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Sudan

Sudan US Consular Information Sheet
August 29, 2008
COUNTRY DESCRIPTION:
Sudan is a diverse, developing country in northeastern Africa. The capital city is Khartoum. The civil war between the northern and southern regions, which began in 1
83, ended in 2005. A multi-party conflict continues in the west in Darfur, and the armed Ugandan group known as The Lord’s Resistance Army is present in the south. Security conditions are adverse in these and some other regions. Transportation networks and other forms of infrastructure are poor and do not meet western standards. Even where available, water and electric services suffer frequent outages. Read the Department of State Background Notes on Sudan for additional information.

ENTRY/EXIT REQUIREMENTS: The Government of Sudan requires all travelers to present a passport and an entry visa. Most travelers must obtain the entry visa before arrival; only American citizens who also possess a Sudanese national identification document (such as a Sudanese passport or national identification card) may apply for an entry visa at Khartoum International Airport. The Government of Sudan routinely denies visas to travelers whose passports contain visas issued by the Government of Israel or other evidence of travel to Israel such as exit or entry stamps.

Travelers must obtain an exit visa before departure from Sudan as well as pay any airport departure tax not included in the traveler’s airline ticket. Visitors may obtain the latest information and further details from the Embassy of Sudan, 2210 Massachusetts Avenue NW, Washington, DC 20008, tel.: 202-338-8565.

Travel permits issued by the semi-autonomous Government of Southern Sudan (GOSS) or by the South Sudan Relief and Rehabilitation Commission (SSRRC) are not adequate for entry to the country, although travelers may find these documents useful to present to local authorities when in the south. Personal baggage, including computers, is routinely searched upon arrival to and departure from Sudan. The authorities will seize material deemed objectionable, such as alcohol or pornography, and may detain or arrest the traveler. Travelers intending to bring electronic items should inquire about entry requirements when they apply for a visa; restrictions apply to many devices, including video cameras, satellite phones, facsimile machines, televisions, and telephones. Travelers are not allowed to depart Sudan with ivory, some other animal products, or large quantities of gold.

All visitors must register with the authorities within three days of arrival. Travelers must register within 72 hours of arrival in Sudan at the Ministry of Interior. All foreigners traveling more than 25 kilometers outside of Khartoum must obtain a travel permit from the Ministry of Humanitarian Affairs in Khartoum. This applies to all travel, including private, commercial, and humanitarian activities. Americans risk detention by Sudanese authorities when traveling more than 25 kilometers outside of Khartoum without a travel permit issued by the Ministry of Humanitarian Affairs. Travelers must register again with the police within 24 hours of arrival. The government requires a separate travel permit for travel to Darfur. These regulations are strictly enforced and even travelers with proper documentation may expect delay or temporary detention from the security forces, especially outside the capital. Authorities expect travelers to strictly respect roadblocks and other checkpoints.

Travelers who wish to take any photographs must obtain a photography permit from the Government of Sudan, Ministry of Interior, Department of Aliens.

Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
On January 1, 2008, unknown assailants shot and killed two U.S. Embassy employees - an American USAID officer and a Sudanese national driver. Terrorists are known to operate in Sudan and continue to seek opportunities to carry out attacks against U.S. interests. Terrorist actions may include suicide operations, bombings, or kidnappings. U.S. citizens should be aware of the risk of indiscriminate attacks on civilian targets in public places, which include tourist sites and locations where westerners are known to congregate, and commercial operations associated with U.S. or Western interests. Terrorists are known to have targeted both official facilities and residential compounds. Anti-American sentiment is prevalent and Americans should exercise utmost caution at all times.

The U.S. Embassy’s ability to provide consular services in Sudan, including emergency assistance, is severely limited. Many areas outside the capital of Khartoum are extremely difficult to access.

Travel in many parts of Sudan is hazardous. Outside the major cities infrastructure is extremely poor, medical care is limited, and very few facilities for tourists exist.

Conflict among various armed groups and government forces continues in western Sudan, in the states of North Darfur, South Darfur, and West Darfur. Banditry and lawlessness are also common in the west. Many local residents are in camps for internally-displaced persons, and receive humanitarian assistance for basic needs such as food, water, and shelter. Expatriate humanitarian workers have been the targets of carjackings and burglaries.

Land mines remain a major hazard in southern Sudan, especially south of the city of Juba. Visitors should travel only on main roads unless a competent de-mining authority such as the UN has marked an area as clear of mines. The armed Ugandan group known as The Lord’s Resistance Army is present along the southern border and reportedly has announced it will target Americans.
Occasional clashes between armed groups representing communal interests continue to occur in the centrally-located states of Upper Nile, Blue Nile, and Bahr al Ghazal. Banditry also occurs.
Sudan shares porous land borders with nine other countries, including Chad, the Central African Republic, Uganda, Democratic Republic of Congo, Ethiopia, and Eritrea. Conflict in these countries occasionally spills over into Sudan.

Americans considering sea travel in Sudan's coastal waters should exercise caution as there have been incidents of armed attacks and robberies by unknown groups in recent years, including one involving two American vessels. Exercise extreme caution, as these groups are considered armed and dangerous. When transiting in and around the Horn of Africa and/or in the Red Sea near Yemen, it is strongly recommended that vessels convoy in groups and maintain good communications contact at all times. Marine channels 13 and 16 VHF-FM are international call-up and emergency channels, and are commonly monitored by ships at sea. 2182 Mhz is the HF international call-up and emergency channel. Wherever possible, travel in trafficked sea-lanes. Avoid loitering in or transiting isolated or remote areas. In case of emergency, contact the nearest U.S. Embassy or Consulate. In the event of an attack, consider activating Emergency Position Indicating Radio Beacons.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME: Crime is on the increase throughout Sudan. Additional security measures should be taken at places of residence to protect life and property. Anti-American sentiments can be found throughout the country. Americans should exercise caution by avoiding crowded public areas and public gatherings. Americans should avoid traveling alone. Report all instances of anti-American acts and crime targeting westerners to the American Embassy, and report incidents of crime to the Sudanese Police.

