Humanitarian Health Action

South Sudan conflict-related crisis - Health situation report no. 7 - 15 December 2009


  • 107 new Kala azar patients were confirmed and admitted to health facilities in Malakal, Lankien, Old Fangak, Pieri and Ayod in week 49 (30 Nov-6 Dec).
  • WHO and the Ministry of Health of the Government of Southern Sudan (MoH/GoSS) have donated additional Kala azar drugs and diagnostic tests.
  • A workshop on the case management and diagnosis of Kala azar was conducted in Malakal.
  • Two training workshops on community case management during an influenza pandemic were conducted in Juba.
  • More than 9000 cases of suspected malaria cases with 13 deaths were reported in week 49.
  • The number of acute watery diarrhoea cases increased to 1987 in week 49.


  • 107 new Kala azar patients were confirmed and admitted to health facilities in Malakal, Lankien, Old Fangak, Pieri and Ayod in week 49.
  • A total of 9532 cases of suspected malaria and 13 deaths (mostly children) were reported in week 49, with most cases and deaths reported from Lakes State and Central Equatoria State (CES).
  • Acute watery diarrhoea (AWD) cases increased substantially in week 49 and are up to 1987 (the highest level since week 40) from 1075 reported in week 48. Most of the cases reported were from Lakes, Warrap, Upper Nile and Unity States.
  • In week 49, one suspected case of acute jaundice syndrome (AJS) was reported in Yei county, CES.
  • In week 49, four suspected measles cases were reported from Nzara county, Western Equatoria State and Kajo Keji & Yei counties of CES. Since SitRep 1 (2 Sep, 2009), 65 suspected cases have been reported across Southern Sudan.


  • Médecins sans Frontières (MSF)-Spain is providing mobile health services in some rural areas in Nzara and Yambio in Western Equatoria State (WES). It has also launched a mobile clinic to service IDP areas in Yambio and three surrounding villages where IDPs have been unable to access medical services. It continues to support Yambio Hospital's operating theatre and paediatric ward as well as Naandi Primary Health Care Centre (PHCC) in Ezo county. MSF-Spain focuses on training medical staff and providing medicines and supplies.
  • Médecins sans Frontières (MSF)-Spain completed a two day mission to Ezo and has documented equipment needs in the Ezo PHCC. The PHC unit in the refugee camp has been resupplied but needs more equipment and facilities.
  • World Vision (WV) has completed the construction of one health post in Napere camp. Five staff have been identified (three refugees and two Sudanese nationals) to provide health care in the settlement. WV is now furnishing the health post, which will start operations soon. Health post staff will review and treat minor cases and refer serious/complicated cases to Ezo PHCC, where drugs have already been pre-positioned by the State Ministry of health (SMoH).
  • A total of 107 new Kala azar cases were admitted to Malakal, Lankien, Old Fangak, Pieri and Ayod treatment centres. One death was reported in week 49. Of these new cases, 50% are in children under five, 33% are in children between five and 17 and 15% are in adults (see Kala azar map below).
  • International Organization for Migration (IOM) conducted a water, sanitation and hygiene (WASH) assessment in the IDP and refugee camp in Ezo town and identified five boreholes and 100 pit latrines to be constructed. IOM also conducted training on the emergency water kit.
  • MSF-Holland together with SMoH is supporting the establishment of new Kala azar treatment centers in Pegil, Khorfulus and Atar. United Nations Children's Fund (UNICEF) donated over 50 cartons of ready-to-use therapeutic food for children with severe acute malnutrition in Kala azar treatment centre in Old Fangak. Kala azar patients in Old Fangak and elsewhere still need additional food supplements in order to reach minimum daily calorie intakes.
  • The SMoH of Unity State and Medair (the emergency response team) have completed a measles outbreak assessment in Mayom and Guit payams of Unity State. No new cases of measles were found: an emergency measles vaccination campaign will not be conducted.


