War fuels cholera outbreak across Sudan with MSF seeing over 2,300 patients and 40 dead in one week

Across Darfur, cholera is hitting people who already struggled with water shortages that made it impossible to follow essential hygiene measures, such as washing dishes and food. The situation is most extreme in Tawila, North Darfur state, where 380,000 people have fled to escape ongoing fighting around the city of El Fasher, according to the United Nations. By the end of July, after one month of responding, MSF teams treated over 2,300 cholera patients in collaboration with the Ministry of Health in Tawila. The cholera treatment centre at Tawila Hospital, officially equipped with 130 beds, had to accommodate 400 patients during the first week of August, overwhelming the facility and forcing staff to add extra mattresses on the floor to cope.

In Tawila, people survive with an average of just three litres of water per day, which is less than half the emergency minimum threshold of 7.5 litres needed per person per day for drinking, cooking, and hygiene, as stipulated by the WHO. As cholera cases rise and resources run out, clean water and sanitation services are urgently needed to prevent more deaths.

“In displacement and refugee camps, families often have no choice but to drink from contaminated sources and many contract cholera,” says Sylvain Penicaud, MSF project coordinator in Tawila. “Just two weeks ago, a body was found in a well inside one of the camps. It was removed, but within two days, people were forced to drink from that same water again.”

About 100 kilometres from Tawila, cholera was reported in Golo, Central Darfur state, on 13 July. MSF opened a 73-bed cholera treatment centre in Golo hospital. This centre was quickly overwhelmed, with 137 patients arriving on 3 August alone. Five oral rehydration points were set up around Golo to manage mild cases and prevent deterioration, but our teams see that the outbreak is still spreading fast. In early August, cholera reached Zalingei and Rokero in Central Darfur state, and Sortony in North Darfur state.

Heavy rains are worsening the crisis by contaminating water and damaging sewage systems. Cases are continuing to rise in South Darfur state, as well, where MSF, in coordination with the Ministry of Health, has expanded the cholera treatment centre in Nyala to 80 beds. There, the response is waiting for vaccines and facing a severe shortage of water purification tablets.

“The health centres are full,” says Samia Dahab, a resident of Otash displacement camp in Nyala. “Some areas have water, others have kiosks that are far or empty. Some water is salty, and we drink it unboiled, unsure if it’s safe.”

As people move around to flee fighting, cholera is spreading further, in Sudan and into neighbouring Chad and South Sudan. In Damazin, Blue Nile state, Sudan, MSF and the Ministry of Health expanded the Damazin hospital cholera treatment centre from 50 to 250 beds in July to cope with an influx of returnees from South Sudan. At this centre, our teams are seeing a deadly combination of cholera and malnutrition. Between 3 and 9 August, six cholera patients who died were also suffering from acute malnutrition.

“The situation is beyond urgent,” says Tuna Turkmen, MSF’s head of mission in Sudan. “The outbreak is spreading well beyond displacement camps now, into multiple localities across Darfur states and beyond.”

“The international response must have an outbreak emergency coordination mechanism able to provide healthcare, improve water and sanitation services, and begin cholera vaccination campaigns in affected areas at a pace that matches the urgency this catastrophic situation requires,” says Turkmen. “Every day of delay costs lives. MSF stands ready to collaborate with the Ministry of Health, UNICEF, and WHO to launch mass vaccination campaigns across Darfur. Survivors of war must not be left to die from a preventable disease.”

Patient Testimony - Samia Dahab

Otash Camp, Center 1, Nyala, South Darfur

I felt sick yesterday at 4:00 p.m. I started vomiting and had diarrhoea, but I’m feeling better now. On Friday, we bought some food from outside, and the next day we all had diarrhea and vomiting. My five children were also got sick. Three of them have recovered, but two are still receiving treatment.

When the symptoms started, I waited two hours until my husband returned from work. He came with a motorbike (riksha) and took us to the hospital. They treated me immediately, and I began to feel better. The distance was very far. I first went to Nyala Teaching Hospital, and then they transferred me to the cholera treatment center at Al-Nahda Hospital. They treated all of us and also provided food. I was very sick yesterday, but today I feel much better.

There are many patients suffering from diarrhoea and vomiting. The health centers are full, and they only operate until noon. We use four jerry cans of water per day. Drinking water is available in some areas, but in others, street stalls that sell water are far away or might not have water at all. Some water is salty, and some is better. We drink the water without boiling it, and I don’t know if it is chlorinated.

Soap is still very expensive, which makes it harder for families to maintain proper hygiene. We hope they will spray insecticides in the camp to prevent diseases. They have provided us with important information on how to prevent cholera, especially about cleanliness. They told us we should always wash our hands with soap and water, keep our homes clean, and not leave trash outside where flies could spread disease.

Diseases are everywhere, and people must take precautions to protect themselves. When I return home, I will take care of my children’s health so they don’t get sick again. I will also try to protect my own health and that of my husband.