Sudan & South Sudan: Cholera crosses the Sudanese border and bursts into South Sudan refugee camps

THANKS to Lola Hierro (Hola Lola!) for informative reports and photos from Renk, South Sudan. At the Renk Transit Center, which has a capacity of 3,000 people, there are more than 16,000 current residents, and the roads that connect this out-of-the-way corner to the rest of the country are waterlogged by floods caused by end-of-summer rains. Renk’s risk lies in the fact that this [Vibrio cholerae] bacillus is transmitted through contact with contaminated foods and liquids, in conditions of overcrowding and lack of safe access to water and sanitation. Read more in this report.

From EL PLAIS

By LOLA HIERRO (Renk / Madrid)
Dated Tuesday, 12 December 2023 - 23:40 WET - full copy:

Cholera crosses the Sudanese border and bursts into South Sudan refugee camps

The Ministry of Health confirms a positive case in the Renk Transit Center, located in the north of the country, where thousands of displaced people are living shoulder to shoulder

Waiting room of the clinic located at the Renk Transit Center in northern South Sudan. ALA KHEIR (UNHCR)

South Sudan’s Ministry of Health has confirmed the first case of cholera in Renk, a city in the far north of the country that is suffering a humanitarian crisis amidst the thousands of people from Sudan who have been displaced since war broke out last April. Sudan has been struggling against an outbreak of the diarrheal disease since September 26 and to date has documented 4,000 cases and 130 deaths.

“The public is advised not to panic, as measures have been put in place to respond to this threat,” the ministry has announced. Nonetheless, in Renk, general sentiment is very different, as described via WhatsApp by Atsuhiko Ochiai, coordinator of a Doctors Without Borders (DWB) clinic located in the Zero settlement of Renk, which has more than 3,500 residents. “[The situation] is getting worse. More people come from Sudan all the time and the water, latrines, food, plastic sheets, hygiene kits, etcetera, are just not enough. Open-air defecation is common,” he warns.

Doctor Ochiai’s fears are due to a minimal health infrastructure. More than 400,000 people have crossed the border in the last eight months. They arrive in impoverished conditions, without money, without a home in which to stay, with no hope of feeding or cleaning themselves or accessing any service beyond what meager humanitarian aid they can obtain. That’s because all the most important United Nations agencies and nonprofits are present in Renk, but the funds available to help the population are not sufficient: only 32% of the more than 225 million euros required by the UN refugee agency (UNHCR) have been covered. At the Renk Transit Center, which has a capacity of 3,000 people, there are more than 16,000 current residents, and the roads that connect this out-of-the-way corner to the rest of the country are waterlogged by floods caused by end-of-summer rains.

A woman cares for her son, who has been admitted to the hospital in Renk, northern South Sudan. ALA KHEIR (UNHCR)

Cholera presents a public health problem in 47 of the world’s poorest countries, where between 1.3 and four million cases are registered annually. The illness is caused by the Vibrio cholerae bacteria, which provokesd intense diarrhea, up to 20 liters a day, which can kill a person within four hours. With adequate treatment — rehydration and antibiotics in the most severe of cases— the death rate does not rise above 1%, but without it, it can soar to 50%.

Renk’s risk lies in the fact that this bacillus is transmitted through contact with contaminated foods and liquids, in conditions of overcrowding and lack of safe access to water and sanitation. This is precisely the scenario in the far north of South Sudan. If the region was already living in poverty and had been punished by nearly a decade of violence caused by internal conflicts, with 74% of the population in need of humanitarian aid, the waves of Sudanese and South Sudanese returnees from the new war have only worsened the situation.

The cholera patient identified at the transit center, a 38-year-old man who had recently crossed the border between the two states, has recovered. For the time being, no other positive cases have been reported. But the fear of new cases is very present. “When community-wide transmission of cholera happens in Renk, it will be catastrophic,” Ochiai predicts.

Doctor Francisco Luquero is the head of the team responsible for high-risk epidemic programs at the Global Alliance for Vaccines and Immunization (GAVI) and was in South Sudan during the 2014-2017 outbreak that affected more than 28,000 people. The doctor explains that since 2019 there have been hardly any cases, and those that have appeared have been very mild thanks to the country’s efforts to control the previous outbreak and the prevention campaigns that have been orchestrated “We know that in these scenarios there is a high risk of transmission and that in these areas it is difficult to provide adequate treatment, so there is concern,” he says over the phone.