Americans should guard their backpacks or hand luggage. When traveling by air, travelers should maintain constant contact with their baggage and assure that they do not contain illicit items, such as alcohol or military ordinance. Americans have been removed from international airlines and detained when suspect items have been detected in checked baggage.

Carjacking and armed robbery continue to occur in western and southern Sudan. Sexual assault is more prevalent in the areas of armed conflict. Travelers who do not use the services of reputable travel firms or knowledgeable guides or drivers are especially at risk. Travel outside of Khartoum should be undertaken with a minimum of two vehicles so that there is a backup in case of mechanical failure or other emergency. Solo camping is always risky.

The Sudanese mail system can be unreliable. International couriers provide the safest means of shipping envelopes and packages, although anything of value should be insured.

INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Individuals with medical conditions which may require treatment are discouraged from traveling to Sudan. Medical facilities in Khartoum fall short of U.S. standards; outside the capital, very few facilities exist and hospitals and clinics are poorly equipped. Travelers must pay cash in advance for any medical treatment. Ambulance services are not available. Medicines are available only intermittently; travelers should bring sufficient supplies of needed medicines in clearly-marked containers.

Malaria is prevalent in all areas of Sudan. The strain is resistant to chloroquine and can be fatal. Consult a health practitioner before traveling, obtain suitable anti-malarial drugs, and use protective measures, such as insect repellent, protective clothing, and mosquito nets. Travelers who become ill with a fever or a flu-like illness while in Sudan, or within a year after departure, should promptly seek medical care and inform their physician of their travel history and the kind of anti-malarial drugs used. For additional information about malaria and anti-malarial drugs please see the Center for Disease Control travelers’ health web site, http://www.cdc.gov/malaria/index.htm.

Officially, people with HIV are not granted a visa and are not permitted to enter Sudan. A negative HIV test result must be presented at a Sudanese embassy or at Khartoum airport in order to obtain a visa. However, anecdotal reports indicate this requirement is not enforced in practice. Please confirm this requirement with the Embassy of Sudan at www.sudanembassy.org.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Sudan is provided for general reference only, and may not be accurate in a particular location or circumstance.

Road conditions throughout Sudan are hazardous due to erratic driver behavior, pedestrians and animals in the roadways, and the lack of basic safety equipment on many vehicles. Only major highways and some streets in the cities are paved; many roads are narrow, rutted, and poorly maintained. Local drivers do not observe conventions for the right-of-way, stop in the road without warning, and frequently exceed safe speeds for road, traffic, and weather conditions. Driving at night is dangerous and should be avoided if possible; many vehicles operate without lights.

In the north and west, dust storms and sand storms, known locally as haboobs, greatly reduce visibility when they occur. Roads in these areas can be quickly covered with shifting sand at any season of the year. Roads in southern Sudan often are impassable during the rainy season, from March to October.
U.S. citizens are subject to the laws of the country in which they are traveling, including traffic laws. In Sudan vehicles have the steering wheel on the left side and drivers use the right side of the road.

Traffic from side streets on the right has the right-of-way when entering a cross street, including fast-moving main streets. Traffic on the right has the right-of-way at stops. Right turns on a red light are prohibited. Speed limits are not posted, but the legal speed limit for passenger cars on inter-city highways is 120 kph (about 70 mph), while in most urban areas the limit is 60 kph (about 35 mph.) The speed limit in congested areas and school zones is 40 kph (about 25 mph).

Many local drivers carry no insurance despite the legal requirement that all motor vehicle operators purchase third-party liability insurance from the government. Persons involved in an accident resulting in death or injury must report the incident to the nearest police station or police officer as soon as possible. Persons found at fault can expect fines, revocation of driving privileges, and jail sentences, depending on the nature and extent of the accident. Persons convicted of driving under the influence of alcohol face fines, jail sentences, and corporal punishment.

Americans may use their U.S. driver's licenses for up to 90 days after arrival in Sudan, and then must carry either an International Driving Permit (IDP) or a Sudanese driver's license. There are no restrictions on vehicle types, including motorcycles and motorized tricycles.

Public transportation is limited to within and between major urban areas. Passenger facilities are basic and crowded, especially during rush hours and periods of seasonal travel. Schedules are unpublished and subject to change without notice. Vehicle maintenance does not meet U.S. standards. There is routine passenger train service on the route from Khartoum to Wadi Halfa (on the border with Egypt) and to Port Sudan (on the Red Sea.) Bus service between major cities is regular and inexpensive. Intra-city bus service in the major urban areas is regular, but most buses and bus stops are privately-operated and unmarked. Taxis are available in the major cities at hotels, tourist sites, and government offices. The motorized rickshaws in common use in Khartoum are unsafe. Travelers are encouraged to hire cars and drivers from reputable sources with qualified drivers and safe vehicles. Irregularly-scheduled mini-buses provide some public transit to rural communities; many areas lack any public transportation.

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Sudan, the U.S. Federal Aviation Administration (FAA) has not assessed Sudan’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

Enforcement of aviation safety standards in Sudan is uneven; civil aviation in Sudan continues to experience air incidents and accidents, including 5 crashes with at least 64 fatalities between November 8, 2007, and June 30, 2008. Incidents included engine failures, collapsed landing gear, and planes veering off the runway. Whenever possible, Americans traveling to Sudan despite the ongoing travel warning are advised to travel directly to their destinations on international carriers from countries whose civil aviation authorities meet international aviation safety standards for the oversight of their air carrier operations under the FAA’s International Aviation Safety Assessment (IASA) program. Adverse seasonal weather conditions, such as dust or sand storms in the north between April and June and severe rain storms in the south between March and October, cause frequent flight cancellations.

Two hijackings originated in Sudan in 2007; no passengers were harmed.

