Sudan Bulletin No. 40
15 March 2006

Cholera outbreak in southern Sudan
In response to the recent cholera outbreak in southern Sudan, the ICRC has airlifted some 30 tonnes of emergency medical supplies to the main town of Juba. These include infusions and oral rehydration salts urgently needed to treat the sick and to replenish fast-dwindling stocks.

The first cases of cholera were reported at the end of January in Yei, a town southwest of Juba. The first case in Juba itself was reported on 6 February. ICRC staff are helping Juba Teaching Hospital to run and expand an isolation ward and have installed an emergency water-supply system. The hospital has been admitting some 20 victims of acute watery diarrhoea per day. Other victims have received care elsewhere. As of 7 March, the total number of cases of acute watery diarrhoea reported in Juba was 4,094 and the number of resulting deaths 79. The World Health Organization puts the overall death toll in southern Sudan at 127.

At the time of writing, cholera had been confirmed in Malakal, a major urban centre on the banks of the Nile to the north of Juba. Thirty-four cases had been admitted to the Médecins Sans Frontières cholera-treatment centre in Malakal, with two deaths recorded. At the Malakal Teaching Hospital, the ICRC thoroughly serviced and purged the main water-treatment plant, installed a back-up generator and a 15,000-litre water bladder for additional capacity. ICRC staff have given the MSF centre technical advice on the layout of latrines and water-distribution points and have helped install a water bladder provided by UNICEF.

The ICRC is coordinating its efforts with the southern Sudanese health authorities and is liaising with other relevant humanitarian agencies in order to prevent the disease from spreading throughout southern Sudan. To better support the tireless work of the Sudanese Red Crescent and its volunteers, the International Federation of Red Cross and Red Crescent Societies has launched an appeal for one million Swiss francs and has opened office in Juba.

The long years of war in southern Sudan have damaged or destroyed water and sewage infrastructure in Juba town, including the Juba Teaching Hospital. And all of southern Sudan lacks adequate health-care facilities. A cholera epidemic would therefore be disastrous for the population.

End of medical evacuations from southern Sudan to Lopiding
As of 1 March, new patients from southern Sudan are no longer being taken to the ICRC's Lopiding Hospital across the border in northern Kenya. The organization will cease its activities in Lopiding after almost 20 years and it is planned to hand that facility over to the Kenyan authorities by the end of June 2006, at which point there should be few Sudanese patients still being cared for there. They will be returned home by the ICRC when their treatment is completed. Lopiding opened in 1987 to treat war-wounded people from southern Sudan. From now on patients will be treated within southern Sudan itself and the ICRC will work with other humanitarian organizations to ensure that the referral system for those needing surgical care is adapted to emerging health-care facilities there. The ICRC will continue to provide Juba Teaching Hospital with clinical and capacity-building support in surgery, internal medicine and paediatrics until 2007.

Southern Sudanese authorities endorse limb-fitting workshop
The authorities of southern Sudan have endorsed a memorandum of understanding with the ICRC that will enable the organization to start with the construction of the New Juba Physical Rehabilitation Reference Centre. The new centre will have the same capacity as the limb-fitting and rehabilitation centre in Khartoum. With the handover of Lopiding Hospital, the limb-fitting workshop in Lokichokio, Kenya will close down on April 28 and the ICRC will step up its support for the smaller Juba workshop while the new centre is being built. Five experienced technicians from Lokichokio will be transferred to Juba to give training and support. Selection of 17 southern Sudanese candidates, including two physiotherapists, for an extensive training programme will start immediately.

In Darfur, fighting continues
Despite the precarious security situation and the continued fighting in Western Darfur, ICRC staff have managed to travel from Geneina northwards to the town of Seleia and, using a second route eastwards, to Saraf Omra. Staff returned to visit and assess the needs of the displaced and the resident population living in Seleia town. However, the possibility of an established ICRC presence and subsequent full resumption of activities in the area requires further assessment.

Persistent fighting in Jebel Marra continues to deny the ICRC access to that area and the organization is greatly concerned about the civilian population there. The information gathered to date suggests that people have had to flee their homes and have scattered to seek refuge in the mountains, where many are have received shelter from the resident population. The ICRC has been engaged in a constant effort to obtain the security guarantees needed to travel to Jebel Marra.

NAPO limb-fitting and rehabilitation centre in Nyala
On 12 February, the limb-fitting workshop run in Nyala by the National Authority for Prosthetics and Orthotics was visited by the walis (governors) of the three Darfur states. They were accompanied by key members of the Southern Darfur government and their visit was broadly covered by local media. The group watched as 12 patients were fitted with artificial limbs, including a two-year-old girl who received an artificial leg.

The limb-fitting and rehabilitation centre in Nyala is the only facility to serve all of Darfur. Since the National Authority and the ICRC began working together in May 2005, it has fitted 260 amputees with artificial limbs. The waiting list of people from all over Darfur continues to grow (56 persons in Geneina alone).

Protection activities
The ICRC continues to visit detainees in Darfur held by the Sudan Liberation Army and, in its capacity as a neutral intermediary, to facilitate the transfer into the care of the local authorities of those who are released. As of 10 March, it had facilitated the transfer of 25 persons to the authorities of Gereida, Zalingei, Kutum and El Fasher.

On 28 February, a nine-year-old boy who had been living on the streets of El Fasher was reunited with his family in Kabkabiya. The Sudanese Red Crescent located the boy's family and this enabled the ICRC and Red Crescent to quickly take him back home.

In 2005 the ICRC carried out the following activities
In Darfur
• Supplied water to seven camps for displaced persons as well as to urban areas, repaired water-supply networks in four towns (El Fasher, Kutum, Gereida and Geneina) and provided some 1.5 million people with a total of two million litres of water per day.
• Distributed over 32,000 tonnes of food to 300,000 people.
• Deployed its mobile field surgical team 30 times between April and the end of the year. The team performed over 370 operations on war-wounded patients (including combatants) who would otherwise have had no access to care.

In Sudan as a whole
• Repaired and upgraded five hospitals and 12 primary health-care clinics. Provided four hospitals and 12 primary health-care clinics with staff, medicines, consultations and surgery, and expanded immunization and training programmes.
• Gave talks on international humanitarian law, ICRC activities and the fundamental principles of the Red Cross and Red Crescent to some 10,500 people, including government officials, military personnel, opposition groups, armed militias and religious and community leaders.
• Collected over 29,300 Red Cross messages and distributed over 30,200.
• Continued to hold confidential discussions on the protection of conflict victims with all parties, at all levels, both in Khartoum and in the areas of ICRC operations.

For further information, please contact:
Andrea Koenig, ICRC Khartoum, tel : + 249 9 121 37764
Paul Conneally, ICRC Khartoum, tel :+249 9 121 70576
Marco Jiménez Rodrيguez, ICRC Geneva, tel : +41 22 730 2271