SUDAN: Hepatitis E spreading across camps in Eastern Sudan infecting hundreds of refugees from Tigray & posing a risk to local communities
Hepatitis E cases in Sudan’s Tigray refugee camps highlights shortcomings of international humanitarian response
Cases of hepatitis E are spreading across camps in Gedaref and Kassala states, Eastern Sudan, infecting hundreds of refugees from Tigray and posing a risk to local Sudanese communities.
In the past few weeks, Doctors Without Borders (MSF) medical teams in Gedaref’s Umm Rakouba camp and Al Hashaba/Village 8 transit centre have received 278 patients, of which 16 were hospitalised, including three pregnant women. Many patients have acute jaundice syndrome, a tell-tale sign of the virus, vomiting and epigastric pain. Umm Rakouba camp is now recording a daily average of 15 cases of hepatitis E. Six cases have also been identified in Al-Tanideba, while three cases have been identified in Hamdayet.
Hepatitis E is a contagious virus that causes liver disease. It noticeably yellows the eyes and skin, causes fatigue and dark urine, and can lead to acute liver failure and death. It is particularly dangerous for pregnant women, for whom the risk of death is about 25 percent. Some of the patients treated by MSF for hepatitis E have arrived comatose.
As with other diseases like typhoid, dysentery and cholera, the hepatitis E virus thrives in environments with poor water and sanitation conditions.
“Since day one, the humanitarian response has been two steps behind the needs of people here,” says François Zamparini, MSF emergency coordinator in Gedaref state. “Early warnings about inadequate sanitation, hygiene and shelter were not heeded, and latrine and tap stand building has been far too slow. As a result we now have widespread open defecation in the camps. Tigray refugees are paying the price of poor international coordination with their health.”
In both Al-Tanideba and Umm Rakouba, latrines are scarce or unusable. In Umm Rakouba, there are only 175 latrines for 20,000 people, while in Al-Tanideba many latrines have been destroyed by heavy rain and wind. Together the two camps host about 40,000 people.
Work is underway to build new latrines, but with the onset of the rainy season many won’t be ready for several months. Some latrines are located right next to water points, increasing the potential risk of contamination. This week, heavy rainfall flooded many parts of Al-Tanideba, making the situation even more acute. Humanitarian actors must urgently increase the quantity and quality of latrines, particularly as the rainy season is likely to increase the spread of other waterborne diseases.
“The toilets have been a problem since we arrived,” says Mehrut, who lives in Al-Tanideba with her five children. “They are never cleaned or maintained and we do not feel comfortable using them.” Because food distributions have been erratic, many refugees have also resorted to selling their soap provisions in order to buy food.
In response to the growing number of cases, MSF has raised chlorine levels in the water it provides, and taken measures to protect and disinfect boreholes under its management from dirty surface water. MSF has also increased health education and outreach in the camps. This has included a jerry can cleaning campaign to ensure refugees can safely store their water. MSF is also following up with pregnant women, providing them with additional soap as a preventative measure.
“The spread of hepatitis E could have been avoided if the basic infrastructure had been in place on time,” says MSF project coordinator Sergio Scor. “Instead there has been a collective failure to provide dignified and safe services to a relatively small number of refugees.”
ENDS
Note to editors: MSF has been working in Umm Rakouba and Al-Tanideba camps since November and December 2020, respectively. In both camps, MSF medical staff run clinics providing primary and secondary healthcare, outpatients and inpatient care, including a maternity, mental health services, vaccinations for children under 18 months and malnutrition treatment. MSF is also supporting with water and sanitation, and operating an emergency water treatment plant to provide clean drinking water to refugees, chlorinates water and provides big bladders to store it in. MSF also works in Hamdayet and Al-Hashaba/Village 8 transit centres. MSF services are available to both Tigray refugees and local Sudanese communities.
.jpg)
Refugee's Testimony, Umm Rakouba, Sudan
Letgbrael Zemickail, 79, sits on a bed with her 89-year-old husband Gebresilase Gebremichael in their tent in Umm Rakouba.
