Cholera Outbreak in South Sudan
“WaterStep doesn’t wait for the perfect conditions. We’re a global network confident to go where the need is greatest, no matter how difficult or dangerous.”
– Mark Hogg, Founder & CEO, WaterStep
Ayok Khot Kuol has watched so many people die from cholera in Duk County, South Sudan. As emergency response manager, Ayok is in charge of the John Dau Foundation’s cholera response, so he’s accustomed to disasters, even death.
But one recent case haunts him.
A mother named Achol, who was still breastfeeding her 5-month-old son, Wal, arrived at the Panaruu Primary Health Care Center on her husband’s shoulders. He and his brothers had taken turns carrying her 50 miles from Majok Island. They walked for 27 hours. Her baby squalled out of hunger, trying to feed at her breast, but there was no milk.
Achol was already dead. She was just 26.
There was nothing doctors could do, Ayok said. And then they realized her husband was infected, too, from the bodily fluids that leaked onto him as he carried her.
“I cried,” Ayok said.
Ayok’s team remains overwhelmed. The nine clinics run by the John Dau Foundation – founded by former Lost Boy and genocide survivor John Dau – are so crowded that doctors have been forced to treat patients outside on the dusty ground. Their IV bags hang from trees. There’s no safe water or disinfectant.
And patients just keep coming. They travel mostly by foot, by canoe if they’re lucky, for two or more days to get to a clinic because there are no roads, and patients live in such remote areas.
Today, the outlook remains bleak. If the outbreak isn’t contained, tens of thousands of people could die, Ayok said.
“If WaterStep does not step in, there is nobody else,” he said. “There is no hope.”
Partnerships will bring relief
WaterStep, a world leader in safe water solutions and innovation, is partnering with the John Dau Foundation, Christ Mission to the World, and In Deed and Truth Ministries, to strategically respond to the cholera outbreak. WaterStep is deploying epidemic abatement kits to 12 healthcare facilities across five counties – Duk, Uror, Juba, Aweil and Tonj – that will reach the most remote and hardest hit communities. These epidemic abatement kits include BleachMakers, handwash stations, Woundwise Care kits, and essentials kits for hygiene. This strategic response is expected to impact more than 40,000 people.
“When people are desperate, they turn to us,” said Mark Hogg, WaterStep founder and CEO. “The situation in South Sudan is beyond critical, and without immediate action, the consequences will be devastating.
“WaterStep doesn’t wait for the perfect conditions. We’re a global network confident to go where the need is greatest, no matter how difficult or dangerous. For 30 years, we’ve known safe water and disinfectant will bring hope, health, and save lives. When the world feels like it’s falling apart, we do
our best to make it right.”
South Sudanese authorities declared a cholera epidemic in October 2024 for the northern town of Renk, which is the main entry point for refugees fleeing the conflict in neighboring Sudan.
Since that time, the outbreak has spread across most of the country, including the capital city of Juba, infecting nearly 27,000 people. A combination of historic flooding and a crush of refugees pouring in since December has pushed the government to a breaking point in its ability to respond.
The cholera outbreak remains uncontained.
“We’ve seen these outbreaks before, and we know what needs to be done,” Mark said. “WaterStep has the experience and the tools to equip locals to stop cholera in its tracks, and with the support of our partners, we’re stepping in where it counts.
“This response isn’t just about providing safe water. It’s about preventing a catastrophe. We’re here to make sure this outbreak doesn’t spread further and to give these communities the resources they need to survive and recover. Every day, lives are lost – and that’s why we’re acting now, to change the course of this outbreak.”
Making history
WaterStep has extensive experience responding to disease outbreaks. In fact, the organization’s patented BleachMaker was developed in response to the Ebola outbreak in Liberia in 2014.
After nearly two years of development and field testing, the device was launched in 2016. In 2017, WaterStep’s BleachMaker won the Environmental Protection Agency’s Award for New Product of the Year.
In 2018, when the Democratic Republic of Congo experienced the second largest Ebola outbreak on record, which lasted nearly two years, WaterStep provided life-saving training and equipment. Because of the geography of where the outbreak occurred, transporting liquid bleach to the area was nearly impossible.
WaterStep’s intervention filled a critical need by allowing medical personnel to produce large quantities of bleach that exceeded World Health Organization standards to treat medical waste. The patented device uses nearly any source of water, ordinary table salt, and a 12-volt power source like a car battery to produce a bleach solution in less than 90 minutes.
“In 2019 alone, more than 100 doctors used WaterStep’s BleachMaker to significantly help reduce further infection of the Ebola virus in the DRC,” Dr. J.J. Muyembe, National Institute for Biomedical Research, Minister of Health, The Democratic Republic of Congo, said in 2020.
Dr. Jean Claude Luhere, a practicing physician, consultant and co-founder of Helping Hand for Survivors, worked with WaterStep to create a strategic response to that outbreak.
A Congolese native, Jean Claude took a map of hospitals and overlayed population numbers to develop a T-technique response. Hospitals along horizontal and vertical lines received tools and training because he knew people would have the best chance to connect on these well-traveled roads.
The science of the BleachMaker is elementary, Jean Claude said, but the effect was extraordinary. The high concentration of bleach was used to disinfect every surface imaginable – bathrooms, medical suits, surgical gloves. It was also used to clean up after blood and medical waste. He started in intensive care units created for Ebola patients, he said, and in fewer than five days, hospitals saw improvements in infection rates.
“It saved millions of lives,” he said.
WaterStep is now using a similar T-technique to respond to the cholera outbreak in South Sudan.
“Our mission is simple,” Mark said. “Get the right resources to the right places, fast, to stop the spread and save lives. Our responsibility is clear. We are called to act when others can’t. In these moments, we trust there’s something bigger going on than ourselves. Doing what’s necessary isn’t always easy, but it’s right.”
Worrying about what’s to come
John Dau, founder and president of the John Dau Foundation, recently visited WaterStep’s international headquarters in Louisville to solidify the partnership between the two organizations to respond to the cholera outbreak in his home country. He’s in touch with his teams daily. All he hears is desperation. People don’t know whether their loved ones will make it. And time is running out because cholera can kill within hours.
The stakes are high, he said. If the war against cholera is lost, people are going to die in big numbers. So, WaterStep’s efforts are monumental because the only thing that matters is the work to keep people alive.
“It means the world to us,” John said. “It means the world to the people of South Sudan by having WaterStep join the war against cholera. … WaterStep is a Godsend to us.”
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