With Sudan’s outbreak in mind, World Health Organization (WHO) mechanisms have been activated to avoid cholera’s arrival. These mainly involve the promotion of personal hygiene, especially hand-washing, raising awareness in communities, and distributing hygiene supplies to 3,000 households, including domestic items for transporting water like disinfectants and purifiers. But such measures are nearly impossible to implement when there are thousands of people sleeping outdoors, on muddy ground where rainwater stagnates and forms putrid puddles, and where there is no sewage system or toilets.

Water stagnates between tents where thousands of refugees survive in Renk. ALA KHEIR

A month before cholera had its opening act, fears were already present. In Zero’s mobile clinic, doctor Ferida Manoah hardly had time for a break: many small patients required her attention. Patients like Nya, María’s daughter. The little girl, at just over a year old, was due for a medical check-up. Her mother brought her to the health center, accessible only by a long row of sandbags that had been placed over the stagnant water.

Since she was apparently healthy, María only received some tips on nutrition and hygiene. Above all, the latter. “We have a large number of diarrhea cases and we’ve suspected the presence of typhus, but we aren’t able to test,” said Mahoah. Before the cholera outbreak, diarrhea was the third leading cause of mortality in Renk, after malaria and pneumonia.

A simple, but elusive remedy

The plan to address cholera begins with giving specific information to all health staff and community workers on how to inform authorities if they detect a suspicious case. Until there is confirmation, an outbreak is not announced, but independent of test results, it’s very important to provide treatment to patients to avoid death by dehydration.

Blocking the entrance of the illness at the border would be ideal, but in practice that turns out to be nearly impossible. The International Organization for Migration (IOM) has health stations open from 6 a.m. to 8 p.m., which means that for 10 hours a day there is no one available to test. Not to mention, with 2,000 to 3,000 people crossing every day, even if the stations were open 24 hours, it would be very difficult to evaluate everyone who passes through.

Drinking water station in the field of Joda, where thousands of people wait weeks to be transported to the Renk Transit Center in South Sudan. 

LOLA HIERRO

Luquero thinks that prevention at the border is not realistic because similar to people affected by Covid-19, a patient can be contagious and also asymptomatic, something that occurs in 80% of cases. Nonetheless, for him it “is super necessary to replenish kits to treat the sick, because rehydration saves lives.”

The GAVI leader trusts in the skills South Sudan showed in the past thanks to its prevention strategy. “South Sudan has taken a lot of initiative in vaccination, reactive as well as preventative,” he says. They have implemented various campaigns and since 2019, received more than three million doses through the Global Task Force on Cholera Control. “It’s true that it’s a very fragile country, but it’s also a case in which they’ve been able to successfully control a national outbreak,” he says.

Immunization campaigns, however, have not yet arrived to Renk. Luquero thinks it would be best to solicit them as soon as possible from the International Coordinating Group (ICG) on Vaccine Provision, which is in charge of emergency requests. “It’s one method that can be used to access the doses more quickly, linked to the humanitarian crisis in the north, without having to make a global vaccination plan,” he says. “What we need to do is to make a good epidemiological assessment as quickly as possible and, based on that, send the vaccine request as quickly as possible. And I emphasize speed.”

View original: https://english.elpais.com/international/2023-12-12/cholera-crosses-the-sudanese-border-and-bursts-into-south-sudan-refugee-camps.html

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Sudan & S. Sudan: From faculties to refugee camps: War has displaced thousands of university students

"The Renk Transit Center [in South Sudan] does not qualify as a refugee camp. It’s a settlement designed as a transit point for about 3,000 people, but Renad, Nyamiji, Nosemba and Emam have been stuck here for several months. More than 18,000 souls are crowded together, due to the incessant flow of arrivals from the neighboring country [Sudan] and the impossibility of transferring refugees to more suitable places. Seasonal rains have flooded and cut off entire roads. Here, the living conditions are dire, because everything is lacking: shelters, clean water, enough food, adequate sanitation, health and educational services". Read more.

From EL PAIS International
Written by LOLA HIERRO Renk (Sudán del Sur)
Dated Saturday, 09 December 2023; 19:46 WET - here is a copy in full:

From faculties to refugee camps: The war in Sudan has displaced thousands of university students

Sudanese higher education students – who have been forced to flee their homes due to violence – now live in poor conditions as displaced people, without any certainty about their education and their future

Nosemba Walaldin, 23, at the Renk refugee transit center in South Sudan, in November of 2023. LOLA HIERRO

Emam Omam is almost an economist. Nyamiji Daniel is almost a programmer. Nosemba Walaldin is almost a teacher. And Renad Abdalkhaman dreams of being a surgeon.