SPECIAL CIRCUMSTANCES: In November 1997, the U.S. imposed comprehensive financial and commercial sanctions against Sudan, prohibiting U.S. transactions with Sudan. Travelers intending to visit Sudan despite the Travel Warning should contact the Department of the Treasury, Office of Foreign Assets Control (OFAC), Office of Compliance, telephone 1-800-540-6322 or 202-622-2490, regarding the effect of these sanctions.

Travelers must be prepared to pay cash for all purchases, including hotel bills, airfares purchased locally, and all other travel expenses. Major credit cards, including Visa, MasterCard, or American Express, cannot be used in Sudan due to U.S. sanctions. Sudan has no international ATMs. Local ATMs draw on local banks only.

Travelers, including journalists, must obtain a photography permit before taking any photographs. Even with a photography permit, photographing military areas, bridges, drainage stations, broadcast stations, public utilities, slum areas, and beggars is prohibited.

Sudan is a conservative society, particularly in the capital and other areas where the Muslim population is the majority. Alcohol is prohibited by law and modest dress is expected. Loose, long-sleeved shirts and full-length skirts or slacks are recommended attire for women visitors. Women who are not Muslim are not expected or required to cover their heads. Men may wear short-sleeved shirts but short pants are not acceptable in public.

Please see our information on Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Sudanese laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in alcohol or illegal drugs in Sudan are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States as well in Sudan.

Sudan’s Public Order Courts have continued to serve as the state mechanism for morality enforcement since the early 1980's. Today the court still issues punishments ranging from fines, to lashings, to lengthy prison sentences for offences such as drinking alcohol, wearing inappropriate clothing, or associating with unmarried women.

Please see our information on Criminal Penalties.

CHILDREN'S ISSUES: For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Sudan are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Sudan. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at Sharia Ali Abdel Latif, Khartoum, Sudan; tel: 249 1 83 774-701, http://sudan.usembassy.gov/.
* * *
This replaces the Country Specific Information dated March 12, 2008, to update sections on Entry/Exit Requirements, Medical Facilities and Health Information, Aviation Safety Oversight, and Criminal Penalties.

Travel News Headlines WORLD NEWS

Date: Fri, 19 Apr 2019 04:57:44 +0200
By Fran BLANDY

Udier, South Sudan, April 19, 2019 (AFP) - By the time he was brought into the remote clinic in northeastern South Sudan, two-year-old Nyachoat was already convulsing from the malaria attacking his brain.   After being given medication he lies fast asleep, naked and feverish, attached to a drip, his anxious mother sitting on the bed next to him.   Nyachoat could be saved, but others are not so lucky.   In South Sudan mind-bending horrors abound of war, ethnic violence, rape, hunger and displacement.

But for civilians living in the shadow of conflict, the greatest danger is often being cut off from health services, whether due to violence or lack of development in the vast, remote areas that make up much of the country.   According to the International Committee of the Red Cross (ICRC), which supports the tiny clinic where Nyachoat is recovering in Udier village, 70 percent of all illness deaths are due to easily treatable malaria, acute watery diarrhoea and respiratory infections.   In case of more serious illness there is "no place" to go, said Nyachoat's 22-year-old mother Buk Gader.

A study by the London School of Hygiene and Tropical Medicine (LSHTM) last year showed almost 400,000 people had died as a result of South Sudan's nearly six-year war.   Half of these were due to violent deaths, and half because of the increased risk of disease and reduced access to healthcare as a result of the conflict.   ICRC health field officer Irene Oyenya said the Upper Nile region was particularly affected.   "There were (aid) organisations which were supplying primary healthcare, but then during the war, most of the organisations got evacuated" and pulled out of the country, she said.

- Blocked by swamps -
Udier is a village with a dirt airstrip whose sun-baked sand, which when not used by twice weekly ICRC flights bringing medicine and supplies, serves as a football pitch for youths. It is also a pedestrian highway for those who come from far flung huts and cattle camps to market.   In the tiny market, there is little fresh food available. Villagers can buy red onions or sit for a strong Sudanese coffee, infused with ginger, while in the dry season nomadic Falata herdswomen in flowing dresses sell milk from their cattle.   A brick building next to the airstrip, its roof long blown off in a storm, is the village school, but for several days in a row no teacher shows up.   In the surrounding villages, women are hard at work mudding their huts and re-thatching the roof in anticipation of the rains to come within weeks.

When they do come, swelling the swampy marshlands and rivers for miles around, roads will become impassable.    It becomes "difficult for young children to swim or women or men to carry patients to reach here," said Oyenya.   Marginalised for decades prior to independence from Sudan in 2011, and engulfed in war since 2013, South Sudan has seen little development. The healthcare sector is one of many propped up by international aid organisations.   However, the country is also the most dangerous for humanitarian workers with around 100 killed over the past five years, according to United Nations figures. Dozens of organisations have been forced to pull out of areas they served due to the conflict.

The Upper Nile region, where Udier is situated near the borders of Sudan and Ethiopia, was wracked by conflict in 2017 as government forces waged a major offensive to seize the opposition-held town of Pagak.   The ICRC was forced to evacuate patients and staff from its hospital and health centre in the village of Maiwut which was looted, leaving "not even a needle on the ground", according ICRC's Oyenya.   Many relocated to Udier, which was spared from fighting.   A year later in 2018, angry protesters looted around 10 humanitarian agency compounds in the town of Maban, 72 kilometres (44 miles) north of Udier.   ICRC's head of delegation in South Sudan, James Reynolds, said a peace deal signed in September 2018 "has improved security, mobility, and access for humanitarian workers".   But fresh fighting in the southern Equatorias region "has made access to certain areas very difficult."

- Women bear the burden -
In opposition-held Udier, the clinic supported by the ICRC provides crucial healthcare support to the region, where like throughout South Sudan, maternal and child mortality is sky-high.   Every day a small group of patients sits outside under a fragrant Neem tree, waiting to be helped, some from nearby while others have walked for a day or two.   Oyenya says a major challenge is that women, who do all the heavy work and take care of up to 10 children, may delay bringing them to the centre in time. That can be deadly.

