Cholera in South Sudan Spells Trouble

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JUBA, South Sudan– The newly formed country of South Sudan is adding humanitarian issues to its “To Fix” list as the conflict that began in December of last year rages on. Public health concerns, particularly the rising cholera epidemic, and food security worries are moving into center stage as aid workers for the UN, UNICEF and regional campaigns work to provide support for civilians affected by the violence.

Trouble started in late 2013 as armed conflict broke out, originally surrounding a rift between President Salva Kiir and former Vice President Riek Machar. Since then, the country has fallen into full-scale violence between the government and rebel groups, with two cease fires broken since January.

This violence has driven 1.3 million people from their homes to refugee status in Ethiopia, Kenya, Sudan and Uganda, as well as placing some 79,000 civilians in UN peacekeeping bases in South Sudan itself. Of these citizens, 32,000 live in displacement camps in the capital of Juba. It is predicted that by the end of the year, 1.5 million civilians will be internally displaced.

As the conflict rages on, the interests of the international community are becoming humanitarian rather than military or political. When civilians are displaced, public health and food security become major concerns.

South Sudan faces two significant humanitarian issues that will become pivotal in the coming months. First is the impending famine. Because of disruption from the violence, civilians are being driven from their crops and good grazing for their livestock, resulting in food strains. Without functioning markets and farms, UN officials predict that upwards of one-third of the population will be on the brink of starvation in the coming months if fighting continues.

However, while food security will become a concern in the near future, the main humanitarian issue of the moment is the recent outbreak of cholera affecting displacement camps. The outbreak  of cholera in South Sudan started on May 15 in the capital of Juba, but has since risen to an estimated 266 cases in both Juba and the city of Bentiu. The disease has left 13 dead thus far.

Cholera, a waterborne disease, is spread through contact with human feces and is amplified in unsanitary conditions. Unfortunately, South Sudan’s overcrowded displacement camps serve as the perfect breeding ground for the disease to spread quickly. A hospital in Juba reports that cases of cholera have been doubling daily since the outbreak started, and the prevalence is predicted to increase in the oncoming rainy season, pushing the outbreak further towards a full-blown epidemic.

Fortunately, the World Health Organizations recognizes that cholera is treatable 80 percent of the time with oral re-hydration salts, and can be prevented with the use of vaccines and purification of water.

Since the outbreak of cholera in South Sudan started about a week ago, UN health agency workers have been working in conjunction with UNICEF, the South Sudan health ministry and other health and humanitarian agencies to curb the outbreak by vaccinating potential patients and treating those already affected. Groups have set up six vaccination sites in Juba and Bentiu with the goal of protecting citizens against the spread of the disease.

In addition, UNICEF has provided tents, clean water and oral hydration solutions to aid in the process of building a treatment center for people in the Juba area.

So far, 21,000 of the 32,000 in Juba’s displacement camps have had the first of two doses of the oral cholera vaccine. An additional 13,000 have been vaccinated in Bentiu. The hope is that vaccinations will keep the outbreak of cholera in South Sudan from becoming an epidemic as increasing rains spread the bacteria-contaminated waters.

But what does the risk of famine and outbreak of cholera in South Sudan really indicate? Cholera is preventable and treatable only when citizens are being cared for, but these humanitarian situations in South Sudan prove that civilians are at risk and their protection is being pushed to the wayside as the politicized conflict between the government and rebels takes national priority.

In short, when conflict supersedes public health, human rights fall behind and the international community becomes concerned for the civilian citizens’ safety.

So where can South Sudan go from here? The rising concern of famine and disease has alerted the international community to the humanitarian concerns, and in response, the UN Mission in South Sudan (UNMISS) calls for an end to the conflict, arguing that if the violence does not end soon, civilians will face further tragedies. As it stands, tension is still high in the cities of Juba and Bentiu where the cases of cholera are highest, but the UNMISS emphasizes the need for the government and rebel groups to put aside their troubles in favor of a peaceful agreement that would bring stability to the new nation and allow people to return to their homes and resume their lives. A conclusion to the conflict is the only way of ensuring solutions to these humanitarian issues.

The cholera outbreak and struggling food supply serve as an awakening to the fact that this conflict in South Sudan is about more than two ethnic groups, two political parties, or even just two opposing sides. It is about the sacrifice of an entire population. As the conflict continues to rage on, it has become clear that South Sudanese are threatened not only by physical violence, but also by humanitarian neglect.

Sources:  Al Jazeera, Huffington Post, SABC News, Voice of America, Washington Post
Photo: Partners in Health

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