These four students were all at different stages of completing their university degrees. They had the worries and responsibilities typical of twenty-somethings. That is, until a war blew up their lives. They have been forced to exchange their houses for the huts of a refugee camp. Classmates and study time have been replaced with loneliness and endless, empty hours.

Students such as Emam, Nyamiji, Nosemba and Renad have been damaged by the armed conflict that Sudan has been experiencing for the past eight months. The condition they’re facing isn’t as visible as a disease, nor is it as irreparable as death, but its impact is of immense proportions for hundreds of thousands of young people who, overnight, have been forced to replace their dreams of the future with the uncertainty of a life filled with need, danger and precariousness.

Of all the humanitarian emergencies in the world where there isn’t sufficient assistance, South Sudan is almost at the bottom. While it’s obscured in the media by other crises – such as Gaza or Ukraine – there hasn’t been a single day without refugees and catastrophes in this African country for almost a year. South Sudan is on the brink of collapse, with 9.4 million people in need of humanitarian assistance, or 76% of the population. Only 40% of the funds needed to address this have been secured, according to the UN Agency for the Coordination of Humanitarian Affairs (OCHA).

Emam Omam was a student at the Omdurman Islamic University, near Khartoum, the Sudanese capital. “I studied Economics because Sudan needs economists. Maybe I could get a job,” he explains. On April 15, 2023 – the day the war began – he was preparing for an exam. “I waited to see if the situation would calm down and I could finish [my courses]... but that wasn’t the case. My degree has stopped, everything has stopped. I no longer know what’s going to happen,” the young man sighs.

Sitting on a mat on the ground – in the shade of a canvas tent that barely offers protection from the intense heat – four young women of similar ages speak about what their life has been like since the violence pushed them out of their homes and classrooms. They’ve been living at a temporary shelter for refugees in Renk, a border town between Sudan and South Sudan.

Emam Omam, 25, was an Economics student at Omdurman Islamic University, near Khartoum. LOLA HIERRO

“Those were very good times. As soon as I got up, I wanted to go to class, see my friends, have a good time with them, have fun. There was no time for anything, I was busy from morning to night,” recalls Nosemba Walaldin. The 23-year-old was in the last semester of her Information Technology degree, which she was completing at the University of Khartoum, the oldest university in the country. Nosemba missed the last exam that was required for her to finish her degree.

Nyamiji Daniel, 22 – a South Sudanese woman living in Khartoum – was studying the same subject at the same institution, but one grade below Nosemba. “I lived with a Sudanese family, because I [was employed as a domestic worker]. I got up at five in the morning, started working at six, then went to class and came home at four. From then on, I finished the rest of the housework,” she explains. Nyamiji studied and worked at the same time. She admits that this wasn’t easy… but now, she says that she would turn back the clock without hesitation.

“I had just finished my high school diploma and was planning to study Medicine. [Becoming a surgeon] is my dream,” says Renad Abdalkhaman. Having just turned 18, she’s the youngest of the four girls, but the most determined. She speaks loudly and clearly.

These four young people now live at the Renk Transit Center. More than 400,000 people have arrived through this border point over the last eight months, fleeing the civil war unleashed between the army and the paramilitaries of the Rapid Support Forces (RSF). This conflict has brought daily armed attacks to the streets of Khartoum, resurrected ethnic clashes in Darfur and has led to the forced displacement of more than six million people. It has also caused the suspension of exams and the closure of educational centers from the first days of the conflict.

The Renk Transit Center does not qualify as a refugee camp. It’s a settlement designed as a transit point for about 3,000 people, but Renad, Nyamiji, Nosemba and Emam have been stuck here for several months. More than 18,000 souls are crowded together, due to the incessant flow of arrivals from the neighboring country and the impossibility of transferring refugees to more suitable places. Seasonal rains have flooded and cut off entire roads. Here, the living conditions are dire, because everything is lacking: shelters, clean water, enough food, adequate sanitation, health and educational services.

Renk Transit Center, on the South Sudanese side of the border with Sudan. With capacity for 3,000 people, it was sheltering over 18,000 by the end of November, 2023. ALA KHEIR (UNHCR)

19 million children left without class

Among all the traumas that any exodus caused by violence entails, there’s that which is faced by the students. Up to 19 million children are out of school, according to UNICEF and Save the Children. And an undetermined number – it could be more than 200,000, if we look at the latest enrollment figures provided by the government, from 2017 – have been left without a university. While Khartoum has always been a city proud of its intellectual tradition, in recent years, its higher education system hasn’t grown in size, due to poor funding, political interference and the economic crisis. There have been protests before, during and after 2019, when dictator Omar al-Bashir was deposed in a coup. This was followed by the massive floods of 2020 and the COVID-19 pandemic.

