July 12, 2006 (JUBA) — As southern Sudan emerges from decades of devastating civil war that has killed an estimated 2 million people, diseases believed to have been under control are resurfacing, the World Health Organization (WHO) has warned.
"South Sudan has pretty much all the neglected diseases and has them in large quantities," said Mickey Richer, WHO communicable disease officer in southern Sudan. "These are not new diseases, but during the war health systems broke down and now the health system needs to be strengthened to get, and keep, them under control."
These so-called neglected tropical diseases include leprosy, elephantiasis, Kala Azar, which breaks down the immune system, river blindness, cholera, sleeping sickness, guinea worm and Buruli ulcer, described by one doctor as the ’flesh-eating disease’.
The populations most affected often are also the poorest and most vulnerable and are found mainly in tropical and subtropical areas. "These diseases don’t have a high visibility, because they occur among populations living in remote areas; they affect people ’at the end of the road’," Richer observed.
Some diseases affect individuals throughout their lives, causing physical disability and, in certain cases, gross disfigurement. Others are acute infections, with severe and sometimes fatal outcomes.
Even if patients survive a neglected disease, the resulting disability or disfigurement has large socio-economic implications, leaving them unable to work or shunned by their communities.
"These diseases also suffer from the lack of resources and research attributed to them," said the WHO’s communicable disease programme officer Jose Antonio Ruiz. "The drugs we are using for sleeping sickness, for example, were developed in the 1950s."
Over the past five years, WHO has developed a special unit to deal with neglected diseases, and some NGOs are campaigning for the development of new and more effective drugs to fight these illnesses. In southern Sudan, the Ministry of Health is working to increase the necessary laboratory capacity to diagnose cases more quickly so treatment is more rapid and the response more effective.
With the advent of peace, many more cases of neglected diseases are being discovered in previously isolated communities, Ruiz observed, while the increased movement of people also increases the risk of further transmission. "Non-immune people moving into an endemic area for a certain disease can quickly develop the disease if they don’t observe the correct precautions," he added.
Large-scale, regular treatment with effective and often inexpensive drugs plays a central role in the control of many neglected diseases. For another category of these diseases, mass drug administration is less effective and the only option is actively tracking case histories, allowing for more effective management at an early stage.
"For both methods of disease control to be successful you need a functioning health system with structures in place, the human resources required to carry out the programmes and ready access to often remote populations - all of which are problematic in southern Sudan at this moment in time," Richer observed.