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September 11, 2017

Concerning Cholera in Sudan:

An Open Letter to Dr. Tedros Adhanom Ghebreyesus, Director General of the UNs
World Health Organization, from American physicians
United Nations Office at Geneva | Palais des Nations, 1211 | Genve, Switzerland

Dr. Tedros Adhanom Ghebreyesus:

The mandate of the UNs World Health Organization (WHO) could hardly be clearer; in the
words of the Organization:

Our primary role is to direct and coordinate international health within the United
Nations system.

Our goal is to build a better, healthier future for people all over the world. Working
through offices in more than 150 countries, WHO staff work side by side with
governments and other partners to ensure the highest attainable level of health for all

And yet this impressive mandate is daily made a mockery of by WHOs refusal to refer to the
cholera epidemic raging in Sudan by name. Neither your organization nor the UNs Office for
the Coordination of Humanitarian Affairs will refer explicitly to the fact that what you
continue to call Acute Watery Diarrhea is in fact cholera, Vibrio choleraa fact established
by laboratory tests in Sudan.

What is most troubling in the present crisis is WHOs failure to confirm or disconfirm the
findings of Sudanese labs tests in Geneva, using stool samples appropriately transferred from
Sudan. As you well know, this is entirely practicable; cholera is easily diagnosed
unequivocally in stool samples by bacterial culture. Laboratories across the world can readily
do this using a samples shipped to them. If this requires special conditions for shipping (e.g.,
specimen has to be collected and stored in a special fluid called transport media to keep the
bacteria alive), the effort seems nonetheless unsurpassably urgent, given the spread of what all
evidence indicates is cholera, now rampant in most of Sudan.

By failing to conduct such laboratory tests, you are conspicuously failing in fulfilling your
mandate as Director General of WHO. Of more immediate consequence, you are failing the
people of Sudan, who have suffered so much at the hands of the current regime.

We are forced to ask: why has such an unequivocal diagnosis not been rendered by WHO,
given the massive spread of cholera in Sudan since August 2016? To be sure, the Khartoum
regime has made clear that it will punish Sudanese journalists and health officials who dare to
use the word cholera, and no doubt threats have been issued to WHO, demanding that you be
complicit in silence about this terrible disease. The regimes motive is transparently a desire
that the reputation of Sudan not be compromised by associations the regime perceives would
inhere in any accurate designation of a disease that is clearly out of control. But the effect of
WHOs silence is to ensure that Sudan has not received international medical resources
necessary to combat cholerapreeminently massive supplies of re-hydration equipment;
medical epidemiologists as well as specialists in treating cholera epidemics; and
water/sanitation equipment and engineers.

By yielding to the Khartoums regimes threat, you are complicit in the failure to respond to a
disease that currently threatens many hundreds of thousands of Sudanese civiliansand is
currently active in at least twelve Sudanese states.

As you are no doubt aware, the current National Islamic Front/National Congress Party
regimewhich came to power my means of a military coup in June 1989is guilty of
continuous assaults on its own people for almost three decades. Among the most barbaric
means used in serial genocidal counter-insurgencies has been the thoroughly documented
denial of humanitarian assistance to desperately need civiliansin Darfur, in the Nuba
Mountains of South Kordofan, in Blue Nile, and in South Sudan during the long civil war.
Eastern Sudan has also been systematically denied critically needed humanitarian resources.
Equally well-documented are the Khartoums military assaults on humanitariansmost
recently and notoriously, bombing of hospitals in South Kordofan (Doctors Without
Borders/Mdecins Sans Frontires (MSF)twicein Frandala, as well as the repeated
bombings of Mother of Mercy Hospital near Kauda in the center of the Nuba Mountains).
Bombings and assaults on humanitarian sites were commonplace during the North/South civil
war (see

Your silence about what is clearly a massive cholera epidemic in Sudan daily becomes more
reprehensible. Your failure to transport stool samples from victims in Sudan to Geneva for
official confirmation of cholera makes you fully complicit in the terrible suffering and dying
that continues to spread, out of control, with daily new reports confirming that this is indeed a
cholera epidemic. The inevitable history that will be written of this epidemic will surely cast
you in an unforgiving light.


Richard B. Brown, M.D., Senior Clinician, Infectious Disease Division, Baystate

Medical Center, Springfield, Massachusetts | Professor of Medicine, Tufts University
School of Medicine

Joanne Levin, MD, specialist in infectious diseases, Northampton, Massachusetts

William Swiggard, MD, specialist in infectious diseases, Northampton, Massachusetts

Karen Abrashkin, MD, Westbury, New York

Julia De Almeida, MD, Easthampton, Massachusetts

Peter A. Elsea, MD, Northampton, Massachusetts

Elizabeth Feuer, M.D. Colts Neck, New Jersey

Aisling Gaughan, MD, Lunenburg, Massachusetts

Samuel Gladstone, MD, Amherst, Massachusetts

Jay Holtzman, MD, Belchertown, Massachusetts

Mordechai Kamel, JD, MD, Easthampton, Massachusetts

Ellen Kaufman, MD, Northampton, Massachusetts

James Kirchhoffer, MD Easthampton, Massachusetts

Jeffrey Korff, MD, Northampton, Massachusetts

Joel Rosen, MD Northampton, Massachusetts

Henry Rosenberg, MD, Northampton, Massachusetts

Carl Saviano, MD, Northampton, Massachusetts

Ellen Senghas, MD Southampton, Massachusetts