Nyamiji Daniel, 22, is displaced. A South Sudanese woman living in Khartoum, she was studying Information Technology. LOLA HIERRO

For refugee children in places such as Renk, at least there are some schools that different humanitarian organizations have set up in the camps. But the situation faced by students who were enrolled, or set to enroll, in the universities and technical colleges is a separate drama. Their specialized training cannot be found just anywhere. Hence, they suddenly find themselves in an inescapable state of limbo.

This is a cruel addition to the rest of the traumas that they carry, as they already have stories of fear and loss behind them. Renad – the youngest of the four young women interviewed – was born in Khartoum, but her parents emigrated to Saudi Arabia when she was a baby. At 16, they told her that they were going back. She was excited to get to know her country of origin… but that joy didn’t last for long. She hadn’t even been living in Sudan for a year when the attacks began.

“The first day, we hid at home. We heard shots outside. That night, a bomb fell right next door,” the teenager recalls. She has lost something much more important than her studies. “My father and my uncle went out one day to get something to eat and they never came back. We spent a month waiting for them. When we didn’t hear any news, my mother and I came here,” she concludes. Her voice trembles – the strong energy that emanates from her falters a little. “I feel totally destroyed. They’ve destroyed my future, our futures,” the teenage laments. She’s been at Renk since August 20.

Nosemba worked at a law firm in the afternoons after university. In her free time, she went out with her friends. “I’m still in contact with two who are in the White Nile [state]. I’ve lost track of the rest of them.” She arrived at the transit center on August 17, after a nine-day trip with her family, during which she almost lost a brother. “On the way some armed men stopped us, they wanted to take one of my brothers with them. We gave them everything we had so they would leave him,” she recounts.

Nosemba Walaldin, 23, was in the last semester of her Information Technology degree when she was displaced. She had been studying at the University of Khartoum. LOLA HIERRO

The Scholars at Risk network (SAR) has chosen Sudan as one of the most worrying cases in its 2023 Free to Think report. The group warns that the civil war has seriously affected the education sector, including higher education. “In the early days of fighting, students and faculty members reported being forced to flee or being trapped, unable to flee, with no food, water, or electricity,” the report denounces. SAR has also reported on militants who have killed, injured or raped students and teachers, warning that Sudan may face a serious shortage of teachers for the next school year, due to the number of people who have fled the country.

According to an SAR estimate, armed clashes and looting have damaged at least 104 public and private higher education facilities and research centers during the first five months of fighting. In at least one case, on June 4, the Sudanese Armed Forces appear to have targeted an institution of higher learning, bombing the campus of the International University of Africa during clashes with the RSF. 10 people were killed.

In recent years, there’s been a growing demand for higher education in refugee camps. Some initiatives have been developed, mainly thanks to the internet, which allows for online studies to be offered. There are also some scholarships, such as the Albert Einstein German Academic Refugee Initiative (DAFI), a program sponsored by the UN Refugee Agency (UNHCR) in 50 countries. It aims to ensure that refugees with strong academic abilities can pursue a university degree or higher education in a third country. But there are very limited spots and options. According to UNHCR, only 1% of the global refugee population finds a path to higher education, compared to a third of young people worldwide.

Renad Abdalkhaman, 18, had just finished high school and wanted to start studying medicine to become a surgeon. Then, the war broke out in Sudan. LOLA HIERRO

Of course, Nosemba, Nyamiji, Renad and Omam would like a scholarship like the DAFI, since all four of them dream of going away to continue their education. The young aspiring surgeon would like to go to the UK or Turkey. Nosemba – who would like to teach about new technologies – thinks that North America could be a good option. Eman wants to get a postgraduate degree in Political Science, while Nyamiji is happy to go wherever she can find a job.

For now, their dreams are farther away than ever before. These young people – along with others like them – feel that their future plans, their intellectual concerns and their efforts have all fallen on deaf ears. There are no guarantees that they’ll leave the refugee camps any time soon, even though they want to shake off a situation and a label which they don’t identify with at all. They’re university students, not refugees. They don’t understand how their lives have taken such a turn from one day to the next. Just thinking about this affects them deeply.

“If I start talking about how I feel, I’ll probably start crying. Life here isn’t good and, psychologically, I’m not well,” Nosemba acknowledges, with a broken voice. “I just hope we can get out soon and continue with our lives,” Renad adds. “The more time you spend in a place like this, the more tired you feel.”

View original: https://english.elpais.com/international/2023-12-09/from-faculties-to-refugee-camps-the-war-in-sudan-has-displaced-thousands-of-university-students.html

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