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A new low: spread of cholera plagues famine-affected regions

Scores of children dying from preventable and curable waterborne disease

  • Scarcity of clean drinking water and poor sanitation in areas of mass displacement and crowding led to a dramatic increase in cases of the waterborne disease
  • Since early 2017, 130,000 + cases of acute watery diarrhea (AWD) and cholera, and 2,100 + related deaths across South Sudan, Somalia, Kenya, Ethiopia and Yemen
  • Situation likely to worsen with rainy season
  • Malnourished children more susceptible to cholera and five times more likely to die from disease
  • Health systems fragmented by conflict and challenges in delivering aid contributed to a high death toll
  • IRC scaling up response across the region and calling for international community to step-up support to avoid worst-case scenario

Widespread drought, food insecurity, and conflict across East Africa and Yemen have now directly resulted in a massive and deadly cholera and acute watery diarrhea (AWD) outbreak, putting millions of children at even more immediate risk, the International Rescue Committee (IRC) said today. Immediate action is required to address it before more lives are lost unnecessarily from this highly contagious disease. The number of cases has rapidly increased in May 2017 alone – more than doubling in Yemen and almost doubling in South Sudan. There are now more than 130,000 cases of acute watery diarrhea and cholera, resulting in over 2,100 deaths across South Sudan, Somalia, Kenya, Ethiopia, and Yemen.

Cholera is caused by ingesting contaminated water or food – something that can be hard to avoid in times of drought or over-crowding. Across East Africa and Yemen, millions of people have been displaced from their homes by hunger or violence, with many living in camps and makeshift settlements that do not meet basic sanitation needs. The disease can spread quickly where groups of people gather without access to basic services such as safe water, latrines, washing facilities and rubbish disposal.

“Famines are complicated – and malnourished children are five times more likely to die from disease,” said Michelle Gayer, emergency health director at the International Rescue Committee. “Refugees are being driven from their homes and are arriving to temporary settlements en masse, creating perfect conditions for the disease to spread. Cholera will come to kick you while you are down, and can spread to disastrous levels if not addressed immediately. With inadequate humanitarian funding, aid agencies are not able to build up and deliver services quickly enough to address food insecurity and the cholera outbreak. This is a recipe for disaster.”

The main symptom of cholera is a sudden onset of acute watery diarrhea (AWD) – this can lead to death within hours unless lost fluids are replaced quickly. Cholera has the greatest impact on the most vulnerable such as children already suffering from malnutrition. There are currently around one million malnourished children across the region, described by the UN as the “largest humanitarian crisis since 1945.”

water kenya cholera refugees

South Sudanese refugees get water at an IRC-operated pump in Kakuma camp, Kenya

Photo: Juliette Delay/IRC

Cholera can be easily treated with urgent medical intervention, and prevented with water, sanitation and hygiene (WASH) services and vaccinations. But in places like South Sudan, Somalia and Yemen, ongoing conflict has interrupted the health care provision at a time when services are needed more than ever.

The IRC is scaling up an integrated cholera and AWD response across the region, poised to work on prevention through distributing an oral cholera vaccine in South Sudan; improving water and sanitation in Yemen, Somalia, and Ethiopia; sending medical supplies and training health staff at cholera treatment centers (CTC) in Yemen, South Sudan and northern Kenya; and educating communities on prevention of the disease.

refugees cholera treatment

Sarah*, a young girl, is treated for cholera at the IRC's Cholera Treatment Center (CTC) in Kakuma Refugee Camp in northern Kenya. She fled with her family from South Sudan and arrived at the Kakuma Reception Center. Her uncle, who has been living in Kakuma since 2000, brought her to the CTC after she fell ill. Her family remains at the reception center waiting to be resettled in nearby Kalobeyei Settlement. Kakuma and Kalobeyei are experiencing an influx of refugees from South Sudan. The influx has led to a cholera outbreak which the IRC is working to treat and control.​

Photo: Kellie Ryan/IRC
  • At Nadapal, the border crossing point from South Sudan into Kenya, double the usual number of South Sudanese asylum seekers are arriving every week from cholera infected areas of the country. Agencies like the IRC are responding with more medical staff to treat the disease, but more funding is needed to scale up this response and for aid agencies to prevent or respond adequately to the worsening outbreak in the camp. Sarah (not her real name), who had just crossed the border from war-ravaged South Sudan with her family on May 25, arrived at the IRC’s CTC with her uncle the next day to be treated for cholera while the rest of her family was waiting to be resettled in the new camp near Kalobeyei.
  • The cholera outbreak is most staggering in Yemen, where 49,495 cases have been diagnosed between 27 April - 24 May in 19 governorates. During this time 420 deaths have been reported, with over 2,000 new cases reported daily. This is the direct consequence of the poor healthcare system as a result of the prolonged conflict in the country. In response to the spiraling outbreak, the IRC is scaling up and adapting its response, supporting diarrhea treatment centers (DTCs) and health facilities with required drugs and medical supplies for treatment, training of health staff, and the provision of laboratory supplies in Qa’ataba, Al-Husha, Damt, Al-Shuaib, and Al Azariq of Al Dhale’e governorate, aiming to treat 2,427 people in the next three months. With more support, the IRC could expand to other governorates to save even more lives.
  • In Central-South Somalia, water scarcity due to drought has led to an increase in AWD and cholera cases, particularly in Guriel, Gaalkacyo south, and Dhusamareeb. IRC mobile outreach teams are going to villages and working in the communities every day, providing integrated health and nutrition services and operating 24-hour health and ambulance services. Severe cases are admitted for rehydration and close observation. Mohamed was one of them. A 28-month old baby from Billicad Village, located 60 kilometers north of Dusamareeb, he was brought to the IRC-supported Hanaan hospital with his mother by ambulance. His mother explained that Mohamed had been having bouts of diarrhea and vomiting for the last four days. On examination he was lethargic, had sunken eyes, dry mouth and tongue. He was diagnosed with severe dehydration due to AWD/cholera. Mohamed was immediately admitted for rehydration and close observation. After one day, Mohammed had improved and was discharged to continue treatment at home.
  • Ethiopia, still recovering from the El Niño driven drought, is experiencing below average rains in the southern and eastern parts of the country, leading to a new drought and resulting in a second wave of Acute Watery Diarrhea (AWD). Between January and May 2017 alone, acute water shortages and population movements in search of water have led to more than 33,000 cases with 776 deaths. The IRC’s work on AWD includes a multi-pronged approach that involves training and assisting health and lab workers, planning for mobile health teams and clinical care, as well as supporting community engagement and assistance with home water purification.
refugees cholera Kenya

South Sudanese refugees await treatment at an IRC-led hospital in Kakuma, Kenya

Photo: Juliette Delay/IRC

“As if fleeing from war and hunger wasn’t enough - kids are dying through no fault of their own,” said Gayer. “As the rainy season is upon us, we cannot sit here idle and watch this crisis take yet another horrific turn. It is our collective responsibility to do everything to stop this outbreak in its tracks.”

Note to editors: View IRC photos of the cholera outbreak in Kakuma.

Learn more more about the IRC’s work responding to the drought and famine crisis across Africa and Yemen.

About the IRC

The International Rescue Committee responds to the world’s worst humanitarian crises, helping to restore health, safety, education, economic wellbeing, and power to people devastated by conflict and disaster. Founded in 1933 at the call of Albert Einstein, the IRC is at work in over 40 countries and 28 offices across the U.S. helping people to survive, reclaim control of their future, and strengthen their communities. Learn more at www.rescue.org and follow the IRC on Twitter & Facebook.