Sometimes the children come alone: a nine-year-old girl in a purple polka dot dress confidently tells Oyenya she is suffering from bloody diarrhoea and, she thinks, malaria. Her parents are nowhere in sight.   For anything more serious, such as pregnancy complications, blood transfusions and operations, the nearest hospital is in government-held Maban, a five-hour drive away or a three-day walk.   The other option is a three-day walk to Gambella in Ethiopia.   "They may reach there alive, or they may not reach there alive," said Oyenya.
Monday 25th March 2019
https://www.afro.who.int/news/south-sudan-launches-yellow-fever-vaccination-campaign-stop-outbreak-sakure-nzara-county

South Sudan launches Yellow Fever vaccination campaign to stop outbreak in Sakure, Nzara county Gbudue State 
 
Yambio, 25 March 2019 – The Ministry of Health with support from the World Health Organization (WHO) and partners launched a reactive yellow fever (YF) vaccination campaign in Sakure, Nzara County Gbudue State to vaccinate 19,578 individuals aged 9 months to 65 years against YF.

The vaccination campaign follows the declaration of a yellow fever outbreak on 29 November 2019, where a total of three laboratory confirmed cases with no deaths have been reported after investigations were carried out in Sakure payam.

In December 2018, a team comprising of epidemiologists, a public health officers, entomologists; laboratory specialists as well as risk communication experts carried out detailed epidemiological, laboratory, and entomological investigations to determine the magnitude of the outbreak, identify the vectors, assess the risk of an epidemic, and to initiate control measures to interrupt transmission and prevent further spread of the disease.

The reactive YF vaccination is part of the global strategy to Eliminate Yellow Fever Epidemics (EYE) by 2026, said Dr Olushayo Olu, WHO Representative for South Sudan. It serves to protect high-risk populations against the YF virus in the immediate term and will serve as a bridge towards the introduction of yellow fever vaccine into the routine immunization system in the long term.

YF is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The "yellow" in the name refers to the jaundice that affects some patients. Symptoms of yellow fever include fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue. A small proportion of patients who contract the virus develop severe symptoms and approximately half of those die within 7 to 10 days.

YF has an incubation period of 3-6 days following infection. Many people do not experience symptoms, but when these do occur, the most common are fever, muscle pain with prominent backache, headache, loss of appetite, and nausea or vomiting. In most cases, symptoms disappear after 3 to 4 days.

South Sudan last experienced a yellow fever outbreak in May 2003, in Imatong region of Torit County, with a total of 178 cases with 27 deaths (CFR 15%) in Imatong and Ikotos districts, Torit County.

With funding from Gavi, the Vaccine Alliance, European Union Humanitarian Aid (ECHO) and the United States Agency for International Development (USAID), South Sudan secured a total of 21 800 doses from the Global emergency yellow fever vaccine stockpile of the International Coordination Group (ICG) on vaccine provision.

For Additional Information or to Request Interviews, Please contact:

Ms Jemila M. Ebrahim
Communications Officer
Mobile: +211 921 647 859
Email: ebrahimj@who.int
Date: Wed 20 Mar 2019
Source: ReliefWeb [edited]

The Federal Ministry of Health, in collaboration with the World Health Organization (WHO), Gavi, the Vaccine Alliance, and UNICEF, has launched a large-scale mass vaccination campaign in Sudan to vaccinate more than 8.3 million people 9 months to 60 years of age against yellow fever in the states of Blue Nile, Gezira and Sennar during 10-29 Mar 2019.

The campaign represents a crucial step in protecting a large portion of the population and reducing the risk of severe and deadly yellow fever outbreaks in the country. It is the 3rd and final drive thatSudan is undertaking to protect populations at risk and prevent yellow fever epidemics, pending the implementation of infant immunization as routine practice.

The campaign forms a critical part of Sudan's ongoing work to protect all populations against yellow fever epidemics, in alignment with the global Eliminate Yellow fever Epidemics (EYE) Strategy. The country plans to complement these yellow fever mass campaigns and ensure long-term protection through the introduction of yellow fever vaccination into routine immunization in the coming months.

"We acknowledge the commitment of the health authorities in Sudan to avail cash and fuel during this economic crisis to ensure that their people, especially children, are protected with a quality vaccine which will contribute to health security and making the world safer," said Dr. Naeema Al-Gasseer, WHO Representative in Sudan.

"Yellow fever vaccination is the most important tool we have to prevent yellow fever outbreaks. The vaccine will be freely available to any eligible person and will provide life-long protection against the disease. While protecting yourself against mosquito bites is important to reduce the risk of many diseases, only vaccination can eliminate the risk of yellow fever outbreaks," she added.

Yellow fever is a viral disease that is transmitted by certain types of mosquito. Infection can cause fatal illness, including jaundice, and death, and can spread rapidly, locally and internationally, especially in urban areas. However, the disease can be prevented by a single dose of a highly effective and safe vaccine. This campaign aims to boost protection in the general population and will target all eligible people.

Sudan is at high risk for the spread of yellow fever due to a combination of climate and ecological factors, and because there are still areas of low population immunity. Recent years have seen global changes in the epidemiology of yellow fever, with outbreaks occurring in areas that were not previously assessed as being at high risk.

"We are observing a changing nature in yellow fever disease dynamics. It is very important that every eligible person in this campaign receives the vaccine to protect themselves, their families and their communities," said Professor Dr. Babkir Kabaloo, Undersecretary of the Federal Ministry of Health.

"The current campaign represents one of the final phases in the Ministry's efforts to protect the entire nation against yellow fever outbreaks. This campaign will cover Blue Nile, Gezira, and Sennar states. In the coming months, the remaining states of Khartoum, Northern and River Nile will also be covered, completing the protection of the entire Sudanese population," he added.

