Chaos and violence in South Sudan has resulted in more internally displaced persons (IDP), some 1.6 million, and has prompted many health partners to reduce staff or leave the country all together.


This has had a profound affect on infectious diseases in IDPs, to include malaria and acute watery diarrhea, preventable and curable diseases. In addition, the rainy season in the country may increase the risk for diseases like cholera.

The challenges are great in South Sudan, according to the World Health Organization (WHO). “Coupled with the conflict, the country is battling threats to health security due to disease outbreaks,” says Dr Abdulmumini Usman, WHO’s Representative for South Sudan.

“The conflict has exacerbated existing challenges with the health system and disease surveillance,” Dr Usman says. “With so many health workers and partners moving to safety, data is more difficult to collect and challenges have emerged as humanitarian access remains limited.”

In response, WHO is working with the Ministry of Health and the few health partners on the ground to enhance disease surveillance to rapidly detect and respond to disease outbreaks in high risk areas.

To cover the growing number of internally displaced persons near Juba and Wau, while availability of health workers decreases, WHO and the Ministry of Health supported 15 new Early Warning and Response System (EWARS) sites capable of monitoring diseases for up to 50 000 more people. This brings the total number of EWARS sites to 71 in South Sudan, which provides the capability of monitoring 300 000 people for disease outbreaks.

WHO’s EWARS initiative is committed to supporting disease surveillance, alert and response even in the most difficult operating environments. EWARS tries to catch disease outbreaks early on to help contain them in emergencies by providing technical support, training and field-based tools to Ministries of Health and other partners.

In 2015, WHO initiated a pilot deployment of its “EWARS in a box”, which is a kit of durable, field-ready equipment needed to establish and manage surveillance or response activities in field settings. A single kit costs approximately US$ 15 000 and can support surveillance for 50 fixed or mobile clinics, or roughly 500 000 people. Deployed to a settlement in Mingkaman with about 80 000 IDPs, WHO trained health workers to use the system.

Thus far in 2016, 45 disease alerts have been detected by the system. Immediate feedback is provided to WHO and Ministry of Health staff, and helps to ensure that alerts can be promptly verified and investigated.

“Before EWARS, the process of data collection was very slow and time consuming,” says Dr Joseph Wamala, WHO epidemiologist in Juba. “WHO colleagues and our partners worked manually with data that was collected in Word documents, which led to slower analysis and response planning. EWARS allows data to be collected and reported using mobile phones in health clinics. It is adapted specifically for use in emergency settings and has the flexibility to gather different kinds of data as a situation evolves.”

For example, South Sudan’s Ministry of Health officially confirmed a cholera outbreak on 21 July 2016. As of 15 August, a total of 1160 cholera cases including 23 deaths have been reported nationwide. The majority of these have been recorded in Juba County, where an average of 35 new admissions are being recorded daily.

WHO and the Ministry of Health added a component to EWARS to help track cholera cases, which has led to a more targeted response to cholera outbreaks. This includes plans to preposition oral cholera vaccines in community centres where cholera outbreaks are expected to rise, based on data collected by EWARS.