WHO Factsheet: Cholera in South Sudan — One Year On

Context and Burden of Cholera in South Sudan

South Sudan experiences recurring cholera outbreaks, driven by risk factors such as frequent flooding, displacement due to political instability, limited access to healthcare and inadequate water and sanitation services. Between 2014 and 2023, five cholera outbreaks of different size and spread occurred in the country with between 424 to 20038 cases and 1 to 436 deaths reported. Before the current outbreak, the largest outbreak started in mid-June 2016 and lasted until August 2017 (14 months) with a national attack rate of 1.8/1000 inhabitants.

The current outbreak was declared by the Ministry of Health (MOH) on 28th October 2024 following confirmation by culture of Vibrio cholerae O1 in samples from Renk County, bordering Sudan. This outbreak has lasted 12 months and it is different from previous outbreaks because it emerged at the end of the rainy season rather than during the typical beginning or peak and started outside of Juba before quickly spreading to 55 of the 80 counties in the country. As of October 27, 2025, the outbreak had totalled 95 450 cases and 1587 deaths, a case fatality rate (CFR) of 1.7%, of which 812 are health facility deaths (HF CFR: 0.9%), reported across 9 states and all three administrative areas (that is Ruweng, Greater Pibor, and Abyei). Unity State continues to account for the highest burden of cholera cases at 32% (30166) followed by Jonglei State at 14% (13218) and Central Equatorial State at 13% (12119). Western Equatoria remains the only state to not report any cholera case in the current outbreak. The rapid spread of the disease was driven by inadequate access to clean water and sanitation, widespread flooding, and mass displacement—both from within South Sudan and across the border due to the ongoing crisis in Sudan.

While cases have declined steeply in the last three months (~100 new cases weekly), a few counties in Unity (Rubkona, Mayom, and Mayendit), Jonglei (Duk), Eastern Equatoria (Ikwotos), Warrap (Tonj North), Upper Nile (Renk), and Northern Bahr-el-Ghazal (Aweil Centre and Aweil South) continue to report new cases. With the country’s limited Water, Sanitation and Hygiene (WASH) infrastructure, further worsened by waning immunity from the oral cholera vaccine (OCV) campaigns conducted late last year and this year, population movements and displacement, and flooding; the risk of a resurgence of cases in currently quiet counties remains very high.

To ensure the transmission chain of the current outbreak is broken, we urge for risk-based and proactive response measures in hotspot counties including preventative oral cholera vaccines, climateresilient WASH interventions, and targeted risk communication and community engagement. Longterm efforts to prevent similar outbreaks in the future requires sustainable investments particularly in infrastructure for WASH together with a proactive readiness to prevent cholera outbreaks as outlined in the National Cholera Preparedness and Response Plan.

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