Over 1 billion in 43 nations at risk amid cholera outbreaks, WHO says

A global surge of cholera cases has put one billion people in 43 countries at risk, the World Health Organization (WHO) cautioned this week.

Three countries, this week alone, have reported outbreaks, WHOcholera team leader Philippe Barboza told reporters at a press conference on Friday.

For the first time, WHO is asking donors for help to fight the outbreaks, he said.

Right now, 22 countries across the world are fighting outbreaks of the acute diarrhoeal infection caused by eating or drinking contaminated food or water. Cholera cases climbed in 2022, following years of falling numbers of cases, and the trend is expected to continue into this year, he said.

He said cases have been reported in five of the six regions where WHO operates. The latest WHO global overview published in early February showed the situation has further deteriorated since 2022.

Poverty, disasters, conflict and climate change consequences continue to be driving factors alongside a lack of access to safe water and sanitation, Dr. Barboza said.

Limited vaccine supplies

“An unprecedented situation requires an unprecedented response,” he said, drawing attention to the limited availability of vaccines, medicines, and testing kits.

Only 37 million doses are available in 2023, he said. More doses are expected to be available by next year.

As a result of the current global surge, WHO is, for the first time ever, appealing to donors to support a $25 million fund to help to address cholera outbreaks and save lives, he said.

Prevention is key, he said, noting that nearly half of the world lacks access to safely managed sanitation.

“Access to safe drinking water and sanitation are internationally recognized human rights,” he said. “Making these rights a reality will also end cholera.”

Outbreak in Africa

An exponential rise in the number of cholera cases in Africa includes an outbreak in Mozambique, which is also grappling with severe storms brought on by cyclone Freddy. The first case of cholera in the current outbreak was reported to the Ministry of Health and WHO from Lago district in Niassa province in September.

As of 19 February, Mozambique reported a cumulative total of 5,237 suspected cases and 37 deaths. All six cholera-affected provinces are flood-prone areas, and WHO anticipates that more will be affected as the rainy season continues.

Considering the frequency of cross-border movement and the history of cross-border spread of cholera during this outbreak, WHO considers the risk of further disease spread as very high at national and regional levels.

An estimated 26,000 cases and 660 deaths have been reported as of 29 January 2023 in 10 African countries facing outbreaks since the beginning of the year, WHO said. In 2022, nearly 80,000 cases and 1,863 deaths were recorded from 15 affected countries.

Multiple countries affected

Neighbouring Malawi is facing the deadliest cholera outbreak in two decades, and cases are being reported in other countries, including Ethiopia, Kenya and Somalia, WHO reported.

The UN health agency said challenges include climate change, which has led to drought or flooding in parts of Africa, resulting in increased population displacement and reduced access to clean water.

Worldwide, people in Haiti, India, Pakistan, the Philippines and Syria, among others, are also affected by outbreaks.

Global threat

Cholera remains a global threat to public health, WHO said. In 2017, affected countries, donors, and partners of the Global Task Force on Cholera Control launched a renewed global cholera control strategy, Ending Cholera: A Global Roadmap to 2030. It aims at reducing cholera deaths by 90 per cent over the next decade.

While the number of cases had been declining, WHO remains concerned about the current surge. Researchers estimate that every year, there are between 1.3 and 4 million cases and 21,000 to 143,000 deaths worldwide due to the infection.

Source: UN News Service

Sudan: Humanitarian Key Messages (February 2023)

Humanitarian needs across Sudan are at an all-time high. Following the October 2021 military coup, uncertainty remains as to how the democratic transition that began in 2019 may evolve. The signing of a political framework agreement on 5 December 2022 brings hope for a political settlement though it is not yet clear how it will impact the humanitarian situation throughout the country. For 2023, the four most significant risks identified are conflict, disasters associated with natural hazards, disease outbreaks, and economic deterioration. Urgent action is required for vulnerable people and affected communities to access lifesaving humanitarian assistance and further build their resilience.

KEY MESSAGES

Conflict, disasters associated with climate shocks, disease outbreaks, and economic deterioration continue to affect Sudan, and against these risks, humanitarian needs continue to grow. About 15.8 million people – roughly a third of the population – will need humanitarian assistance in 2023. This increase of 1.5 million people compared to 2022 is the highest since 2011.

Humanitarian partners have appealed for more than US$1.7 billion to provide humanitarian assistance and protection to 12.5 million of the most vulnerable people in Sudan in 2023, with an additional $500 million for resilience activities. The 2023 Humanitarian Response Plan (HRP) will provide humanitarian assistance and support to the most vulnerable people in Sudan – IDPs, people who have recently returned to their places of origin, refugees and other vulnerable groups. This plan, a collective effort of all humanitarian actors and stakeholders in the country, will address the specific needs of women, children, the disabled, and other vulnerable groups.