Sudan's health authorities and partners are working to introduce yellow fever vaccine in the national immunization schedule in the near future. This will help ensure the protection of the whole population and generations to come against this fatal but preventable disease.
=====================
[It is good to see this ambitious yellow fever (YF) vaccination campaign drawing to a close. Incorporating YF vaccine into routine childhood vaccination schedules is prudent and if successful will eliminate the need for intensive, country-wide campaigns to deal with outbreaks. YF is no stranger to Sudan. Between 3 Oct and 24 Nov 2013, a total of 44 confirmed cases of YF were reported, including 14 deaths. A total of 12 localities in West and South Kordofan were affected by that outbreak. There was a large YF outbreak in the Darfur state in 2012-2013. In 2012, the World Health Organisation (WHO) said that more than 840 people were infected with YF in Darfur and that the epidemic affected 35 of 64 localities in the region since September 2012. The total recorded cases of YF in Greater Darfur hit 849 with a 20% death toll during an epidemic in 2012 (see WHO Disease Outbreak News <http://who.int/csr/don/2012_12_03/en> as reported by ProMED post http://promedmail.org/post/20130125.1513849, as noted at the time by Mod.JW). Mounting campaigns in the face of these types of outbreaks is inefficient, logistically difficult, and costly -- financially and in terms of human lives. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Date: Wed 6 Mar 2019
Source: Relief web, report from Medair [edited]

More than 75,000 measles vaccines have been airlifted to South Sudan's Gogrial West County in response to an outbreak declared by the State Ministry of Health. There are 98 suspected measles cases, with one death reported. Medair, an international humanitarian organisation, has mobilized an emergency response team to vaccinate children under 5 years of age in an area where the population is estimated at over 400 000 people. The campaign is expected to be conducted from 7-17 Mar 2019.

Responding to this measles outbreak is made even more urgent by high levels of global acute malnutrition (GAM) among children in Gogrial West County. "This is an area where the population is incredibly vulnerable," said Jennifer Turner, health manager with Medair's emergency response team. "Children who are malnourished are more at risk of being infected with measles, and the complications are often more severe. The food insecurity in this region is rated at a "crisis" level."

To reach so many children with vaccinations over a short period of time, Medair will train and deploy more than 800 people from the affected communities who will work steadily for 10 days. Teams of 8 will head out each day carrying a supply of vaccines, which must be kept cold despite daytime temperatures of 40 deg C [104 deg F]. During shipping, storage, and distribution, the ice packs will be frozen using generator power and, where available, solar-powered vaccine fridges. All vaccines and supplies must be transported by air from Juba.

Medair South Sudan's emergency response team is always available to respond to healthcare emergencies. In 2018, the team completed 23 emergency interventions in health, nutrition, water, and sanitation, and the distribution of critical items.
Date: Fri 21 Dec 2018
Source: WHO Regional Office for Africa [edited]

Situation update on the yellow fever outbreak in South Sudan
------------------------------------------------------------
The yellow fever outbreak in South Sudan was declared on 29 Nov 2018 in Sakure payam, Nzara county, Gbudwe state.

Since the reporting of the outbreak, the Ministry of Health and partners have scaled up preparedness and response activities to mitigate and control possible spread. These activities entailed conducting follow up epidemiological; entomological; and laboratory investigations in addition to providing supportive clinical care to symptomatic cases by national rapid response team.

As of 19 Dec 2018, only one confirmed yellow fever case and 2 presumptively yellow fever positive cases have been reported from Sakure payam, Nzara county, Gbudwe state. Sakure payam is located at the border with Democratic Republic of Congo (DRC) a rural setting with households and farms located close to forested areas (with the risks of yellow fever transmission and cross-border spread). The population of Sakure payam is estimated to be 16 759 people with most engaged in farming and cross-border trade with DRC.

According to Dr Wamala Joseph, WHO Epidemiology, the assessment of the types of mosquito in Sakure, Nzara, and Yambio towns, revealed no evidence of yellow fever carrying mosquitoes (the _Aedes_ species). He noted that the number of the mosquitoes found in the 3 places was below the required levels to cause yellow fever outbreaks. This he said is attributed to the prevailing dry season and hence the greatly reduced breeding and mosquito populations at this time of the year.

The population in South Sudan is regarded as vulnerable to yellow fever outbreaks since the vaccine is not integrated into the national routine vaccination schedule. In addition, the last major yellow fever vaccine reactive campaign was implemented in 2003 following the Imatong mountains yellow fever outbreak in Torit and Ikotos counties.

These findings highlight the need for the country to rapidly catch up on WHO Eliminate Yellow Fever Epidemics (EYE), a strategy premised on 3 pillars that include: protecting vulnerable populations through yellow fever vaccination; preventing international spread of yellow fever; and containing outbreaks rapidly through enhanced surveillance and laboratory capacities and establishing national yellow fever vaccine stockpiles.

With the contribution from donors, South Sudan is able to conduct active surveillance for yellow fever and other diseases. These include the European Commission's Humanitarian Aid and Civil Protection department (ECHO) for Early Warning And Response Network (EWARN) support, United States Agency for International Development (USAID) for Integrated Disease Surveillance and Response (IDSR), and GAVI vaccine alliance for the assessment of capacities for yellow fever and testing.

Yellow fever is a viral infection transmitted by infected mosquitos, which can be deadly but easily prevented by a safe and effective vaccine. The disease has re-emerged as a public health threat in many parts of Africa and South America, due to several factors including climate change, rapid urbanisation, and increasing population movements.
=======================
[The risk of a yellow fever (YF) outbreak seems minimal at this time, with just one confirmed case and 2 presumptive cases and no evidence of mosquito vectors in the affected area. The statement that YF virus vector mosquito populations decline during the dry season is not always the case. Because water availability may be reduced, in some cases there may be a tendency to store additional water in and immediately around the house, providing breeding sites for YF virus vectors such as _Aedes aegypti_. Increasing surveillance and YF vaccine coverage in South Sudan are prudent preventive measures. - ProMED Mod.TY]

[Maps of South Sudan:
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World Travel News Headlines

Date: Tue, 23 Apr 2019 13:01:09 +0200
By Ron LOPEZ

Porac, Philippines, April 23, 2019 (AFP) - Philippine rescuers raced Tuesday to reach some two dozen people still feared buried under a building near Manila that collapsed a day earlier in a deadly earthquake, as a powerful second tremor hit the nation.   The US Geological Survey put the second quake -- on the central island of Samar -- at 6.4 magnitude, stronger than the one that wrought significant damage Monday near the capital in the north.

