The tankers that roar down the streets of the Southern Sudanese capital of Juba carry precious water, but health experts suspect much of what they deliver is contaminated.
"The sources of the water are often contaminated, the containers used to ferry it are contaminated and the people [are unknowledgeable] about the best way to avoid diseases," an aid worker in the town said.
Juba has neither a functioning water nor sewerage system. Whatever existed in the 1950s and 1960s was destroyed during more than two decades of conflict between the South and North.
The situation has been compounded by generally poor hygiene. Recently there have been reports of diarrhoeal disease outbreaks, including suspected cholera cases.
"The sanitation situation is deplorable," said Sahr Kemoh, emergency water and sanitation project officer for the UN Children's Fund (UNICEF), in Juba. "No latrines [and] the indiscriminate disposal of garbage."
In May, a diarrhoeal disease outbreak was reported in the Juba military barracks - a unit that houses about 6,000 people, including a joint integrated force made up of both northern and southern troops.
There have also been suspected cases in Eastern Equatoria. Alfred Alunyo of the UN World Health Organization office for Southern Sudan said samples had been sent to Nairobi for analysis after rapid tests found cholera in three out of 53 suspected cases.
"That is a cumulative number for four weeks," Alunyo said. "When we add on the [suspected] cases from this week, we expect it to increase to more than 80."
The Eastern Equatoria outbreak has yet to be confirmed, said Heather Dunlop, emergency preparedness and response officer at the UN Office for the Coordination of Humanitarian Affairs in Juba. A team was due to visit Magwi, Palajok and Owiny Ki-Bul to assess the situation.
Meanwhile, three reported cases from the barracks were referred to Juba teaching hospital – the only main health facility in the town, but sources said the facilities were inadequate.
"The clinic being used for treating this is a general clinic and there is concern that it would spread fast among the population," Kemoh said.
The situation in the barracks was compounded because the soldiers shunned a borehole, claiming the water was salty. Instead, they chose to collect their water from shallow wells. "These [wells] are unprotected sources," he added.
Samples collected from these wells by the Swedish Flemish Mission for analysis confirmed one borehole was polluted, according to Charles Gale, UNICEF's project manager for water and environmental sanitation in Southern Sudan.
Access to latrines
Millions of people across Southern Sudan, especially women and children, lack access to adequate safe drinking water. While more than 20 million people lack access to sanitation, 17 million have no source of safe drinking water, according to UNICEF.
|Cases of cholera have been rising, stemming from sharp increases in the population as people return from being displaced and find few essential services such as safe drinking water or proper sanitation|
As a result, disease outbreaks are rampant. In April, an outbreak was reported in Yei. According to the NGO Medair, diarrhoeal diseases have become an endemic problem in Yei town this year, with cases rising with the onset of rains.
Between 12 March and 5 April, 118 cases of acute watery diarrhoea were seen in Yei hospital. "Across Southern Sudan, cases of cholera have been rising in the last two years, stemming from sharp increases in the population, as people return from being displaced and find few essential services such as safe drinking water or proper sanitation," the NGO said in a statement on 25 April.
Health experts say two peak periods of cholera outbreaks have been recorded annually in Sudan since 2005: from late January to mid-March and April up to mid-May, when the rains start. This year, efforts to raise awareness have been increased.
"I think the government has done a lot of cholera preparatory work," said Dunlop, who sits on the emergency preparedness and response task force made up of aid agencies and the Southern Sudan health ministry.
Ban untreated water
In the long run, say aid workers, the solution for Juba is to ban trucks that ferry and sell untreated water from the River Nile where most of the town’s sewage is dumped. In return, water pressure pumps and treatment tablets should be provided at specific areas.
And people should be encouraged to dig latrines, although this has proved to be a challenge. At the barracks, for example, the soldiers were reluctant to build their own pit latrines. Last week, prefab latrines were delivered there.
"They were asking for incentives for digging their own pit latrines," Kemoh said, "until the aid agencies went through a local official who went through the senior commanders. In [a] couple of hours, five pits were ready for installation of slabs."