VZCZCXRO9343
PP RUEHROV
DE RUEHKH #0741/01 0821424
ZNR UUUUU ZZH
P 231424Z MAR 06
FM AMEMBASSY KHARTOUM
TO RUEHC/SECSTATE WASHDC PRIORITY 2017
INFO RUCNIAD/IGAD COLLECTIVE

UNCLAS SECTION 01 OF 02 KHARTOUM 000741 
 
SIPDIS 
 
AIDAC 
SIPDIS 
 
STATE FOR AF/SPG, PRM, AND ALSO PASS USAID/W 
USAID FOR DCHA SUDAN TEAM, AF/EA, DCHA 
NAIROBI FOR USAID/DCHA/OFDA, USAID/REDSO, AND FAS 
USMISSION UN ROME 
GENEVA FOR NKYLOH 
NAIROBI FOR SFO 
NSC FOR JMELINE, TSHORTLEY 
USUN FOR TMALY 
BRUSSELS FOR PLERNER 
 
E.O. 12958:  N/A 
TAGS: EAID PREF PGOV PHUM SOCI KAWC SU
SUBJECT:  ACUTE WATERY DIARRHEA OUTBREAK - EARLY RAINS 
INCREASE RISKS IN SOUTHERN SUDAN 
 
REF:  a) Khartoum 0478,  b) Khartoum 0700 
 
------------------- 
Summary and Comment 
------------------- 
 
¶1.  The outbreak of acute watery diarrhea (AWD) continues 
in Southern Sudan.  The U.N. World Health Organization 
(WHO) has confirmed that the AWD outbreak derived from a 
single strain of cholera.  WHO reported that between 
January 28 and March 22, 8,684 cases of AWD including 231 
deaths had been reported throughout Southern Sudan. 
According to WHO, although the illness originally spread 
by road north and east of Juba, AWD cases are now being 
reported in Ikotos along the southern road from Juba to 
Uganda.  On March 14, the Government of Southern Sudan 
(GoSS) Under Secretary of Health announced that the AWD 
outbreak in Yei had ended.  WHO reported that as of March 
19, 1,807 cases including 53 deaths had been reported in 
Yei and 4,523 cases including 87 deaths had been reported 
in Juba.  Local health facilities report that the number 
of cases has been steadily declining in these cities, but 
new cases are being reported along major routes and in 
villages surrounding major towns throughout Southern 
Sudan.  At least 1,651 new cases of AWD including 64 
deaths had been reported in other areas of Southern Sudan 
as of mid-March. 
 
¶2.  The onset of early rains in Juba and other parts of 
central Equatoria has increased the risk of renewed 
outbreaks in the area, especially in Juba and Yei, where 
conditions are crowded, sanitation is poor, and many 
shelters are flimsy and temporary.  End summary and 
comment. 
 
----------------- 
The Spread of AWD 
----------------- 
 
¶3.  Although the number of cases of AWD appears to have 
declined in Yei and Juba towns in recent weeks, 
increasing reports of new cases of AWD from areas outside 
of Juba pose a serious challenge to the ongoing response 
efforts.  New cases of AWD have now been reported at 
health facilities throughout the south: 300 kilometers 
(km) northeast of Juba in Pibor and surrounding villages 
of Jonglei State; 250 km south of Juba in Kajo-Keji; 
along a 200-km route north of Juba in Terekeka, Padak, 
Bor, and villages west of Bor; 150 km northwest of Juba 
along the route to Mundri in Rokon and Tijor villages; 
500 km west of Yei in the villages surrounding Yambio; 
and 800 km north of Juba in Malakal and Nyilwak in Upper 
Nile State.  WHO and USAID partner Adventist Development 
and Relief Agency (ADRA) reported that barge passengers 
have carried the illness north in at least once instance. 
 
¶4.  Of particular concern are reports from Lohutok 
outside Torit town, where more than 700 cases have been 
reported recently by the non-governmental organization 
(NGO) Medecins sans Frontieres.  In Malakal the number of 
new cases has been increasing daily, reaching 80 cases as 
of March 10, with unconfirmed reports of many more since 
then.  During the past three weeks, 363 cases including 
18 deaths were reported in Torit town, 137 cases 
including 3 deaths were reported in the Pibor area, and 
109 cases including 10 deaths were reported in Bor, where 
all cases are believed to be linked to Juba's Lologo 
internally displaced person (IDP) camp. 
 
