A. Situation analysis
Description of the disaster
On 3 November 2015, four and a half months after a cholera outbreak was declared on 23 June, the government of South Sudan, through its Ministry of Health, declared an end to the outbreak . At final tally, the emergency recorded 1,818 laboratory-confirmed cases and claimed 47 lives in Central Equatoria State and Jonglei State . Juba County in Central Equatoria was, by far, the most-affected, accounting for 89 per cent (1,622) of cases in seven payams.
Generally, the outbreak was characterized by predictable epidemiological patterns, peaking in late July when case fatality rate reached 6.6%, before tapering off after a secondary peak in August. Potentially triggered by heavy rains which normally arrive mid-year, the worst was over within the first two months, with only 100 new cases recorded since 5 September, largely due to concerted intervention efforts from the government and international agencies.
The emergency response took place as an ongoing internal conflict entered its twentieth month in August, although the outbreak was largely confined to Juba, away from the fighting that continued to rage farther north in the states of Jonglei, Unity and Upper Nile.
Summary of response
Overview of Host National Society As soon as the outbreak was declared on 23 June 2015, SSRC began mobilizing its resources to prepare for its response. An initial plan of action was drafted, largely based on a review of capacities already available as a result of the previous response in 2014. Following the National Cholera Taskforce allocation of intervention areas for agencies, SSRC identified seven locations in Juba to intervene with social mobilization and WASH activities for 60,000 people (10,000 households) with direct implementation starting on 3 July 2015. Although the outbreak spread to Bor County in neighbouring Jonglei State, the situation was quickly brought under control, as the state was well-covered by existing contingency planning that led to a well-organized response from external actors and the government. A key component in Torit branch preparedness activities was in water production, through the M40 water plant handed over to the branch by the Water and Sanitation Emergency Response Unit (ERU) deployed in 2014. SSRC operated the plant under a Memorandum of Understanding with the Torit Municipal Council and the State Ministry of Physical Infrastructure to share management and maintenance responsibilities, with a costing mechanism for water obtained used to help sustain operations.
By early September 2015, operations in Juba had more than tripled original targets and a revision to the budget and EPoA was drafted by mid-September 2015, with the formal revision launched on 5 October 2015.
Overview of Red Cross Red Crescent Movement in country
The IFRC through its East Africa and Indian Ocean Islands (EAIOI) representation based in Nairobi, Kenya; and South Sudan country representation in Juba has been providing technical assistance in the implementation of the DREF operation. The International Committee of the Red Cross (ICRC) also has a country delegation, with its interventions located in the conflict-affected states. In addition PNS with in country presence include: Austrian, Canadian, Danish, Netherlands, Norwegian, Swedish and Swiss Red Cross National Societies, which are providing bilateral support, including in response to the cholera outbreak, complementary to the DREF operation.
Overview of non-RCRC actors in country
Under the joint guidance of the Ministry of Health and WHO, the National Cholera Task Force provided technical leadership and coordinated the various health and water, sanitation and hygiene (WASH) cluster partners involved in surveillance; laboratory support; case management; WASH; social mobilization and Logistics. Other than the government, Catholic Relief Services were the only other agency apart from SSRC implementing social mobilization under the coordination of the task force.
Agencies such as MSF, with the Ministry of Health, also set up treatment points for receipt, screening and treatment of all suspected cholera cases. These included: three cholera treatment centres at Juba Teaching Hospital, Munuki, and Bor State Hospital; two cholera treatment units at Juba 3 Protection of Civilian camp (PoC) and Gumbo; and six oral rehydration points in Nyakuron, Kator, Gurei, Munuki, Al Sabah, and Lologo.
The government, with support from WHO, UNICEF, MSH, IOM, Medair, IMC and other health cluster partners, provided cholera buffer stocks, other medical supplies and necessary equipment.
In order to prevent the continued spread of cholera in the high risk areas, the MOH with support from WHO, UNICEF, IOM, IMC and MSF conducted oral cholera vaccination campaigns in several cholera hot spots in Juba, reaching more than 290,000 people.