The city of Kosti in White Nile State is grappling with a dire health crisis as a cholera outbreak sweeps through its communities. This catastrophe is unfolding amid severe shortages in electricity, water, and public health services.
The prolonged power outage has rendered the water purification plant, inaugurated in 2020 with funding from the Japan International Cooperation Agency (JICA), completely inoperative. The facility, which supplies clean water to all of Kosti’s neighbourhoods, has ceased functioning, forcing residents to rely on untreated water sources such as canals and seasonal streams, without taking even the most basic purification measures.
The crisis has been exacerbated by the unregulated water trade, where contaminated water, often transported in barrels on donkey carts, is sold indiscriminately, serving as a primary vector for the spread of cholera.
Meanwhile, authorities have been unable to secure the diesel needed to power the purification plant, which requires more than five barrels daily.
Fatima Mohieddin, a nurse in Kosti, explained to Atar that the outbreak became evident around February 20, when the surge in cholera cases overwhelmed the capacity of Kosti Teaching Hospital. As the only public hospital with an isolation centre, it was forced to erect tents to accommodate patients, while others resorted to lying on the hospital floor.
Despite the unwavering dedication of medical staff, the crisis was compounded by price gouging on intravenous fluids, an exploitation Fatima attributes to opportunists, until intervention by local pharmacists initiatives and humanitarian organizations helped provide these essentials at reduced prices.
early warning signs emerged three weeks prior when the Um Dabakir power plant was targeted by drone strikes from the Rapid Support Forces on February 16
By February 23, field statistics recorded approximately 1,200 cholera cases at the hospital, not including additional cases at external clinics that provide emergency services. Though cases in the state capital, Rabak, remained comparatively lower, both the military and police hospitals also reported admissions.
Mohamed Faisal Dirar, the head of laboratory services at the National Health Insurance Fund’s White Nile branch, indicated that early warning signs emerged three weeks prior when the Um Dabakir power plant was targeted by drone strikes from the Rapid Support Forces on February 16. This attack led to a citywide blackout lasting five consecutive days.
While the central districts regained electricity through rationed supply, only two hours per day, this partial restoration was insufficient for sustained water provision. Outlying neighbourhoods and villages bore the brunt of the crisis, relying on water purchased from “karro” vendors who drew from contaminated seasonal streams. The unchecked consumption of this unsafe water significantly accelerated the spread of cholera.
Officially, the city recorded 2,820 cases and 69 deaths though estimates suggest unreported fatalities could bring the toll to around 140
“Initially, health authorities reported the cases as acute watery diarrhea, but as infections surged, the health minister confirmed that Kosti was facing a full-blown cholera outbreak,” Dr Faisal told Atar.
Officially, the city recorded 2,820 cases and 69 deaths though estimates suggest unreported fatalities could bring the toll to around 140.
Although vaccination campaigns commenced on the second day of the outbreak and have since expanded across Kosti, Fatima noted that public response has been mixed.
Some individuals developed side effects resembling cholera symptoms, including vomiting, diarrhea, nausea, headaches, and fainting, while those who arrived at the hospital in critical condition often suffered from kidney complications, with many diagnosed with renal failure. Others outrightly refused to take the vaccine. In response, residents turned to pharmacies for disinfectants and water purification tablets in an attempt to safeguard themselves.
As the number of cases continues to climb, peripheral areas remain particularly vulnerable due to the lack of health education and awareness about the risks of consuming contaminated water. The outbreak has affected all age groups, from children to the elderly.
Waddah Mutasim, a Kosti resident and nursing student at Imam Mahdi University, recounted to Atar how the situation escalated dramatically from February 20, when daily cholera cases surged to 600. Prior to that, cases had remained limited, rarely exceeding 50.
The root cause of this outbreak is water contamination, a direct consequence of the prolonged power outage
Following his visit to the main water purification plant, now inoperative due to power instability and fuel shortages, Waddah witnessed the health minister allocate an open budget for fuel to resume water pumping and mandate increased chlorine levels for disinfection. However, cases still spiked later that evening, reaching 1,200.