Communicable diseases
  • WHO continues to support disease surveillance activities (support supervision, on-job training, assist in data collection, analysis, and dissemination) in all counties in Jonglei, Upper Nile and Western Equatoria States.
  • In response to the increased number of AWD cases, WHO provided technical support to the rapid response team (RRT) investigating and collecting stool samples for laboratory testing. WHO will also send cholera rapid tests to some health facilities for on-site investigation.
Trainings & Meetings
  • In response to the Kala azar outbreak in Upper Nile and Jonglei States, WHO and MoH/GoSS conducted a workshop on the case management and diagnosis of Kala azar from 7-11 December 2009 in Malakal. A total of 26 participants from counties across Upper Nile, Unity & Jonglei States attended the workshop. Training for this group of health cadres emphasized epidemiology & community surveillance, clinical management, treatment & rapid test techniques, and demonstrations. A follow-up workshop on laboratory diagnosis and techniques is scheduled from 14-18 December 2009.
  • WHO conducted two training-of-trainers workshops on community case management during an influenza pandemic on (3 – 5 Dec and 7 – 9 Dec in Juba). A total of 37 clinical officers and nurses were trained on the following modules:
    • Pandemic influenza and its implications for communities;
    • Key messages for the prevention and control of pandemic influenza at the community level;
    • Home based care: how to manage patients with influenza-like illnesses;
    • Assessment and treatment of diseases in the community;
    • Community health education for pandemic influenza;
    • Protection of the community health worker;
    • A framework for monitoring and reporting of pandemic influenza preparedness and response activities.
  • The second annual review and consultation meeting on the Integrated Disease Surveillance and Response (IDSR) system was held in Juba from 23 to 24 November 2009. This meeting was organized and facilitated by WHO in close collaboration with MoH/GoSS and partners. Its objectives were to 1) review the status and performance level of IDSR system in Southern Sudan, 2) explore ways to integrate all vertical surveillance programmes with the aim of improving the effectiveness of the central surveillance system, and 3) develop a three-year plan of action. In the end, following recommendations were made:
    • Completion of IDSR trainings in all counties and payams in order to enhance surveillance;
    • Recruitment of state and county surveillance officers by SMoH;
    • GoSS and state governments to consider allocation of emergency funds to the SMoH and counties to support outbreak investigation and response;
    • GoSS/state Governments and partners to provide the counties with transport and communication means;
    • Strengthen communication and feedback from GoSS down to the counties, payams, community and vice versa;
    • States to strengthen the County Health Teams (CHT) and encourage monthly meetings;
    • GoSS to preposition supplies in the state, county and satellite PHCCs;
    • Strengthen supportive supervision at all levels (GOSS > State > County > Payam).


  • 2 Interagency emergency health kits (IEHKs) and 3 trauma kits are urgently needed.
  • According to MSF-Spain, the Ezo PHC unit inside the refugee camp and the Naandi PHCC both need medical supplies and equipment.
  • The PHCCs in Lainya and Bereka need more medical supplies.
  • According to WV, the Andrea and Baragu PHCUs need support in terms of staffing, staff capacity building, drugs and medical equipment.
  • Health providers in Upper Nile and Jonglei States need to be trained on the diagnosis and management of Kala azar.
  • Health service providers need refresher training on the case management of epidemic-prone diseases.
  • MSF-Spain reported the need to train medical staff at the Naandi PHCC.
Access to care and treatments
  • Referral hospital capacity needs to be improved. Most state referral hospitals do not have the capacity to treat wounded patients. These patients are referred to the Juba Teaching Hospital, which has its own limitations in terms of supplies and treatment. An ambulance is urgently needed for referral services of patients to nearby hospitals in Nzara County, Western Equatoria State (WES). The Ezo PHCC, which is supported by MSF-Spain, urgently needs an ambulance to transport patients referred to other facilities.
  • International Organization for Migration (IOM) reported gaps in referring HIV/AIDS patients to the nearest hospital in Ezo town, which is 100 km away. HIV-positive individuals living in refugee and IDP camps need improved access to antiretroviral therapy.
Preventive activities
  • Follow-up measles and tetanus campaigns are needed to mitigate possible outbreaks in North Bahr El Gazal and Unity States.
  • Immunization campaigns in all IDP and refugee camps in Jonglei and WES should be supported and organized if and when security improves.
Situation monitoring and coordination
  • Disease surveillance for common communicable diseases needs to be strengthened.
For further information please contact:

Dr Abdi Aden Mohamed
Head of Office
WHO Southern Sudan Office
Tel: + (249) 927 361 440

Dr Irshad Shaikh
Emergency Preparedness and Humanitarian Action
WHO Regional Office for the Eastern Mediterranean
Tel : +20 2 2276 5525
Mobile: +20 1 0173 3924

Mr Jukka Sailas
External Relations
Health Action in Crises
WHO Geneva

Mr Paul Garwood
Communications Officer
Health Action in Crises
WHO Geneva
Tel: +41 22 791 3462
Mobile: +41 79 475 5546

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