Op-Ed By Dr Humphrey Karamagi, WHO Representative for South Sudan
South Sudan is combating its largest and longest cholera outbreak since independence in 2011. The outbreak, which began in September 2024 has been sustained for now one year, testing the country's experiences, defining new frontiers to interrupt transmission and providing new lessons for future similar outbreaks.
After 12 months of sustained Cholera transmission, the outbreak is slowing but has caused nearly 100 000 suspected cases and slightly over 1 500 deaths across 55 counties in 9 States and 3 Administrative Areas. The country's multi-sectoral response -- featuring surveillance, deployment of rapid response teams, medical supply prepositioning, case management, Infection Prevention and Control, Water/Sanitation/Hygiene promotion, reactive vaccination campaigns using oral cholera vaccines, and response coordination -- has helped mitigate the risks to communities and saved hundreds of lives. The weekly number of new Cholera cases has drastically reduced from an average of 1000 cases at the peak of the outbreak in December 2024 to a record lowest of 114 in the last week of September 2025. The number of infected Counties declined from 55 to 7 in the same reporting period. And there was no newly infected county since June 2025.
South Sudan's Cholera response Journey
South Sudan's cholera outbreak was confirmed on 27 September 2024. A national Cholera outbreak was declared on 28 October. The response efforts to this day have focused on a) coordination of response actors using the Incident Management System; b) Strengthening surveillance for acute watery diarrhea (AWD), c) Laboratory diagnostics support for aetiological agents of AWD, d) Case management of acute watery diarrhea, especially severe dehydration, e) Risk communication and community engagement, f) Infection Prevention and Control, g) Water/Sanitation/Hygiene promotion, h) vaccination using Oral Cholera Vaccines, and i) Logistics.
Notably, the cholera outbreak spread so fast, reaching slightly over 27 000 cases and 472 deaths in 40 counties within the first 4 months of confirmation. The increased hostilities in Sudan, where the outbreak originated, facilitated the multiple importations into several areas of South Sudan. But even most importantly, the outbreak affected high-density areas hosting returnees/refugees' settlements. The cholera outbreak was therefore an emergency complicating another.
Although slightly over 67 000 additional cholera cases were reported in the last 8 months, the geographical spread has been much slower with only 15 new counties reporting cases. At this one-year milestone, we should celebrate:
Over the one-year response period, the country has documented the following best practices to promote in seeking the goal of interrupting Cholera transmission:
WHO's Contribution: Working Hand in Hand
Out of the WHO mandate of setting norms, standards and guidelines, the country office in South Sudan has devolved to delivery of cholera response services. We have stood alongside the Ministry of Health, communities, and partners in strengthening the foundations of care. Specifically, WHO:
In the tail end of the Cholera outbreak, WHO re-commits to a) care and treatment of more than 71 people that are currently admitted in multiple cholera treatment centres/units in 7 counties; b) Provide care and treatment products for an additional 10,000 cases predicted for the 3-4 months ending December 2025; c) Engage the communities on context appropriate technologies for mitigating the risk of cholera infections; d) Providing education and communication materials needed to create a behavioral practices needed to interrupt Cholera transmission and e) Mobilise the resources (human, financial and materials) needed to see the end of the cholera outbreak.
At the very heart of the successful response is multisectoral collaboration led by the government. However, WHO will remain the technical and coordination agency (using the Health cluster mechanism) to support donors and response partners for the best in-class tools and technologies for Cholera control. As we head to the tail end of the outbreak, more efforts, resources and context learning will be needed. In turn, we call on the government of South Sudan, all Donors and health partners to double efforts, even when the numbers look positive.
Lesson learnt
This cholera response serves as a foundation to enhance future emergency preparedness and health system strengthening in South Sudan. Key lessons learnt include:
Call for Action
As we South Sudan moves towards the end of the current Cholera outbreak, WHO calls for a renewed collective commitment to: