Armed conflict, violence, disease and climatic shocks in South Sudan
South Sudan has been affected by complex emergencies resulting from prolonged conflict, climate change, a broken health system, and outbreaks of communicable diseases. Toward the end of 2015, South Sudan’s people faced multiple threats, including armed conflict that began in 2013, inter-community violence, disease, and climatic shocks. More than 2.3 million people have fled their homes since 2013 and there are now 1.66 million internally displaced people, 50% of whom are estimated to be children. When tens of thousands of people fleeing the conflict sought refuge in United Nations’ bases positioned around the country, these sites were quickly overwhelmed, with families crammed together with little or no access to safe water or sanitation.
More than 686,200 children under the age of five are estimated to be acutely malnourished; 231,300 of these children are classified as severely malnourished. On a population level, by September 2015 there were 3.9 million people classified as severely food insecure, with an estimated 30,000 people facing “catastrophic food insecurity.”
In terms of disease, malaria is the biggest recorded killer; there were more than 1,100 deaths reported in health facilities between January and October 2015. Throughout the country, communicable diseases are a concern due to poor sanitation, lack of access to safe water, and crowded living conditions. There has been a notable upsurge in the scale and frequency of outbreaks of epidemic-prone diseases, especially in displacement sites; malnutrition and weakened immunity makes young children and pregnant women particularly vulnerable.11 Sexual and gender-based violence are pervasive in South Sudan.
An estimated 4.42 million people are in need of emergency health care and approximately 304,000 refugees are expected to need health assistance in 2016. 11 Displacement has caused a severe shortage of medical professionals; there are only 12 trained midwives, one anesthetist, and one obstetrician/gynecologist per 200,000 people in South Sudan; there are no pediatricians in the country.11 As of September 2015, some 55% of the health facilities in Unity State, Upper Nile State, and Jonglei were no longer functioning since the majority of health facilities in these areas had been attacked and looted. In Unity State, there is only one county hospital for more than a million people. Essential medicine shortages are likely to exacerbate this already critical situation.11
Between late December 2015 and early May 2016, the National Health Regulation Focal Point (NFP) of South Sudan notified the WHO of an outbreak of hemorrhagic fever syndrome. As of May 9, 2016, a total of 51 suspected cases of hemorrhagic fever syndrome were reported from the counties of Aweil North and Aweil West; 74.5% of the suspected cases involves those under the age of 20. Between August and November 2015, Darfur, Sudan reported at least 469 cases of undiagnosed viral hemorrhagic fever, including 120 deaths. Because of frequent cross-border movement between Sudan and South Sudan, the risk of international spread of the disease must be considered.12