Gebresilase says: “I’ve got an eye problem and arthiritis, but there is no one in the camp who can help people with chronic conditions. We need specialist doctors and specialist follow-up. We need more help. ” Photographer: Dalila Mahdawi.jpg)
Hepatitis E cases in Umm Rakouba, Sudan
Tigray refugees in Umm Rakouba camp cut up Himbasha (also known as Ambasha), a slightly sweet type of bread that is made for special occasions. The poor sanitation and hygiene conditions in the camps have led to an outbreak of hepatitis e, which is spread through contaminated food or water. Photographer: Dalila Mahdawi.jpg)
Patient's testimony, Hepatitis E in Umm Rakouba, Sudan
Lemlem Birhanu, 40, sits with her 70-year-old mother Alganesh Tlhaymanot, who is blind: “When we saw people being shot and stabbed, we ran into the fields and hid for seven days. We hid at a camp for migrant workers on a farm and survived off fresh sorghum. From there we took a donkey to Hamdiyet, in Sudan. My mother is blind so cannot walk for very long. On the road there were many armed people and if they saw young men trying to run away, they would kill them. We saw many dead bodies on the way. From Hamdiyet we were brought here to Umm Rakouba. For the past two months we have not received any food. We have no money and feel so hungry. We also have no firewood or charcoal to cook with, so sometimes we use cow dung. Everyone gets diarhoea from the water or food. Sometimes we try to boil the water but fuel is a problem. My mother received some plastic sheeting to build a shelter, but we had to sell it so we could buy firewood to cook on.
Now my 16-year-old son has yellow eyes, so we took him to MSF, who have taken a sample to test. We’ve also visited a traditional healer, who used fire on his skin and cutting on his neck as a treatment. My mother has been given some medicine from MSF for diarhoea. We go to the toilet out in the open because the nearest latrines are so filthy. We don’t feel safe using them.” Photographer": Dalila Mahdawi.jpg)
Hepatitis E cases in Umm Rakouba, Sudan
Inside the Inpatient department (IPD) at MSF’s medical facility in Umm Rakouba camp for Tigray refugees. Photographer: Dalila Mahdawi.jpg)
.jpg)
.jpg)
.jpg)
Al-Tanideba refugee camp, Sudan
A man in Al-Tanideba camp works to reinforce his shelter. Weeks of heavy rain and wind have destroyed many refugee shelters across the camp, contaminating water and food supplies. Besides an increase in toilets and handwashing stands, refugees need more help to safely store their water and food.
In response to the outbreak, MSF has raised chlorine levels in the water it provides, and taken measures to protect and disinfect boreholes under its management from dirty surface water. MSF has also increased health education outreach in the camps. This has included a jerry can cleaning campaign to ensure refugees can safely store their water. MSF is also following up with pregnant women, providing them with additional soap as a preventative measure. Photographer: Dalila Mahdawi.jpg)
Al-Tanideba refugee camp, Sudan
One of the water tanks at MSF’s water treatment plant in Al Tanideba camp. MSF is treating water as an emergency measure to ensure refugees have clean water. Open defecation is widespread in Al Tanideba and Umm Rakouba camps. As a result, cases of hepatitis e have emerged. Besides an increase in toilets and handwashing stands, refugees need more help to safely store their water and food.
In response to the outbreak, MSF has raised chlorine levels in the water it provides, and taken measures to protect and disinfect boreholes under its management from dirty surface water. MSF has also increased health education outreach in the camps. This has included a jerry can cleaning campaign to ensure refugees can safely store their water. MSF is also following up with pregnant women, providing them with additional soap as a preventative measure. Photographer: Dalila Mahdawi.jpg)
Hepatitis E cases in Al-Tanideba, Sudan
Gebraselaisse Tesfamariam, a community leader, walks through Al-Tanideba camp with MSF community health worker/HP supervisor Solomon Mokonen. Cases of hepatitis e have emerged in Al Tanideba and Umm Rakouba camps, as well as Al Hashaba/Village 8 transit centre. Besides an increase in toilets and handwashing stands, refugees need more help to safely store their water and food.
In response to the outbreak, MSF has raised chlorine levels in the water it provides, and taken measures to protect and disinfect boreholes under its management from dirty surface water. MSF has also increased health education outreach in the camps. This has included a jerry can cleaning campaign to ensure refugees can safely store their water. MSF is also following up with pregnant women, providing them with additional soap as a preventative measure. Photographer: Dalila Mahdawi.jpg)
Hepatitis E cases in Al-Tanideba, Sudan
Women walk behind the coffin of a woman being taken for burial in Al Tanideba camp. MSF has been treating a growing number of hepatitis e cases in the camp, as well as in Umm Rakouba and Al Hashaba/Village 8 transit camp. Photographer: Dalila Mahdawi
