In a region with limited access to safe water, that’s a red flag. On top of that, it was March – the final month of the dry season. Since November, there had been almost no rainfall and many water sources had dried up. This region often sees no rain at all between November and March.

We knew cholera was a possibility – but we had to be sure.

We collected samples and sent them to the lab. At the same time, we began monitoring case numbers. As soon as the first tests came back positive for cholera, we had to act quickly. The outbreak was now officially confirmed – and every minute counted.

In a region where many people lack access to clean water, a disease like cholera can escalate quickly. One of the most dangerous aspects is that the only available water source is often a river – the same river where animals bathe, where people wash themselves, and from which they drink. In situations like this, contamination with germs can have catastrophic consequences.

We immediately set up a cholera isolation ward at the hospital. 

In Malakal, this was especially challenging, as we already had a separate isolation area for measles. We had to ensure that patients with the two highly contagious diseases wouldn’t come into contact and that other patients would remain protected from infection.

At the same time, we started prevention efforts: we installed additional handwashing stations and educated the public about the importance of hygiene and handwashing.

Our health promoters went into surrounding communities to explain the early symptoms of cholera and when to seek treatment. Cholera is a severe diarrhoeal illness and diseases like this are especially dangerous for small children. Though treatable, an infection can lead to death within just a few hours if left untreated.

In many parts of South Sudan, there are no wells or pumps – people collect water from rivers or ponds, which are often contaminated.

I remember one situation where a mass cattle die-off occurred and hundreds of carcasses were left lying along the riverbank. Yet people had no choice – they had to continue drinking from the river. Many didn’t realise that the water could be dangerous.

Together with the World Health Organization (WHO) and other partners, we tested the water quality and investigated potential sources of contamination. We knew we couldn’t just treat the disease – we had to prevent more people from getting infected.

That’s why we started distributing clean water. In some villages, we used charcoal filters or chlorine treatment to improve the water supply in the long term. We also installed sanitation facilities like latrines.

In addition to treating those already infected, the next major step was vaccination. Cholera can be contained with an oral vaccine – a major advantage, as it allows us to quickly and efficiently vaccinate large groups of people.

Before starting the vaccination campaign for the community, we had to protect our medical teams. Doctors, nurses and support staff are in direct contact with patients, so vaccination is essential for their survival. Only after that could we begin the large-scale rollout for the affected population.

Education also played a crucial role. In crisis areas, people are not generally sceptical of vaccines – but often, they simply don’t know that a vaccine exists. As soon as we explained the purpose and benefits of the vaccine to the first groups, acceptance increased rapidly.