Waddah believes the ministry’s measures fell short, pointing out that the worst affected areas are the peripheral districts, particularly Hilla Jadida, where water supplies remain non-existent.
“The root cause of this outbreak is water contamination, a direct consequence of the prolonged power outage,” he emphasized.
At the onset of the outbreak, diagnoses were based solely on symptomatic assessment due to the absence of laboratory testing. Over time, lab-based confirmation became standard practice.
Initially, patients had to purchase IV fluids and medications at their own expense, but intervention from the National Health Insurance Fund secured 3,000 units of IV fluids, while international organisations, including Médecins Sans Frontières (Doctors Without Borders), UNICEF, and the Red Cross, provided substantial medical aid, allowing the hospital to offer free treatment.
Intensive awareness campaigns have since been launched to educate the public about cholera prevention. As part of containment efforts, local authorities ordered the closure of schools and kindergartens, a decision widely welcomed by the community, which contributed to curbing the spread of infection. Additionally, deceased victims were handled under strict health protocols, with burial procedures supervised by isolation centre teams to ensure compliance with sanitary measures.
Meanwhile, medical staff adhered to World Health Organization (WHO) protocols, categorizing patients into three isolation zones: the red zone for critical cases, the yellow zone for those stabilizing but still requiring medical supervision, and the white zone for recovered patients ready for discharge.
Thanks to the efforts of the Red Crescent and Doctors Without Borders, medical services in Kosti have somewhat stabilized.
By February 25, the number of infections and fatalities had begun to decline, with recovery rates improving due to measures taken to address water contamination. However, the city remains in dire need of additional protective equipment for healthcare workers and an increased supply of cholera vaccines to prevent a resurgence of the outbreak.
On February 21, the number of infections had surged dramatically. Many cases and fatalities went unreported, according to Waddah, who noted:
“Some patients died within a day of showing symptoms, while others succumbed on the second day.”
In response to the outbreak, authorities took swift action.
On the second day of the epidemic, restaurants were shut down and street vendors were banned. By the following day, all shops near the hospital were closed. Private clinics and hospitals, which had suspended operations on the first day, reopened by the third day. Meanwhile, Kosti Teaching Hospital dedicated all its departments to isolation and treatment.
Gradually, paediatric, internal medicine, and surgical wards resumed operations, along with the hospital’s laboratory, except for the emergency unit, which remains designated as an isolation centre.
Wajdi Mohammed, a volunteer at Kosti’s isolation centre, told Atar that by the eighth day of the outbreak, more than 2,000 cases had been admitted, with approximately 105 recorded deaths. However, fatalities have since declined to just two per day, while recovery rates soared to between 20 and 25 cases daily.
Wajdi attributed this improvement to a stabilized supply of medications and the presence of volunteers who provided meals for healthcare workers, patients, and their attendants. Wajdi also noted that water supplies had stabilized after several organizations contributed fuel to the water authority.
Kosti’s geographic and topographic features have played a critical role in shaping the city’s vulnerability to health crises. Situated on the flat plains of the White Nile’s western bank, Kosti is highly susceptible to flooding. Compounding this risk is its clay-rich soil, which hinders water absorption and infiltration into the ground. With no proper drainage systems in place, the city faces extreme fragility in managing floods and water stagnation, leading to the formation of ponds and swamps that create ideal breeding grounds for disease.
Cholera is caused by bacterial infection resulting from the consumption of contaminated water. Flooding accelerates the spread of the disease by increasing water contamination, often due to the destruction of sanitation facilities, which forces people to resort to open defecation and urination. These factors collectively create the perfect conditions for the Vibrio cholerae bacterium to thrive.
Global reports indicate a significant rise in annual cholera cases over the past few years. While estimates in September 2024 recorded 342,800 infections, figures from December 2024 suggest the number has surged to between 1.3 million and 4 million.
Scientists attribute this increase to global warming, which fosters environments conducive to bacterial growth, as well as ongoing armed conflicts in African nations that hinder vaccine distribution and access to healthcare services.
