‘Fleeing danger, finding water scarcity': sanitary emergency threatens people in Abyei Special Administrative Area - South Sudan

Poor sanitation, severe water shortages, and inadequate infrastructure are exacerbating the spread of the virus through contaminated drinking water, placing thousands at risk.

In July 2024, health authorities in Abyei declared an outbreak of hepatitis E, since then 41 cases have been reported, resulting in six deaths (a 16 per cent case fatality rate), including five women, of whom three were pregnant, and one male. The situation has worsened due to the influx of over 22,000 people crossing the border into Abyei since the beginning of the conflict in neighbouring Sudan. The incessant movement of internally displaced people and refugees significantly increases the risk of hepatitis E transmission in the region, while MSF has faced barriers to diagnose the disease due to a shortage of rapid detection tests.

"Currently, we have four patients in the isolation ward, but the situation is fluctuating, and we urgently need wash and sanitary infrastructures to prevent further deaths,” says Zélie Antier, MSF project coordinator in Abyei Special Administrative Area.

Since violent conflicts erupted in February 2022 in and around Agok, an estimated 70,000 people were displaced, with many seeking refuge in Abyei. The influx of displaced people has put an additional pressure on the limited services that were available for the already fragile communities, with over 85 per cent of people in need of humanitarian assistance.

In Amiet market, located about 14 km from Abyei town, more than 900 refugees, returnees from Sudan and internally displaced people live in overcrowded and unsanitary conditions. Here, hepatitis E has been particularly deadly - more than half of the total hepatitis E cases were people living in the Amiet market. With an estimated 20,000 people nearby and no available latrines, people are forced to practice open defecation, further contaminating water sources and worsening the virus's spread.

On August 22, approximately 250 families were displaced from the Abyei surroundings to Abyei town. Elizabeth Chatek, who arrived after her home was flooded, said, "We don’t have latrines. I have to defecate in the bushes, and my children use a bowl near the shelter." Privately owned latrines charge up to 1,000 SSP (around 20 US cents) per use, a cost too high for Elizabeth's family and many people in Abyei.

In Abyei town and Amiet market, a 20-liter jerrycan of water costs 500 SSP (around 10 US cents) a price many families can't afford. Displaced families have told MSF that rising inflation will soon make clean drinking water out of reach.

In one of Abyei’s secondary healthcare facilities, as of 12 September, MSF had provided supportive care services for 41 patients for hepatitis E at Ameth Bek Hospital and increased health promotion activities targeting pregnant women and new mothers to raise awareness about disease prevention.

As the ongoing rainy season continues to cause widespread flooding and threatens drinking water sources and drainage systems overflow, the risk of hepatitis E and other waterborne diseases such as cholera is at stake. Flooding is expected to worsen within the coming weeks with experts predicting extreme riverine flooding and flash floods.

“We urgently call on international donors and aid organisations to scale up their efforts by improving sanitation and providing clean drinking water in Abyei Special Administrative Area,” says Zélie Antier.