The latest quake sent terrified locals fleeing into the streets, with images on social media showing cracked roads, crumbling church walls and shattered glass.   "No one started crying, but of course some panicked because it was really strong," said Rey Estrobo, a supervisor at a hotel in Borongan town, near the epicentre.   At the same time, the toll in Monday's quake rose to 16, with most of the fatalities in the worst-hit northern province of Pampanga, national disaster officials said.   More than 100 others were injured by falling rubble on Monday, including in Manila, according to police.

However, initial reports indicated relatively minor destruction in Samar given the strength of Tuesday's quake, which could be down to differences in ground composition.   "The damage is more pronounced if the houses and buildings are built on a foundation of soft soil," seismologist Myla Advincula told AFP, referring to Pampanga's soft sediment. "It enhances the shaking effect."

Scores of rescuers in the northern town of Porac spent Tuesday using cranes and jackhammers to peel back the pancaked concrete structure of a four-storey market building where the Red Cross said 24 people were unaccounted for.   "Every minute, every second is critical in this rescue," Cris Palcis, a volunteer rescue dog handler, told AFP. "Time is short for the people under the rubble so we have to be quick."

Pampanga Governor Lilia Pineda told journalists that rescuers could still hear at least one person trapped beneath the rubble, but the digging was proceeding delicately to avoid accidentally crushing the survivor.   Rogelio Pacelo was shopping with his wife and child when the market building collapsed around them, but they incredibly made it out almost without a scratch.   "I thought this only happens in movies. I thought that was the end of the world, it's our end," he told journalists. "I looked for a way out."   The quake also damaged several centuries-old churches which were crowded with worshippers in recent days as the majority-Catholic Philippines marked the Easter holiday.

- 'Ring of Fire' -
Father Roland Moraleja, who is based in Porac, said the 18th-century belfry of the Saint Catherine of Alexandria church collapsed in the quake.   "It was the only part left from the old church," he told AFP. "The historical value is now gone, but we are hopeful that it will rise again."   High-rise buildings in the capital swayed after the tremor struck Monday evening, leaving some with large cracks in their walls.

Thousands of travellers were stranded after aviation authorities shut down the secondary Clark Airport, which is located on the site of the former US military installation that lies about an hour's drive north of the capital.   It was still closed on Tuesday as officials assessed the heavy damage to the terminal building and some cracking on the air traffic control tower.

The quake was centred on the town of Castillejos, about 100 kilometres (62 miles) northwest of Manila, local geologists said.   Seismologists put Monday's tremor at 6.3 initially, but subsequently downgraded it to a 6.1 magnitude.   The Philippines is in the Pacific "Ring of Fire", an arc of intense seismic activity that stretches from quake-prone Japan through Southeast Asia and across the Pacific basin.
Date: Tue, 23 Apr 2019 10:08:27 +0200

Johannesburg, April 23, 2019 (AFP) - At least five people died early Tuesday in South Africa's coastal city of Durban after torrential rains triggered mudslides that crushed homes, emergency services said.   Among those killed were a six-month-old baby, a child of about 10 and two adults.   "Torrential rains damaged peoples houses (and) there were mudslides," Garrith Jamieson, spokesman for Rescue Care, told AFP.

"I can confirm five (deaths) but there are many more casualties," he said, adding there were unconfirmed reports of "multiple" deaths in other parts of the KwaZulu-Natal province.   Victims were either crushed to death by the mudslides or drowned in flood waters.   It was not immediately clear how many people were missing, but search and rescue operations continued on Tuesday.

Downpours have caused flooding in the southern and eastern parts of the country.   The military has been dispatched to help in rescue and evacuation efforts in some of the affected areas.   The South African Weather Services warned that more heavy rain was expected until Wednesday which could lead to more flooding and pose a threat to low-lying bridges and roads.
Date: Tue, 23 Apr 2019 06:03:52 +0200

Colombo, April 23, 2019 (AFP) - The toll from a string of deadly suicide bomb attacks in Sri Lanka has risen to 310, with several people dying of their injuries overnight, a police spokesman said Tuesday.   Around 500 people were wounded in the blasts, Ruwan Gunasekera said in a statement.   He added that 40 people were now under arrest in connection with the attacks, which Sri Lanka's government has blamed on a previously little-known local Islamist group, National Thowheeth Jama'ath.
Date: Mon, 22 Apr 2019 06:22:23 +0200

Melbourne, April 22, 2019 (AFP) - A father and son lifesaving team drowned while trying to save a tourist swept out to sea near one of Australia's most famous sights off the south coast, officials said Monday.   Ross Powell, 71, and his son Andrew, 32, died on Sunday after their lifesaving boat overturned in the surf during the rescue of a 30-year-old man near the Twelve Apostles, a set of 12 limestone stacks off the Victoria state coast.

The tourist, whose nationality or name has not been released, had been wading at the mouth of a river when he got into trouble.   He was winched from the water alongside a third lifesaver from the boat, who was seriously injured, by a rescue helicopter and taken to hospital, Victoria Police said. The bodies of the Campbells were found in the water shortly after.   The tragedy has rocked the small tourist town of Port Campbell where the two men came from, with Prime Minister Scott Morrison leading the tributes.   "Surf lifesavers are selfless & brave. We thank them all for their service & extend our deepest sympathies to Ross & Andrew's family & friends," Morrison tweeted Monday.

