14 December 2015 - In South Sudan, the World Health Organization (WHO) is working alongside the Ministry of Health to implement a new disease early warning system capable of monitoring approximately 500 000 people in hard-to-reach settings for only three cents per person.

Humanitarian emergencies increase the risk of transmission of communicable diseases and other health conditions. Disease outbreaks, such as measles and cholera, are often a major cause of illnesses and death during crises. WHO constantly strives to support governments and improve people’s health, even in the most challenging settings.

“The Global Early Warning and Response System (EWARS) project is an initiative that brings together expertise in disease outbreaks and humanitarian emergencies to strengthen early warning, alert and response in emergency settings,” said Dr Christopher Haskew, WHO Epidemiologist, who coordinates the project.  

Direct field support: EWARS in a box

The project supports Ministries of Health and health partners through the provision of technical guidance, training and field-based tools. This includes a standardized EWARS application that can be rapidly configured and deployed within 48 hours of an emergency being declared.

“It is designed with frontline users in mind, and built to work in difficult and remote operating environments,” said Haskew.

Direct field support is provided in the form of “EWARS in a box”, which is a kit of ruggedized, field-ready equipment needed to establish and manage surveillance and response activities in field settings without reliable internet or electricity. One kit costs approximately $US 15 000 and can support surveillance for 50 fixed or mobile clinics, or roughly 500 000 people.

South Sudan: one of the worst health emergencies worldwide

Conflict has disrupted the lives of millions of South Sudanese people since December 2013, and displaced more than 2.2 million people. About 1.6 million of them have been displaced internally in South Sudan and over 600 000 are refugees in neighbouring countries.

In settings like South Sudan, EWARS reinforces the national surveillance system by providing much needed support when the existing health system is disrupted due to a crisis.

Internally displaced persons (IDP) settlements in Unity and Jonglei States face particular challenges in collecting and submitting data, due to ongoing insecurity and inaccessibility. Overcrowded conditions and poor access to safe water, sanitation and hygiene increase the risk of diseases such as bloody diarrhoea, hepatitis E and cholera.

“EWARS is a vital tool to allow us to detect and respond to disease outbreaks in emergency-affected areas,” said Dr Joseph Wamala, Epidemiologist in WHO Country Office, South Sudan. “It played a key role in detecting the first case of cholera during the 2014 and 2015 outbreaks, and helped us prevent many avoidable cases and deaths as we were able to mount a rapid and effective response.”

By deploying EWARS in a box and training frontline health partner staff on how to collect data using mobile phones, the project aims to improve the coverage of the system in priority areas. Immediate feedback via SMS is provided if public health actions need to be taken.

“This innovative project really increases the reach of the surveillance system in South Sudan and lets us know when a disease outbreak might be happening in IDP areas at the earliest opportunity,” said Dr Abdulmumini Usman, WHO Representative in South Sudan. “This gives us the best possible chance of reacting and stopping it before it is too late.”

Future plans

Global EWARS maintains readiness to be deployed rapidly to other countries whenever an emergency is declared. The project also aims to scale up in 2016 to include a total of eight additional priority countries.

“If this works the way we expect it to, then we should be able to support national governments and provide effective disease surveillance for millions of people in emergencies in a very cost effective way,” said Haskew. “It is a key tool in reducing illness and saving lives in crises.”

More information can be obtained by writing to Global EWARS Project, WHO Geneva. info [at] ewars.ws (info[at]ewars[dot]ws)