Lifesaving Water Sanitation and Hygiene (WASH) services as response to Acute Watery Diarrhea outbreak in 29 localities in 4  states (Blue Nile, Gezira, Khartoum and Sennar) continuously reporting cases in Sudan, The request is made to respond to the ongoing Acute watery diarrhoea outbreak that has started in August 2016 in Kassala and rapidly spread to 42 localities. At present, consequent to the response already initiated, only  Sennar, Blue Nile, Gezira, and Khartoum states are reporting clustered cases in localities Al tadamoon, Bau, Damazine, Roseries, Geisan, East Jezeera, West Jezeera, Un El Qura, Great Madeni, El Hasa feesa, mEl kameleen, El Managel, River Atbara, North Delta, Feefi Aroma, Ud El Hellow, New halfa, Hashma El Girba, Jabal Al Awlia, Sharq El Neel, Um Bada, Abu Hogear, El Dali, Dindir, Souki, Sinja, Sennar, East Sennar.. OCHA and the CHF advisory group requested the projects include response activities in the states and localitiesthe where there are active confirmed (by laboratory) cases. At the time of writing the concept note, Gadaref was reporting cases, and the suspected  cases in Khartoum were not yet confirmed. At present, Gedaref is not reporting for more than 3 weeks (outbreak controlled) and the cases in Khartoum have been lab confirmed (19 Sept 2016). In Khartoum at present the number of acses are increasing steadely (close to 300  with 15 death) and the case fatality rate is very high at 5%. A special task force has been established for Khartoum response due to the severity of the situation, potential for rapid massive spread and high case fatality rate. Thus Gedaref has been excluded from the response (outbreak considered controlled - WHO guidelines) and Khartoum affected areas (mostly accomodating vulnerable IDPs and refugees) included. The planned project activities are aiming to provide  lifesaving Water Sanitation and Hygiene (WASH) services to 833,156 people in the 27 affected  localities in these states. reporting cases. Some flexibility of use of funds to new states/localities that eventually are starting reporting cases during the project implementation is requested to initiate immediate response until additional resources are made available. The activities includes continuous checking of the quality of water with focus on the free residues chlorine level and the microbiological contamination, and vector control activities to reduce the disease transmission to control the outbreak.  Regular checking of the water quality will allow the immediate identification of the source of infection as in most of the circumstances the source of transmission is a common contaminated water source.   The results, centralised, analysed and disseminated to all stakeholders will guide the implementation of corrective measures. Ensuring the safety of the water will stop the transmission through contaminated water. The vector control activities, spaying for adult phase and elimination of breeding sites will limit the water and food mechanical contamination contributing to the control of the transmission.
WHO activities will help guiding and complement other WASH activities implemented by WASH UNICEF,  IOM, MOH and other partners, and complete with the health intervention of the WHO and UNICEF the recommended response and containment package. An important factor for ensuring these complementarities is to have all the interventions simultaneously implemented in all affected locations. As most of the activities have been initiated with WHO surge funds borowed from regional office due to the urgency of the situation, we request the start date of the expenditures as per 1st october 2016.