A. Situation analysis
Description of the disaster
South Sudan, one of the world’s newest Country, has declared a cholera outbreak for the third year in a row since 2014 as it continues to face rising numbers of cases in Central Equatoria, Eastern Equatoria and Jonglei states. The start of the rainy season in the country has contributed to difficult situation of accessing safe water and sanitation, particularly in overcrowded areas such as Internal Displaced Persons (IDP) settlements, Protection of Civilian sites (PoCs) and urban residential areas. The current crisis has displaced many vulnerable people into settlements and Protection of Civilians which at the moment have become overcrowded making access to clean water difficult, as well as access to hospital, sanitation facilities and as a result this has contributed to the cholera outbreak in the Country. Putting into consideration that this is a rainy season which is also another risk factor to Cholera out break As of 23 July 2016, the South Sudan capital of Juba in Central Equatoria State recorded a total of 233 cholera cases including 5 deaths (CFR 2.15%). Juba Teaching Hospital has been designated as a Cholera Treatment Centre (CTC). In Juba the areas of Giada, (Tiger military area). Gorom, Khor and William have been worst affected by the outbreak while Terekeka County in Central Equatoria State has reported 10 suspected cases of cholera with 4 deaths (CFR 40%).
Samples have been taken for laboratory confirmation. In Jonglei, 46 suspected cholera cases with 7 deaths (CFR 15.21%) have been reported from Duk County involving 5 settlements namely, Atuek, Atul, Koyom, Moldova and Watkuac with the index case date of onset 3 July 2016. In Terekeka (Central Equatoria) 12 cases of cholera have been reported, with 5 deaths (CFR 41.66%).
As of 26 July 2016, a total of 391 cholera cases including 17 deaths have been reported in South Sudan, since the initial case was reported by the Ministry of Health (MoH) and World Health Organization (WHO).
Summary of the current response
Overview of Host National Society (South Sudan Red Cross)
The South Sudan Red Cross (SSRC) was actively involved in the cholera preparedness and responses in May 2014 - June 2015 and as a result, has existing capacities to respond to the current outbreak. In 2015, in response to the cholera outbreak, more than 200 SSRC volunteers were trained in Juba (Central Equatoria State), 80 in Torit (Eastern Equatoria State) and 30 in Jonglei State branches in cholera awareness social mobilization activities and Health Education (hygiene promotion).
SSRC as part of the preparedness had conducted a refresher training to Volunteers in Juba and Torit before the outbreak with the aim of starting social mobilization with financial support from the Swiss Red Cross.
Refresher training for 80 volunteers in Torit on cholera preparedness, and response (6 June 2016)
Forty-eight (48) in Juba as part of the preparedness plan for 2016 on 8 July 2016 at Juba Regency Hotel in Juba
Forty-four (44) Volunteers trained on 28 July 2016 at SSRC Compound in Juba
The volunteer trained so far will be added to meet the required number needed in the National Society to enable NS respond effectively.
The NS has 4 trained water and sanitation Regional Disaster Response Team (RDRT) members. It has 45 Emergency Action Teams (EATs) established across the 10 states, comprising 20-25 volunteers per team. A total of 280 volunteers are trained in Participatory Hygiene and Sanitation Transformation (PHAST) and another 624 in community-based health and first aid (CBHFA) in Torit, Juba, Yambio, Wau, Aweil, Kuajok, Bentiu and Malakal Branches. The SSRC has been participating in the weekly National/State Cholera Taskforce chaired by the MoH.
The NSs cholera response plan that was developed in 2015, is currently being reviewed and revised and the target SSRC branches are now reactivating staff and volunteers involved in the 2015 response. A draft operational plan and budget has been prepared, with a focus on integrated community-based approach in social mobilization, WASH activities, Psychosocial Support (PSS), Oral Cholera Vaccination (OCV) and Rapid Diagnostic Test (RDT).
Overview of Red Cross Red Crescent Movement in country
The IFRC South Sudan country office based in Juba is led by a Country Representative, 2 Logistics Officers, a Finance Officer, an Administrative Officer and a driver. The focus of the country office is organisational development support to SSRC and Movement coordination.
The International Committee of the Red Cross (ICRC) has a significant presence in South Sudan, with its main operations focusing on the conflict affected areas in the Country. Partner National Societies (PNS) present in country for bilateral programming are the Austrian, Canadian, Danish, Netherlands, Norwegian, Swedish and Swiss Red Cross Societies, while the British and Finnish Red Cross Societies are also supporting SSRC.
A Movement Cholera Task Force has been activated and is composed of all Movement partners. However, due to the conflict ICRC is the only active Movement partner present in South Sudan at the moment. A team composed of SSRC Managers, Coordinators and Officers at the headquarter (NHQ) has been activated to continuously get updates and attend the National WASH and Health Cluster meetings at both National and State levels. The SSRC team is being coordinated by the SSRC Head of Programmes.
On 19 July 2016, the SSRC issued an alert using the IFRCs Disaster Information Management System (DMIS) and following further coordination between Red Cross Red Crescent Movement partners indicated the intention (on 27 July 2016) to request a DREF allocation to support the response to the cholera outbreak. On 28 July 2016, an Operational Strategy Call was convened with representatives from the SSRC, IFRC South Sudan, Africa Region and Geneva levels.
Given the complicated situation in South Sudan, it was agreed that DREF was an appropriate modality to support the NS with their response to the cholera outbreak. The DREF allocation will enable the immediate implementation activities planned under the SSRC response plan. Partner National Societies have allocated funds to enable SSRC in preparations as it awaits the release of a DREF allocation. ICRC has installed a water treatment plant in Lologo, Juba with the capacity to produce 700,000 litres per day, facilitate water trucking to cholera affected areas, install water distribution points and will also be providing initial WASH related supplies (e.g. buckets, oral rehydration solution (ORS) etc.).