interventions in
Lologo, without more concerted attention to shelter and
hygiene conditions, the IDPs will face extreme hardship
and deplorable conditions this rainy season.

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USAID Recommendation
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12. USAID will continue to monitor closely the situation
at Lologo camp through USAID partners in Juba, especially
with regard to plans to move Lologo IDPs to another camp.
If the situation deteriorates or the IDPs do not move,
USAID is prepared to respond quickly through partners in
Juba.

STEINFELD