Surf Lifesaving Victoria president Paul James hailed the pair as heroes, and said the conditions had been rough and "not the place to be swimming".   "It's just terrible, it's heart-breaking," he told reporters in an emotional press conference of the death of the dairy farmers and experienced volunteer lifesavers.   "I understand the boat was operating in a two-metre (6.5 feet) swell, so a very high swell, and we know that it is very treacherous down there... These brave people, these heroes, have gone out to try and help."   Amber Griffiths, the partner of Andrew Campbell and who local media reported was pregnant with their second child, wrote about her heartbreak on Facebook.   "Today we lost two of the most beautiful people to ever exist -- always putting others first," she wrote.   "The love of my life, light of my life, father of my baby girl. My heart is broken. I miss you Andrew Powell."

Australia's beaches are among the island continent's biggest tourist drawcards, but can have strong rips and tides. Swimmers are advised to keep between areas bounded by flags and patrolled by lifesavers.   The area where the tourist was rescued is near high cliffs and said to have wild and treacherous seas.   The Twelve Apostles are giant rock stacks of varying heights in the Southern Ocean which began forming 20 million years ago when erosion gradually began whittling away the limestone cliffs of Port Campbell.
Date: Mon, 22 Apr 2019 01:55:28 +0200

Montreal, April 21, 2019 (AFP) - Flooding in eastern Canada forced the evacuation of more than 1,500 people while over 600 troops have been deployed in response, authorities said Sunday.   Warming weather over the Easter weekend has brought spring floods due to heavy rains and snowmelt from Ontario to southern Quebec and New Brunswick.

Authorities, who initially feared a repeat of catastrophic 2017 floods in Quebec, the worst in half a century, appeared more confident about the situation on Sunday.   "We are optimistic about the coming days," civil security spokesman Eric Houde told AFP.   "There will be significant floods but overall not at the level of 2017, except in certain areas like Lake St Pierre," a widening of the St Lawrence River in Quebec, he added.   "The big difference from 2017 is the level of preparation of municipalities and citizens."

Over the past several days, towns have mobilized volunteers and distributed hundreds of thousands of sandbags to erect barriers or protect houses in threatened areas.   The areas most affected were around Ottawa, and Beauce, a region south of Quebec City where nearly 800 people were evacuated. More than 1,200 homes had been affected by the flooding in Quebec by late Sunday.

The provincial governments of Quebec and New Brunswick asked for reinforcements from the military.    About 200 soldiers had deployed in Quebec by late Saturday, and 400 others near Ottawa, in Laval north of Montreal and in Trois-Rivieres between Montreal and Quebec City.   About 120 additional soldiers stood at the ready to be mobilized in New Brunswick.   On Saturday, the flooding claimed its first victim in the municipality of Pontiac, west of Ottawa: a man in his seventies who did not see that a bridge had been washed away, and plunged his car into the stream below.
Date: Mon, 22 Apr 2019 01:08:11 +0200

Montreal, April 21, 2019 (AFP) - The bodies of three world-renowned professional mountaineers -- two Austrians and an American -- were found Sunday after they went missing during an avalanche on a western Canadian summit, the national parks agency said.   American Jess Roskelley, 36, and Hansjorg Auer, 35, and David Lama, 28, of Austria went missing late Tuesday at Banff National Park. Authorities launched an aerial search the next day.   The three men were attempting to climb the east face of Howse Pass, an isolated and highly difficult route.

They were part of a team of experienced athletes sponsored by American outdoor equipment firm The North Face.   "Parks Canada extends our sincere condolences to their families, friends and loved ones," the agency said in a statement.   "We would also like to acknowledge the impact that this has had on the tight-knit, local and international climbing communities. Our thoughts are with families, friends and all those who have been affected by this tragic incident."

Roskelley was the son of John Roskelley, who was also considered one of the best mountaineers of his own generation.   Father and son had climbed Mount Everest together in 2003. At the time, the younger Roskelley was only 20 years old, and became the youngest mountaineer to climb the planet's highest mountain above sea level.   Auer and Lama, from Tyrol in Austria, were also considered among the best mountaineers of the times.
Date: Sun, 21 Apr 2019 23:36:53 +0200

Kano, Nigeria, April 21, 2019 (AFP) - Two people including a British aid worker have been shot dead and four tourists abducted in an attack by armed gunmen on a holiday resort in north-western Nigeria, police said on Sunday.   Police and aid agency Mercy Corps named the dead woman as Faye Mooney.   "Faye was a dedicated and passionate communications and learning specialist", Chief executive Neal Keny-Guyer said in a statement posted on social media, adding that colleagues were "utterly heartbroken".   Mooney had "worked with Mercy Corps for almost two years, devoting her time to making a difference in Nigeria", Keny-Guyer added.

Gunmen stormed the Kajuru Castle resort, 60 kilometres (40 miles) southeast of Kaduna City at 11.40 pm (2240 GMT) on Friday, Kaduna state police spokesman Yakubu Sabo told reporters.   The Briton "was gunned down from the hill by the kidnappers who tried to gain entrance into the castle but failed", Sabo said.   "They took away about five other locals but one person escaped," he said.   A Nigerian man believed by local residents in Kajuru to be Mooney's partner was also killed in the attack on the resort where a group of 13 tourists had arrived from Lagos, southwest Nigeria the police spokesman said.   In Kaduna and the wider northwest region, kidnapping for ransom has become an increasingly rampant, particularly on the road to the capital, Abuja, where armed attacks have thrived.

Kidnapping in Nigeria's oil-rich south, has long been a security challenge, where wealthy locals and expatriate workers are often abducted.   Yet the problem has escalated in northern areas too, like Kaduna where criminal gangs made up of former cattle rustlers have been pushed into kidnapping after military crackdowns on cattle theft.   Kajuru is also flash point in the deadly conflict over increasingly limited land resources in Africa's most populous country, between herders and farmers, predominantly across central and northern Nigeria.    The conflict has increasingly taken on ethnic and religious dimensions in the region, with the Fulani Muslim herders in conflict with Christian Adara farmers in Kajuru.

