Kang Gatlok, 4 years old, during a medical consultation. Days before reaching the hospital, he tested positive for malaria. Despite receiving medication, fever persisted and his urine became dark. Then his mother decided to take him to the MSF hosptial in Bentiu camp where he was diagnosed with hepatitis E. © Damaris Giuliana/MSF

South Sudan: Two deaths from hepatitis E as a result of sanitation conditions in Bentiu IDP camp

An alarming jump in the number of patients with hepatitis E and acute watery diarrhea has been seen in the camp for internal displaced persons (IDP) in Bentiu, South Sudan. The situation is critical with two deaths already registered within a month since end July, alerted the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

“We have repeatedly warned of the health risks of inadequate water and sanitation service provision in the Bentiu camp,” said Federica Franco, MSF Country Director. “A failure to address these issues, with agencies actually reducing their water and sanitation services over the past year, has now resulted in this avoidable situation.”

Since July 2021, MSF teams have treated four times more patients with hepatitis E than in the previous months. Of 186 cases reported in 2021, over 60% were recorded over six weeks between in July to mid-August. Amongst the patients who passed way, one was a pregnant woman, as the Ministry of Health in South Sudan called attention to on August 15. This is a highly concerning disease especially for this group, as they are more likely to experience severe illness and the mortality rate can be as high as between 10-30 percent.

The spread of Hepatitis E

Hepatitis E is a viral liver disease prevalent in environments with poor water supply and sanitation. It is most commonly spread through the oral-faecal route, when people ingest water or food contaminated by an infected person’s faeces. The symptoms are acute jaundice, which turns people’s eyes and skin yellow, as well as fever, reduced appetite, nausea and vomiting, dark urine and enlargement of the liver, though people may not show symptoms at all.

MSF teams have also witnessed an exponential growth in the number of people with acute watery diarrhoea. While we were treating an average of 230 patients per month throughout the year, we have seen 1,454 in July – a 50 percent rise in the number of patients seen in June. The most affected are children aged under five years.

Children walk, play and bath in dirty water – a key source of infection that is driving an alarming jump in the number of patients with hepatitis E and acute watery diarrhea presenting at the MSF hospital in Bentiu camp.Damaris Giuliana/MSF

“We don’t have water containers in our house and sometimes my children go to bed without showering because the one jerry can we have is not enough for showering the five of us. We just use it for drinking,” explained camp resident Nyaker Deng Bol, 24 years old.

Lack of access to proper hygiene

A lack of soap and latrines, as well as open sewers, are among the poor hygiene issues contributing to the appalling situation for over 100,000 people who live in the camp. During a survey MSF teams conducted this month, less than 27 percent of the sampled households could show a piece of soap while being interviewed in their shelters. Additionally, only around 13 percent of people have access to hand washing points with water and soap close to the latrines.

An earlier MSF assessment in April showed that the number of functional latrines in the camp was ten times below the minimum international standard for the size of population.

People collect water with the available resources, including buckets. Many residents need to use the same buckets for washing clothes, transport all sort of items and even to defecate during the night if they have diarrhea.Damaris Giuliana/MSF

“The deplorable water and sanitation situation in the Bentiu camp is not a new phenomenon but has continued to drastically deteriorate in the last two years, leaving an already vulnerable population at high risk of outbreaks, as we are currently witnessing,” analysed Samreen Hussain, MSF deputy medical coordinator.

While MSF has mobilized a medical response, organizations that provide water and sanitation in Bentiu camp have been increasing services to address the unacceptable conditions. Desludging, cleaning and rehabilitation of existing latrines, construction of new latrines, and distribution of soap and water containers should urgently continue, as the water and sanitation conditions are still extremely poor.