¶5.  In Yei the number of cases of AWD peaked between 
February 1 and 7, just as the outbreak was beginning in 
Juba.  The number of cases peaked in Juba at an alarming 
2,400 cases approximately two weeks later, at the same 
time reports started arriving of the spread of AWD cases 
to other areas of Southern Sudan.  In week 10 of the 
outbreak, reports indicated a steady increase in the 
number of cases outside Juba and Yei. 
 
¶6.  Response efforts continue (Ref B) and include 
coordination, surveillance, case management, and 
environmental control measures on the part of the GoSS 
 
KHARTOUM 00000741  002 OF 002 
 
 
Ministry of Health (MOH), the U.N. Children's Fund, WHO, 
and NGO partners.  Nevertheless, the spread of the 
illness has been quick and has posed a challenge for 
agencies on the ground in terms of both treatment and 
containment. 
 
---------------------------------------- 
Early Onset of Rains and Lologo IDP Camp 
---------------------------------------- 
 
¶7.  Three torrential rainstorms swamped Juba between 
March 7 and March 12, nearly a month earlier than 
expected.  Health professionals are concerned that the 
early onset of heavy rains may lead to a resurgence of 
new cases in Juba.  Many households in Juba do not have 
access to latrines, and the combination of heavy rain, 
surface defecation, and AWD could yield a wave of new 
cases.  Population movements throughout the south 
compound the risk. 
 
¶8.  Lologo camp on the outskirts of Juba hosts 
approximately 3,000 IDPs, mostly Bor Dinka, living in 
temporary shelters of plastic sheeting suspended on 
makeshift wooden frames.  USAID staff visited the camp 
the morning of March 13, after heavy rains drenched the 
area.  The shelters were completely inundated and 
families had spent the night sleeping in mud.  All 
household belongings, including food rations, were 
soaked, and women reported fevers and coughs among the 
children.  The camp was a quagmire, with large pools of 
standing water all around, providing excellent breeding 
grounds for disease and mosquitoes.  On March 17, the 
U.N. Children's Fund (UNICEF) reported that the rains had 
destroyed some of the camp's shelters, although the exact 
number was unknown. 
 
¶9.  Although health workers at the Lologo clinic reported 
that cases of AWD had declined in the camp during the 
previous week, they were concerned that cases could spike 
again with the early rains.  Through a U.N. program, 
Lologo IDPs were scheduled to be returned to Bor by barge 
the end of the dry season, but transportation was halted 
after the AWD outbreak began in Yei and Juba.  No IDPs 
have returned to Bor since early February.  Now with the 
early rains, the potential for a renewed AWD outbreak, 
and the possibility of spreading additional illnesses 
such as as typhoid and meningitis, it is probable that 
these IDPs will be stranded in Lologo camp until the next 
dry season. 
 
¶10.  As most men have moved ahead to Bor with their 
cattle, Lologo camp residents are predominantly women, 
children, and the elderly.  These populations are most 
vulnerable to diseases that spike during the rainy 
season.  Currently one camp health center, run by USAID 
partner ADRA, sees more than 120 patients daily.  The 
camp has only one borehole.  The only other water 
available in the camp is Nile River water trucked in and 
stored in bladders. 
 
¶11.  A joint U.N., MOH, and NGO coordination group for 
Lologo has discussed relocating IDPs from Lologo to 
another camp near Juba, but these plans have stalled. 
Although there is tremendous political pressure against 
making any permanent additions or interventions in 
Lologo, without more concerted attention to shelter and 
hygiene conditions, the IDPs will face extreme hardship 
and deplorable conditions this rainy season. 
 
-------------------- 
USAID Recommendation 
-------------------- 
 
¶12.  USAID will continue to monitor closely the situation 
at Lologo camp through USAID partners in Juba, especially 
with regard to plans to move Lologo IDPs to another camp. 
If the situation deteriorates or the IDPs do not move, 
USAID is prepared to respond quickly through partners in 
Juba. 
 
STEINFELD