Tourists are rarely affected by the herder-farmer violence and Kajuru Castle resort has attracted many foreign and local visitors.   Yet police have struggled to thwart kidnappers in the region. The latest attack comes in a resort in northern Nigeria, particularly popular amongst foreign and well-to-do local tourists.   In January four western tourists -- two Americans and two Canadians -- were also abducted in Kaduna by gunmen in an ambush in which two of their police escorts were killed.   Earlier in April, recently re-elected President Muhammadu Buhari, ordered his most senior security chiefs to curb kidnapping in the region.
Date: Sun, 21 Apr 2019 09:55:31 +0200

Lilongwe, Malawi, April 21, 2019 (AFP) - Three people died after a landslide hit a village in the Rumphi district in northern Malawi, with at least five still missing Sunday and many others injured and hospitalised.   Rumphi police spokesperson Tupeliwe Kabwilo told AFP that incessant rains in the area led to the landslide early Saturday which washed away an entire village nestled between Mphompha Hills and Lake Malawi.   Among the dead are two boys aged 12 and 15 and a 35-year-old woman, according to police.   The missing persons, who are feared dead, include a one-year-old boy, two other boys aged six and 10 as well as two women aged 35 and 46.

A Rumphi district council official who was at the scene of the disaster told AFP that the affected area was inaccessible by road and it would be impossible to mount a rescue operation.   "Huge boulders rolled from the mountain and these are the ones that cause the biggest damage and if the missing victims are buried under these rocks, then we will need an excavator to move them." said council official Wakisa Mtete.    "But there is no access by road to the area so this is an impossible task. The boulders are so big that moving them by hand is not possible," Mtete said.    He added that it was also possible for some of the missing bodies to have been washed into the lake, in which case the bodies would resurface within the next two days.

Disaster management officer Alufeyo Mhango told AFP that government ministries were preparing to step in to transport heavy duty excavation equipment over the lake as soon as the weather cleared.   "We have been informed by government ministries that we should get ready to transport the equipment. But this will depend on whether we get a large boat for that and on whether the hailstorm stops because there could be a recurrence of the landslide," he said.   According to Mhango, Police officers, soldiers and emergency personnel are on site attending to the disaster.
Date: Sat, 20 Apr 2019 15:21:54 +0200

Butembo, DR Congo, April 20, 2019 (AFP) - The DR Congo army fought off an attack on a hospital by a rebel group, killing one militiaman, police said Saturday, in the latest assault on medical staff trying to rein in an Ebola outbreak in the east of the country.   Armed rebels from the Mai-Mai militia attacked Katwa hospital near the city of Butembo at around 3.40 am (0140 GMT), officers told AFP.   "We have resisted and repelled the attack even though these 'Mai-Mai' had a PKM machine gun," said Butembo police chief Colonel Paul Ngoma.   He said one rebel was killed and four captured.   The attack came a day after a WHO doctor, Richard Valery Mouzoko Kiboung, was shot dead in an assault by armed militiamen on Butembo University Hospital, according to the World Health Organization.   The WHO said the epidemiologist had been deployed to help combat Ebola in the region.

The attacks are the latest in a string of assaults on teams grappling with a near nine-month-old Ebola outbreak that has claimed almost 850 lives.   UN Secretary General Antonio Guterres on Friday condemned the Butembo University Hospital attack and called on Congolese authorities to bring the perpetrators to justice.   DR Congo declared its tenth outbreak of Ebola last August, in north-eastern North Kivu province, before the virus spread into the neighbouring Ituri region.   Local organisations have said the number of Ebola deaths is rising.    An updated toll by the health ministry, issued on Wednesday, said there had been 843 deaths since August.

WHO data from April 9 put the number of confirmed or probable cases at 1,186, of which 751 had been fatal.   The outbreak is the second deadliest on record, after the epidemic that struck West Africa in 2014-16, which killed more than 11,300 people.    Efforts to roll back the highly contagious haemorrhagic fever in DRC have been hampered by fighting but also by resistance within communities to preventative measures, care facilities and safe burials.    On March 9, an attack on a treatment centre at Butembo left a policeman dead and a health worker wounded. It was the third attack on that centre.   On February 24, a treatment centre in Katwa was set ablaze.
Date: Fri, 19 Apr 2019 16:36:32 +0200

Khokha, Yemen, April 19, 2019 (AFP) - Oxfam has warned that war-torn Yemen risks a "massive resurgence" of cholera, with around 195,000 suspected cases of the disease recorded so far this year.   "Fears that the world's worst cholera outbreak could be set for a massive resurgence are growing," the relief organisation said Thursday.   It said aid agencies were struggling to reach suspected cases.

In a statement, Oxfam pointed to "fighting and restraints on access, including checkpoints and permit requirements imposed by the warring parties", and warned the coming rainy season was likely to accelerate the spread of the disease.   The water-borne bacterial infection has claimed more than 3,000 lives in Yemen since the outbreak began in 2016, according to Oxfam.

At a medical centre for the displaced in the government-held western town of Khokha, Qassem Suleiman had brought his son Alaa for tests after a serious case of diarrhoea.   Doctor Wadah al-Tiri told AFP that several patients had been transferred to Aden while others had been treated at the Khokha centre.   He said a tent was to be set up for suspected cases.

The doctor said Yemen badly needed international aid to combat the epidemic.   The UN's humanitarian coordination office OCHA said last month that children under the age of five make up nearly a third of this year's cases.   The spike, which comes two years after Yemen suffered its worst cholera outbreak, was concentrated in six governorates including in the Red Sea port of Hodeida and Sanaa province, both combat zones, it said.

Yemen's conflict, which pits Iran-linked rebels against a regional pro-government alliance led by Saudi Arabia, has left some 10,000 people dead since 2015 and pushed millions to the brink of famine.   Aid groups say the actual death toll could be five times as high.    The war has created the perfect environment for cholera to thrive, as civilians across the country lack access to clean water and health care.