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South Sudan -High priority areas / Hotspots


  • IDPs as well as military or armed groups in various counties

2014: cholera incidence higher among IDPs compared with non-IDPs outside of Juba (Wau Shilluk)

  •  Displaced and host communities living on islands of the Sudd Swamp during 2016-2017
  • Nomadic pastoralist communities especially in cattle camps during 2016-2017
  • Goldming site in Budi and Kapoeta states

Risk factors

  • Conflict and population displacement

1970s and 1980s: refugee displacement from Uganda and Ethiopia following political turmoil and famine

2005-2013: returnees from Kenyan, DRC and Ugandan refugee camps

Since the onset of the civil war in Dec. 2013:

  • massive population movement in and out of crowded IDP and refugee camps (> 2M IDPs);
  • Security concerns hindering timely and comprehensive response
  • Structural factors

Restricted access to safe drinking water and adequate sanitation facilities

  • Straying away from Home
  • Damaging of facilities
  • Increase cost of fuel

Restricted access to Health services

  • Poor road network and insecurity (hard to reach)
  • Population displacement in the Sudd
  • Cattle camps

Protracted crisis coupled with drought led to food shortages and famine in some areas

  • Environmental factors

The Sudd, one of the world’s largest swamps stretch from Bor to Malakal

  • Thousands of IDPs settled on floating vegetation islands in overcrowded conditions
  • Use the swampy water for drinking, cooking, bathing and defecating
  • Low water table prevents from building pit latrines
  • High-risk practices

61% of the population practice open defecation and are less likely to wash hand with soap after defecation

Case control studies in Juba 2007-2014: using a water source close to the place of residence, eating outside of the home, and traveling or living in Juba for less than one year

Case investigations in 2006 – 2017:  cholera transmission during funeral rituals, around affected households and in a facility that receives cholera cases


  • The priority strategic actions should include early detection, community-based surveillance, cross-border activities, and preparedness plans and actions in 17 identified cholera hotspots (Type 1  to 4)
  • Mid-term WASH and social mobilization activities (1-3 years) should be implemented in priority counties regularly affected with significant outbreak duration: Type 1 and Type 2
  • The priority hotspots (Type 1 and Type 2) comprise 12 counties with both urban and rural features which account for two-thirds of the disease burden. Those cholera foci host approximately 2,280,000 people (18% of the total estimated population)
  • An identification of transmission foci at a finer geographical scale (e.g., city section, boma, village) within the priority counties is necessary to better target the at-risk population.