Through the 2023 HRP, 92 humanitarian partners plan to reach 12.5 million people in need of assistance through 254 projects: HRP partners plan to provide timely, multi-cluster, life-saving assistance to people affected by crisis to reduce mortality and morbidity; mitigate protection risks and respond to protection needs through humanitarian action; improve vulnerable people’s access to livelihoods and life-sustaining basic services; and support the implementation of resilience solutions to reduce the drivers of the needs.

Vulnerable populations need long-term solutions that build their resilience to shocks: Despite substantial investment in humanitarian response over many years, Sudan continues to face the same challenges year after year, with limited progress on key development outcomes. Sudan’s humanitarian response needs to be able to respond with agility to emergencies, while maintaining a long-term vision to create sustainable solutions.

Sudden-onset disasters (conflict, flood, and disease outbreaks) affect hundreds of thousands of people in Sudan every year. The number of food-insecure people in 2022 increased by about 2 million compared to last year, to a staggering 11.7 million during the lean season. In 2022, about 314,000 people were newly displaced due to conflict and violence. Additionally, over 990 people were reported killed and almost 1,200 injured. The majority of the displaced are from Blue Nile (127,961), West Darfur (93,779), South Darfur (33,976) West Kordofan (31,089) and North Darfur (14,733). Large attacks against civilians led to the burning of hundreds of villages and the destruction of means of livelihood. Overall, 370 security incidents (due to localised conflict and armed attacks) were reported across the country in 2022. Floods affected about 349,000 people and the economy took further turns for the worse.

For a third year in a row, conflict continued to displace an increasing number of people. There are 3.7 million internally displaced people (IDPs) in Sudan, of which 2.2 have been displaced for one or two decades. Amidst growing insecurity and political instability, the roots cause of displacement and conflict, such as the issue of land and resources, and access to justice are yet to be addressed. Civilian displacement as well as the number of people who need assistance is likely to increase further if roots causes are not dealt with. Of the people in need, 50 per cent are concentrated in areas affected by conflict and are therefore at risk of being displaced again.

The food security situation is deteriorating further. The number of acutely food insecure people continued to increase for the third year in a row, reaching a record 11.7 million people in the Integrated Food Security Phase Classification (IPC) Phase 3 and above between June-September 2022 due to dry spells, conflict, reduced grain production, high prices and eroding livelihoods due to the multi-year economic crisis and protracted displacement. According to the latest IPC report on the status of food security in Sudan, more than half of the acutely food insecure people in the country (53 per cent) are in central, eastern and northern Sudan. While food insecurity has continued to deteriorate in areas not usually targeted for humanitarian assistance, the ability of humanitarian partners to respond was restricted by a lack of funds for these specific areas and, in some cases, for eastern Sudan.

Rates of malnutrition are increasing across Sudan at a concerning rate, especially among children. About 4 million children under five and pregnant and lactating women (PLW) are estimated to be acutely malnourished and need humanitarian lifesaving nutrition services in 2023, of these 611,000 are facing severe acute malnutrition (SAM). With global acute malnutrition (GAM) prevalence of 13.6 per cent, Sudan is among the countries with the highest levels in the world and these elevated levels persisted for the last decade. The 2022 SMART surveys implemented in eight localities depicted mixed results, with half recording significant deterioration compared to 2018. Overall, 64 localities in nine states have GAM prevalence equal to and above WHO’s very high prevalence of 15 per cent. The malnutrition situation is exacerbated by multiple factors, including inadequate dietary intake, high prevalence of disease, inadequate care and feeding practices and sub-optimal health and WASH services. The deteriorating economy, inflation, high food prices (see food security section above), and displacement contributed to the worsening of the nutrition situation in 2022 and are likely to continue into 2023.

The health situation in Sudan continues to be dire. To reach the nearest medical institution, 30 percent of the population must walk for more than an hour. Sudan cannot maintain an adequate supply of medicines and medical supplies because of the economic crisis. A survey to evaluate the availability of medications in 2022 found that, on average, only 31 per cent of critical medications were available in public facilities and 30 per cent in the private sector. This is a significant decline from the previous year (43 per cent availability in 2021). That number rose to 51 per cent in facilities supported by humanitarian actors. In combination with water collecting in debris left after flood events, vector-borne diseases such as malaria, dengue and chikungunya have increased. With communities increasingly exposed to risks, Sudan is considered a high burden and high-risk country for vector-borne diseases. The reported malaria cases in late 2022 crossed the epidemic threshold in 14 states, with more than a two-fold increase compared to 2021. Meanwhile, 147 suspected cases of Mpox were reported by 29 September in 12 states, and 17 cases were confirmed, including the death of a 27-day-old baby. Outbreaks of polio and measles further threaten the health and safety of people in Sudan and require urgent attention.

