Published online 6 August 2004 | Nature | doi:10.1038/news040802-20


Sudanese refugees face cholera time bomb

Aid agencies fear outbreak unless sanitation in camps is improved.

Inadequate latrines are leaving Sudanese refugee camps open to disease.Inadequate latrines are leaving Sudanese refugee camps open to disease.© Unicef

Refugees from the fighting in Sudan are facing a potentially devastating outbreak of cholera, aid workers have warned. Without improved sanitation facilities at refugee camps, the disease could strike at any time, say officials at the British agency Oxfam.

Hundreds of thousands of people have been driven from their homes in Darfur, in the west of the country, by clashes between rival militia groups. In the past three weeks the number of refugees in the camp at Kalma has ballooned to around 60,000.

“Given the conditions these people are living in it's a serious concern”

Brendan Cox

The lack of adequate sanitation, combined with the current rainy season, have created a disease time bomb, Oxfam officials say. The agency is leading the effort to provide adequate sanitation and drinking water, and its staff are currently working to construct around 1,000 extra latrines at Kalma.

The handful of existing toilets at the camp cannot cope with the sheer numbers living there, and residents are currently forced to defecate on the ground nearby. The regular rains wash this sewage back into areas where people are living, leading to fears that it is only a matter of time before cholera strikes.

"Given the conditions these people are living in it's a serious concern," Oxfam spokesman Brendan Cox told "We haven't had any cases yet in the camps, but we're keeping an eye on it." He adds that cholera is present in neighbouring Chad, and could easily spread into Sudan.

Deadly disease

“We must work urgently to prevent a health catastrophe”

Lee Jong-wook

Cholera, which is caused by the bacterium Vibrio cholerae, can be a killer. The infection is transmitted by water contaminated with faeces, and causes diarrhoea, dehydration and, in extreme cases, death within hours. Health workers in Darfur also fear that refugee camps could be hit by malaria and by shigellosis, a similar disease to cholera.

Last month, top officials from the World Health Organization (WHO) journeyed to Darfur to survey the scene. "We must work urgently to prevent a health catastrophe," said WHO director-general Lee Jong-wook. "Many more could die in the coming weeks unless we prevent the lack of sanitation, malnutrition, shortage of clean water and the coming rains from combining into a recipe for death."

Health measures for refugees in Darfur will cost millions of dollars.Health measures for refugees in Darfur will cost millions of dollars.© World Health Organization

With around 300 refugees arriving at Kalma every day, aid agencies have a huge struggle on their hands. The WHO estimates that its efforts to avert a health disaster in Darfur will cost US$1.2 million per month.

Other agencies are spearheading efforts to get food, shelter and malaria protection into the camps, says Cox. But with around 250,000 people needing aid in Darfur, the need to avoid disease epidemics is paramount. "We've got our teams in place," he says. "The first priority is water and sanitation."