Ongoing measles crises in South Sudan and Yemen.

South Sudan: ​

A measles crisis is mounting in South Sudan’s Western Equatoria state, just as health authorities struggle to overcome an outbreak of yellow fever. Between February and March 24th, 460 cases and 7 deaths among children under-five have been recorded in three health facilities in Yambio and Nzara counties; 90 per cent of these children had never been vaccinated against the disease.

With measles cases on the rise and vaccination coverage alarmingly low, international medical organisation Médecins Sans Frontières/Doctors Without Borders (MSF) urges health authorities and the World Health Organization (WHO) to launch an immediate vaccination campaign to prevent the disease from spreading further.

Measles has become a persistent emergency in South Sudan, with recurring outbreaks challenging healthcare systems and endangering communities. More than 12,000 cases have been recorded this year; only last week South Sudan recorded more than 400 cases.

To respond to this emergency, MSF teams are treating measles in Nzara and Yambio Counties via Gangura and Sakure health centers, as well as at Yambio State Hospital. Twenty percent of children treated for measles at MSF-supported facilities are over the age of five, highlighting the need for a reactive vaccination campaign to reach this group of older children who did not receive measles vaccinations as part of the existing expanded immunization programme (EPI).

The measles outbreak is a double blow for a region still struggling to deal with yellow fever after the most recent outbreak – the fourth in just six years – was declared by health authorities in December 2023. As of mid-March, 81 cases of yellow fever, including three confirmed ones, and six deaths have been recorded. The Ministry of Health, in collaboration with WHO, launched a yellow fever vaccination campaign, immunising around 357,000 people across three counties of Western Equatoria state. The campaign resulted in a reduction in numbers of suspected and confirmed cases – a testament to the efficacy of mass vaccination campaigns.

Low vaccination coverage in South Sudan has a significant impact on the population, particularly children, who are highly vulnerable to diseases such as measles which can lead to serious health complications and deaths. Given the gravity of the health threats posed by both measles and yellow fever, MSF calls for increased efforts to raise community awareness about the diseases and to adopt best practices to stop them from spreading.

"South Sudan’s fragile health system cannot bear the burden of recurrent outbreaks. ​ It is imperative that the Ministry of Health and other health organisations, including WHO, intensify their efforts to expand vaccination coverage across the country and especially those areas most prone to disease outbreaks,” urges MSF head of mission Zakaria Mwatia.

Yemen:

Over the last six months, doctors in MSF’s supported Mother and Child hospital (MCH) in Taiz Houban have been reporting an unprecedented and persistent rise in number of measles patients. Numbers reached a peak with 347 patients admitted in December last year; at least a three-fold increase compared to August of the same year.

Between August and December 2023, our measles unit received 1,332 children, 85 per cent of them under the age of four. In February 2024 alone, we received 220 measles patients. Our epidemiological projections do not foresee a decrease in patient admissions anytime soon.

Many children infected with measles present very late to the MCH hospital, with their health condition deteriorating to a critical stage – as their parents speak of constant struggles to secure means to afford medical treatment and/or transport to receive free-of-charge quality healthcare.

Dr Ei Ei Khaing, MSF clinical team leader in Taiz Houban mother and child hospital, describes efforts to tackle the life-threatening disease.

“Although measles is a preventable disease, vaccination coverage among children being treated for measles is just 16 percent. Once the virus spreads in the community, morbidity and mortality can be high, especially among young children.

Measles is endemic to the area where we work. In our mother and child hospital, we’re used to seeing an average of eight measles patients each month. But last June, the pattern began changing. Suddenly the numbers started to increase alarmingly, with children from many districts in Taiz governorate arriving at our hospital.

Soon the number of measles patients had doubled. We could not risk cross-contamination in our wards, so in late-August we decided to open a dedicated measles isolation unit. Six months later, the upsurge in measles cases shows no sign of abating and our efforts to address and contain the infection seem quite limited.

Children under five are particularly affected by measles since their immune systems are not sufficiently developed to withstand the infection. Once children contract measles, a temporary immunodepression causes measles-related infections such as pneumonia, conjunctivitis, inflammation of the ear and mouth, diarrhoea and swelling of the brain.

People in Taiz, like the rest of Yemen, struggle to access healthcare. The nearly decade-long conflict in Yemen has had a devastating toll on the country’s health infrastructure; many health facilities are either non-functional or are ill-equipped to cater to people’s needs. Added to this, basic health services in public health facilities are costly for the majority of people, whose financial capacity is quite constrained.

The lack of primary healthcare services pushes caretakers to delay bringing their sick children to our hospital in the hope that the symptoms will resolve on their own with home remedies or medication from their local pharmacy, if they have one. In addition, the long distances people have to travel to get here serves as an additional constraint, since most can barely afford the transport costs."

Despite MSF’s ongoing efforts, there are no signs of the disease abating, as the impact of our intervention is ​ limited. There must be an improvement of the overall collective response mechanisms of preventive and curative care at a primary healthcare level; ensuring the availability and accessibility of vaccines, bolstering nutrition programmes and strengthening the capacity of existing primary healthcare systems/facilities.