What is the current situation in the country?

“South Sudan is experiencing a massive humanitarian emergency: the people have acute needs now and will continue to do so in the coming years. The situation is already critical in terms of the availability of healthcare. Added to this, the civilian population has borne the brunt of emergency after emergency: regular, violent clashes resulting in death, injury and mass displacement; the arrival of 300,000 people returning from the north; and chronic malnutrition and frequent outbreaks of diseases such as kala azar, measles and meningitis. The humanitarian response to these repeated crises has often been complicated and delayed. Prevailing logistical challenges make it difficult to reach people and provide lifesaving assistance.

“Since February, 2011, there has been a marked increase in violent clashes in South Sudan and the contested border areas between North and South Sudan. This has resulted in an increase in the number of violence-related trauma patients, some of whom are being treated in MSF’s medical facilities, but too many people in need of care – often the most vulnerable, including women and children not suffering directly from violence-related trauma – never make it to a medical facility.

“The heightened hostility between both sides and violent attacks by the North in contested border areas [Abyei, South Kordofan, and similar patterns of violence on the border between South Darfur and Western Bahr El Ghazal] is making media headlines In the lead-up to the South’s independence from the North. However, other violence has also claimed lives and displaced people this year, but has rarely made it into the news. This includes intertribal/communal related violence, cattle raiding and the rise of new southern militias.”

What are the consequences of the violence and insecurity?

“The violence has taken a massive toll on the civilian population, causing to death and displacement in states across South Sudan. An estimated 210,000 people were displaced by violence in South Sudan in 2010.

“In Western Equatoria state, for example, at least 18 incidents related to the Lord’s Resistance Army (LRA) have resulted in abduction, death or displacement in 2011, creating fear and anxiety among communities who are already struggling with high burdens of disease, limited access to basic services and an uncertain economic future due to the disruption to their farming cycles.

“Insecurity increases vulnerability to disease - particularly communicable diseases and malnutrition - and further restricts people’s access to healthcare. It prevents many people from traveling to seek treatment, whether it is for violence-related injuries or for another medical problem. The various levels of insecurity also affect supply routes, hampering not only trade but also the delivery of drugs and medical supplies.”

What is the health context in South Sudan?

“In Sudan, 75 per cent of people do not have access to even basic healthcare. Critical gaps remain for basic medical services, and particularly for emergencies. Currently, more than 80 per cent of healthcare available in South Sudan is provided by international non-governmental organisations (NGOs).

“While the context is rapidly changing – a Ministry of Health is being established and there has been a marked influx of NGOs  – it will take the government of South Sudan many years to establish a functioning health system that can meet the needs of its people.  

“The extreme shortage of trained, skilled health workers in South Sudan is a major concern. MSF is investigating how it could play a role in improving the situation. For example, in Yambio county, in addition the usual training we offer South Sudanese staff working with MSF, we are focusing on malaria. We are training local health staff in rural health centres, donating medical supplies and providing on-site support and supervision to improve the early diagnosis and treatment of simple malaria. People with severe and complicated malaria are referred to Yambio state hospital, where MSF provides free healthcare to pregnant women and children – the groups most at risk from severe malaria.“

What are the health needs in the country?

“Women and children are the most vulnerable to the lack of access to healthcare. South Sudan has one of the highest maternal and infant mortality rates in the world. Many women in labour have to walk for hours or even days to reach a health facility. If they make it, it is often too late.

“Food insecurity is increasing. The seasonal hunger gap started in May, and this year the levels of malnutrition are expected to be higher than last year because of violence and insecurity.(2) More people will need access to limited food supplies, including over 300,000 returnees as well as the 210,000 people displaced by conflict. In addition, food and fuel prices are rising for several reasons, including blockages of routes from the north.

“Malaria is endemic in South Sudan and hyperendemic in Western Equatoria state. In 2011, MSF has already treated more than 10,000 people for malaria.”

Are there a lot of returnees coming back from North Sudan?

“An estimated 300,000 people have returned to South Sudan – the influx appears to have slowed since the referendum in January. These people are particularly vulnerable. They tend to have poor immunity to diseases such as kala azar and are at increased risk of sexual violence. They are also in a difficult socio-economic position, as they face problems accessing and cultivating land.”

What is MSF’s response to the situation?

“As well as running its regular basic and specialist healthcare projects with a specific focus on maternal health and on children under 15, this year MSF has also sent emergency teams to assist people wounded or displaced by violence in Malakal (Upper Nile state), Bentiu (Unity state), Akon (Warrap state), Bor (Jonglei state) and Mvolo, Gangura and Tambura (Western Equatoria state). These teams have set up regular mobile clinics to ensure that displaced people living in remote areas can access healthcare. They have carried out measles vaccinations and distributed relief items and emergency food rations.

“In this humanitarian emergency, MSF will continue to provide essential medical aid where the needs are greatest, and where we can be of most relevance and benefit to the population. Improving access to healthcare and improving its emergency response has to be a priority for this new country. However, the government of South Sudan has allocated just 3.7 per cent of its budget to health in 2011, a decrease from 7.9 per cent in 2006. It is essential that emergency humanitarian needs are adequately prioritised by the South Sudanese government, by donor governments and by international humanitarian NGOs.”

Currently, MSF runs 13 regular projects across eight out of the ten states of southern Sudan,  providing a range of services, including basic and specialist healthcare, responding to  emergencies as they arise, nutritional support, reproductive healthcare, treatment for kala azar, counselling services, surgery, and paediatric and obstetric care.