On February 22, 2023, Medicines' San Frontiers Spain (MSF Spain) in Malakal, Upper Nile State, received an alert of increasing cases of acute watery diarrhea and vomiting in children aged one year and below. Two samples were collected and tested positive for cholera on rapid diagnostic testing (RDT), while nine additional samples were collected and transported to the National Public Health Laboratory in Juba on March 2, 2023, for further testing. Two out of the nine samples tested positive for Vibrio cholerae on PCR testing.

The Ministry of Health received a notification of a suspected case of cholera in Malakal on February 25, 2023. Since then, the Malakal county has continued to receive more alerts of increasing cases of acute watery diarrhea and vomiting. On March 11, 2023, the Malakal cholera update reported a total of 265 cholera cases, including one death, in Malakal, Upper Nile State. Of the reported cases, most are males (147/55%), while 118 accounting for 45% are females. The majority of case patients are between 0-4 years old. Since February, the curve of children under four has represented between 91% to 95% of the reported cases. On March 7, 2023, children from 0 to 4 years old were already 170 (95%) of the 179 cases reported. Of these, 109 (61%) are from Malakal Town, while 70 (39%) are from Malakal Protection of Civilians Sites (POC).

The Malakal PoC site was established during the civil war that began in South Sudan on December 15, 2013, as civilians fled indiscriminate and deliberate attacks. It remains a crucial safe haven for 34,056 IDPs/civilians (source: DRC April 2021 population headcount) who still perceive the security environment outside the PoC site as unsafe. The PoC site serves as a critical coping mechanism for populations facing risk in Malakal and beyond.

On March 7, 2023, with the positive PCR test result, the Ministry of Health declared a confirmed outbreak of cholera in Malakal, Upper Nile State, South Sudan, and issued situation report number one. The government and humanitarian agencies are responding to the outbreak by providing clean water, sanitation, and hygiene services to affected communities. The Ministry of Health is also conducting awareness campaigns to prevent the spread of the disease and ensure early detection and treatment of cases.

The situation in Malakal, Upper Nile State, requires urgent attention and support to prevent the outbreak from escalating further and to mitigate its impact on vulnerable populations, particularly children under four and those living in the Malakal Protection of Civilians Sites.