‘The worst we've ever seen': Cholera wards buckle as South Sudan races to contain deadly outbreak
The stench of vomit, chlorine and waste hangs heavy in the air at Juba Teaching Hospital's cholera ward.
Patients lie on ageing military cots, half-naked and almost lifeless, as IV lines drip steadily into their shrivelled arms.
Groans and retches break the stillness as nurses rush between beds tending to the sick.
Mudasir Hasan survived after collapsing from dehydration three days earlier at a private hospital. The doctors there, unequipped to deal with serious cases of cholera, did not manage to hydrate the heavily built 41-year-old fast enough. He was brought in unconscious.
'Some people don't believe cholera exists, but it does,' he said.
Mr Hasan was lucky he recovered after responding well to antibiotics and intravenous fluids, used when oral rehydration fails. But not everyone makes it in time.
'They often come in with severe dehydration and it can be too late for some,' said Lucia Thomas Loro, the ward's supervisor.
Since October 2024, when a cholera outbreak was officially declared in South Sudan, the situation has spiralled out of control.
The current caseload has reached over 56,000 across 45 of the country's 78 counties, with a mortality rate of 1.9 per cent, almost double of the global standard for the emergency threshold.
Cholera, a treatable disease, has already claimed over 1,000 lives in South Sudan, with one death occurring just a day before The Telegraph visited the ward.
Cholera can kill within hours. It starts suddenly, draining the body with diarrhoea, vomiting, and cramps.
Without swift rehydration, organs fail. In severe cases, the skin becomes slack, the eyes hollow, and the pulse weakens. Death comes not from the bacteria itself, but from the speed and severity of the dehydration it causes.
Officially, the facility holds 80 beds, but during peak periods it has to deal with as many as 140 patients at once, forcing the nurses to put people on the ground until a bed frees up.
This is the only treatment centre for severe cholera in South Sudan's Central Equatoria state, where the capital Juba is located.
The outbreak originated two years ago in neighbouring Sudan, where some 60,000 cases have since been recorded.
South Sudan has reached nearly the same tally of cases in just seven months.
The disease first began to spread in Renk, a northern border town, after it was brought in by refugees fleeing Sudan's civil war.
More than one million people have crossed into South Sudan since the latest round of violence erupted in April 2023.
Unity State, home to the Bentiu camp for internally-displaced people, now has the most cases. Pibor, which had none in March, has become the second hardest-hit.
Central Equatoria State now ranks third, driven by the arrival of displaced people from Upper Nile State, where recent political tensions have turned violent, pushing the UN to warn that South Sudan is once again 'on the brink of war'.
South Sudan has long suffered periodic cholera outbreaks, but this one is unique in speed, scale, and scope as conflict-created displacement, flooding, and lack of access to clean water are fuelling the outbreak, according to interviews with experts and officials.
Now, even at the country's top public hospital in Juba, patients are being turned away due to lack of space and resources.
'This is the worst we've ever seen,' said Dr Kediende Chong, the Director General of Preventive Health Services and incident manager for the outbreak response.
'The rainy season, set to begin in June, is expected to worsen the crisis, as flooding latrines and dwindling access to clean water threaten a country where more than half the population already lacks safe drinking water. In theory, cholera thrives in wet conditions, but South Sudan's worst transmission occurred in the current dry season.
'Our fear is that when the rain starts, people in slum areas will be infected and we'll be overwhelmed,' said Dr Loro, the cholera ward supervisor.
The government, supported by the World Health Organization (WHO), has launched a comprehensive vaccination campaign.
Over five million people out of a target population of six million have received the oral cholera vaccine so far. But without clean water, vaccines are only a stopgap.
'We have no logistics capacity,' said Dr Chong, the government official. 'But funders don't invest in us directly, only through NGOs and they have had their funding cut now.'
Cuts to global development aid – especially from USAID, which has heavily invested in South Sudan – are already having catastrophic consequences.
Five children died on the way to a treatment centre after funding cuts forced the nearest health facility to close, according to Save the Children.
Before the cuts, international donors kept the health system afloat, covering as much as 80 per cent of its operating costs.
Kennedy Wafula, country director for the Norwegian Refugee Council (NRC) in South Sudan, told The Telegraph that recent aid cuts have reduced their budget by an estimated 15 per cent.
The organisation's cholera response programmes primarily focus on access to clean water and hygiene services for Sudanese refugees and people displaced by ongoing violence in South Sudan.
'The reduced funding has severely limited our ability to respond effectively to the outbreak.' he said. 'Our emergency response teams have been cut in half, so we're no longer reaching the numbers we need to.'
In many areas, response efforts have been reduced to distributing chlorine tablets and oral rehydration salts, while projects focusing on long-term solutions for water and sanitation infrastructure have either stalled or been scaled back.
Meanwhile at the cholera ward, the sick continue to arrive daily. Many will recover if they're treated in time, but some will never leave.
As the rainy season approaches and funding cuts start to bite, it's not certain the ward at the Juba Teaching Hospital will be able to treat everyone.
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