A. Situation analysis
Description of the disaster
Just over a year after the world’s newest nation declared its first cholera outbreak in May 2014, another outbreak has been declared, as South Sudan faces rising numbers of cases. The start of the rainy season has exacerbated an already difficult situation of access to safe water and sanitation, particularly in overcrowded populations such as IDP settlements and urban residential areas. Between 22 May and 4 June, eight suspected cases and one confirmed case were recorded in Juba, seven of which were in the UN House Protection of Civilian (PoC) sites in the city, under the protection of UNMISS. The Republic of South Sudan’s Ministry of Health belatedly declared the outbreak in Juba on 23 June 2015.
WHO data confirms that there have been 396 confirmed cholera cases and 26 deaths (CFR 6.6 per cent) recorded from 64 villages in 8 Payams (an administrative level below county with a minimum population of 25,000) of Juba County as of 28 June 2015. The same source back the earliest cases to 18 May in the UN House PoC camp, followed by cases at New Site, Mangatain IDP settlement, Gumbo, Gudele, Khor William and Munuki, all within the city of Juba. Children below five accounted for 14 per cent of cases, including 2 deaths. An estimated 5,000 children are at risk from cholera. Whilst no cases outside of Juba have been confirmed, suspected cases are being reported from many locations including Torit, Bor, Bentiu, Kodok and Malakal.
On 25 June, the Juba City Council asked restaurants around the city, including Jebel and Custom Market areas, to temporarily close for a week, as part of preventive action. However, there is little sign that this is being implemented. Based on the current analysis, the outbreak is expected to be on a smaller scale than 2014, however, the situation in many of the states is unclear, given the lack of access in many areas. The situation in many areas of the country over the past two months has been highly volatile, with an escalation of the conflict and subsequent population displacement. The PoC camps in Bentiu and Melut have seen large influxes of people fleeing from the fighting. There has also been instability in states outside of the conflict zone such as Western Equatoria. In such a volatile context, accurate reporting of cholera cases will be extremely challenging. This should be recognized in any analysis of the situation.