An effort to tackle a hepatitis E outbreak in South Sudan has been hampered by floods that have isolated populations and turned villages into islands.
A groundbreaking vaccination campaign has begun to protect people from a surge in cases, but the true scale of the disease outbreak is unknown.
Health workers from the charity Doctors Without Borders (MSF) are having to take eight-hour boat trips to deliver vaccines to some of the affected villages in Fangak province, northern South Sudan.
Doctors Without Borders said it was aware of 21 deaths and had treated more than 500 people infected with hepatitis E in the past nine monthsbut the majority of people in the region are cut off from healthcare.
It is the first time that a vaccination campaign has been undertaken during the acute phase of a hepatitis E outbreak, with the added logistical problem of shipping the vaccines from China, where they are produced.
Hepatitis E spreads through contaminated water, has no cure and is potentially fatal for pregnant women. Although rare in the developed world, it infects more than 20 million people annually in poorer countries that lack proper sanitation.
Doctors Without Borders wants to reach 12,000 women aged 16 to 45 by June, but faces extreme challenges.
“Fangak Province is located in an extremely remote part of northern South Sudan, on the Sudd Marshes – a vast swampland dotted with small communities, where people have exceptionally limited access to even the most basic health care,” says Mamman Mustapha, MSF worker. head of mission in South Sudan.
“Even getting our routine childhood vaccinations to Old Fangak is a challenge. The hospital can only be reached by boat, across the Nile or by air.”
Repeated floods in Fangak, Jonglei State, have inundated much of the countryside, with repeated flooding also worsening malaria rates as mosquitoes thrive in stagnant floodwaters.
Damage to crops and livestock has also contributed to this malnutrition of childrenwhich in Jonglei was higher than anywhere else in South Sudan, with 130,000 cases in 2023.
Mustapha said the true extent of the hepatitis E problem kills 70,000 people – mostly women – every year, is not known in Fangak.
“We know for a fact that 21 people have died from hepatitis E during this current outbreak, but that is only because they were able to reach hospital. It is very likely that many more people have died at home without even being able to access treatment,” Mustapha said.
Doctors Without Borders says the high cost of vaccines is a barrier to a larger-scale vaccination policy.
The hepatitis E vaccine was recommended for use by the WHO in 2015, but has only been used once before: at the Bentiu displacement camp in South Sudan in 2022.