World Bulletin / News Desk

Health workers in South Sudan have been alarmed by a sharp increase in cases of Kala Azar, a fatal disease caused by the bite of the sand fly, in the eastern Jonglei and Upper Nile states, according to an official with Paris-based humanitarian aid agency Doctors without Borders (MSF).

"We are looking at a Kala Azar outbreak," MSF deputy medical coordinator in South Sudan Dr. Ahmed Abdi told Anadolu Agency.

Kala Azar, a Hindi word that means "black fever," is a potentially fatal parasitic disease of the viscera, or internal organs – particularly the liver, spleen, bone marrow and lymph nodes – due to infection by the parasite known as Leishmania donovani.

Kala Azar can cause few or no symptoms, but it is typically associated with fever, loss of appetite, fatigue, enlargement of the liver, spleen and nodes and bone marrow suppression.

"The disease itself is endemic in South Sudan. Usually the peak starts after the rainy season from October; but this year, it started to increase from April," Dr. Abdi told AA.

He said that the number of people arriving from remote areas in the two states to seek treatment – and being diagnosed with Kala Azar – was alarming health workers.

"We have treated 2,000 patients of Kala Azar already this year. This number is high when you compare it with 1,300 in the whole of last year," he added.

"On mortality, I don't have figures, but many people are dying. We also suspect that more people are dying in the remote areas," Dr. Abdi said.

The MSF official noted that, when there is co-infection with HIV/AIDS, the risk of the patient's death is very high due to low immunity – although the number of such cases is very low among Kala Azar patients.

Between 200,000 and 400,000 new cases of Kala Azar – which is considered the most serious form of the leishmaniases disease – occur worldwide each year, according to the WHO, resulting in an estimated 20,000 to 30,000 deaths annually.

Over 90 percent of these cases occur in Bangladesh, Brazil, Ethiopia, India, South Sudan and Sudan.

-Political factor-

According to Dr. Abdi, a political crisis that has gripped the country for months has also been a factor in the rising number of Kala Azar cases.

"The population has fled to the bush where they don't have shelter and are sleeping under trees exposed to sand flies," he explained.

Due to insecurity caused by the rebellion led by sacked vice-president Riek Machar, Abdi said, medical agencies have left areas badly affected by the fighting – leaving only the MSF battling the poor health situation there.

"With the insecurity now, it is only the MSF in… the villages," Dr. Abdi said. "We are treating many patients, like in Lankien [in Jonglei State], where we have 680 patients on treatment and [where] 180 others were recently admitted."

"Another factor is nutrition. If a patient is malnourished, he is at high risk. This is what we are seeing in these areas," he added.

The rainy season, meanwhile, is not making it any easier to deliver drug supplies to affected areas, posing another challenge.

"Supply is a big challenge. It is also difficult to estimate the number of people at risk, since the population are in the bush and displaced," Dr. Abdi said. "We cannot easily transport supplies. Airstrips are sometimes flooded and cut off for weeks."

When approached by AA at a recent press briefing, Health Minister Riek Gai Kok admitted that Kala Azar was on the rise in the two states, lamenting that efforts to fight the disease were being frustrated by a lack of security.

"We have noticed that many people are being affected by Kala Azar in parts of Jonglei and Upper Nile, but efforts to fight the disease are being frustrated by the ongoing conflict – especially in areas controlled by rebel forces," he said.

"But we are doing our best to combat the Kalar Azar pandemic in Jonglei, especially with our health partners from nongovernmental organizations," he added.

South Sudan has been shaken by violence since last December, when President Salva Kiir accused Machar of plotting to overthrow his regime.

Hundreds of thousands of South Sudanese have since been displaced in fighting between the two rivals, which has led to an increasingly dire humanitarian crisis for large swathes of the population.