Lack of access to water. About 25.3 per cent of households in Sudan reported that water points were not functioning in their location. Another 28.4 per cent of the population reported that the water quantity is insufficient to meet their basic needs, and approximately 26 per cent of the people reported that it takes more than 50 minutes to fetch water, exposing them to security risks, especially for women and girls. Moreover, 46 per cent of schools do not have access to sufficient drinking water services and 71 per cent of schools reported not having any handwashing facilities.

About 72 per cent of the population does not have access to basic sanitation facilities, which are not shared with other households. Sudan has the highest ratio of people practising open defecation in the Middle East and North Africa region, posing grave public health risks to the transmission of diseases such as cholera, diarrhoea, dysentery, hepatitis A, typhoid, and polio. Open defecation is an indicator of other problems such as poverty and malnutrition. The situation is particularly alarming in gathering sites and displacement camps, where WASH infrastructure is often dilapidated and largely insufficient.

Approximately 4.1 million people need better access to protection services. People affected by conflict, IDPs, vulnerable residents, returnees, and refugees are highly vulnerable and face various protection challenges. In 2022, many IDPs were displaced multiple times; they were often traumatised, physically abused, injured, or lost family members, personal belongings, shelters, villages and access to land, water points and firewood collection. The majority of them reside in temporary gathering sites. Due to security concerns, they often cannot return to their places of origin or places of previous displacement.

GBV remains a grave concern in Sudan. The MSNA shows that more than half of the respondents are not aware of support services for women and almost 80 per cent have heard about cases of violence against women or girls. This is also confirmed in the findings from “The Voices from Sudan” report, where 19 per cent of respondents in the study perceived domestic violence and sexual violence as the most common GBV incident in their community.

It is estimated that 6.9 million children 6-18 years old are out of school, which is 35 per cent of the total school-aged population. Of the 12.4 million children who can attend school, their learning is severely hampered and disrupted by poor school infrastructure, teacher strikes, and a lack of teaching and learning materials. About 70 per cent of 10-year-olds cannot read and understand a simple sentence. The situation for refugees is particularly concerning: 70 per cent of primary-school-age and 90 per cent of secondary-school-age refugees are out of school.

The most common factors preventing children from fulfilling their right to education include financial barriers, such as school-related fees and negative economic coping mechanisms, child labour or child marriage. Other factors include long distances to school in areas without affordable transportation options or without fuel for transport and an insufficient number of schools to accommodate all children, particularly in areas affected by conflict (most notably in the Darfur and Kordofan regions) where many schools have been damaged.

The current economic and political situation continues to hamper humanitarian operations, negatively impacting people’s access to essential services and impeding the delivery of assistance. Humanitarian partners are also experiencing increasing bureaucratic and administrative impediments, delaying the importation of food assistance, nutrition commodities, medical supplies and other relief items. These impediments are limiting principled access to populations in need and ultimately delaying the delivery of assistance. Access to affected people in need is also increasingly challenging due to recurrent fighting. Incidents of armed attacks and looting continue to increase across states, especially in Darfur limiting movement. Security remains a major concern for the affected population and humanitarian partners operating on the ground.

Almost 1 million refugees in Sudan will need humanitarian assistance in 2023. The UN Refugee Agency (UNHCR) estimates that the number of refugees in Sudan will be reduced from 1.14 million in 2022 to 926,000 refugees in 2023 as a result of an ongoing verification process. However, this still will be Africa’s second-largest refugee population. The majority of them (67 per cent) are from South Sudan. Khartoum and White Nile states host about 60 per cent of all South Sudanese refugees in the country, with Khartoum having the highest number amongst all states. At the same time Khartoum has one of the highest food-insecure urban populations in the country, with refugees and the urban poor affected the most.

Sudan has been doubly vulnerable to climate change and environmental deterioration. According to the latest submitted Nationally Determined Contributions (NDC) document, over the past three decades, climate change has led to crop failures, deterioration of natural rangelands, an increase in seasonal fires, and livestock deaths due to increasing temperature trends and poor management of natural resources. Such impacts are deepening already profound poverty levels across Sudan and hindering humanitarian operations. Flash floods have led to contamination of water supplies and increased cases of diarrhoea and cholera. Vector breeding zones have expanded in terms of coverage and intensity due to changes in precipitation and exposure-time linked to changes in seasonal patterns.

Source: UN Office for the Coordination of Humanitarian Affairs