Refugees in South Sudan, having fled the ongoing civil war in Sudan, are faced with harsh living conditions and limited access to sanitary facilities, potable water, and medical care. There are 169,463 Sudanese refugees in South Sudan, with 104,960 in upper Nile State and 64,503 in Unity State. Although diarrheal disease is the leading cause of death due to deplorable living conditions in these camps, refugees in some camps are faced with a new burden. Recently, an outbreak of hepatitis E has infected close to 400 and left 16 dead in three separate refugee camps.
Hepatitis, an inflammation of the liver, is commonly caused by viral infection. According to the WHO, hepatitis E is included amongst the most concerning iterations of the disease (types A, B, C, D and E) because its epidemic potential. Unsanitary living conditions have allowed hepatitis E to flourish. As stated by the WHO, "hepatitis A and E are typically caused by ingestion of contaminated food or water," so the fecal-oral route is likely the primary route of transmission in these refugee camps.
Flooding has contributed to sources of contaminated surface water, exasperating the situation.
Clinical symptoms manifest themselves differently throughout populations. Symptoms of acute infections range from nothing at all, to jaundice, dark urine, nausea, vomiting and extreme fatigue. In severe cases, a patient may present with acute or subacute liver failure. In population based outbreak surveys, a low mortality rate has been identified (0.07-0.6 percent).
More than 380 cases have been identified since the outbreak was first recognized in July according to South Sudan's Ministry of Health. Of the 16 recorded deaths, according to the UN Refugee Agency (UNHCR), 13 were identified in Jamam camp out of 255 cases of acute jaundice syndrome, two in Yusuf Batil out of 77 cases, and one in Gendrassa out of 52 diagnosed cases. One case has been diagnosed in Doro camp, but no deaths have been recorded. Collectively, these four camps in South Sudan are home to about 110,000 refugees. Pregnant women are particularly susceptible to the disease and represent a much high death rate than the normal population. Five of the 16 deaths were pregnant women.