Health

This rapid review synthesises the literature from academic, policy and NGO sources on the drivers of malnutrition in South Sudan. The conflict and lack of a resolution is the key driver and much of the other issues are closely connected to the conflict. UNICEF argue that the main contributing factors to high malnutrition rates in South Sudan are the unprecedented high levels of food insecurity, widespread conflict and insecurity, population displacement, poor access to services, high morbidity, extremely poor diet (in terms of both quality and quantity), low coverage of sanitation facilities and poor hygiene practices (UNICEF, 2017c). Key findings are as follows: first, the population of South Sudan mainly relies on farming, fishing or herding for their livelihoods, but displacement due to conflict has forced people to abandon their source of income and food. Second, displacement also puts a strain on the resources available in areas hosting those displaced. Third, the forced migration of cattle herders leads to the spread of bovine diseases, the loss of cattle and less production of milk. Fourth, the return of people to their areas of origin puts a strain on food resources as food production does not march the population numbers. Fifth, the conflict and resulting insecurity makes it difficult to deliver aid to much of the country and restricts access to safe water and basic sanitation facilities leading to malnutrition and the lack of treatment for the same. Sixth, whilst structural constraints connected to historic poor governance, corruption, the lack of investment in infrastructure, and striking inequality across the country also drive food insecurity. Furthermore, fighting has restricted the planting of seeds, meaning that even though there was decent rainfall in 2018 not enough crops were planted to take advantage and therefore, the conflict food prices have increased dramatically. As a result, many in South Sudan only eat one, nutrient-poor, meal a day. Next, South Sudan’s health system is in dire condition as a result of the conflict, which means people are not being treated at the early stages of malnutrition or for diseases that exacerbate malnutrition, such as cholera. Finally, the Fall Armyworm was first reported in South Sudan in 2017 and has spread across the country, it has led to significant crop loss in the major staple crops in South Sudan maize and sorghum.

While South Sudan is endowed with 3.5 billion barrels of proven oil reserves, the exploitation of this natural wealth is turning into a catastrophe for some local communities, particularly in Melut County. Through focus group discussions, individual interviews, and field observations, we found the following:

Many households in Paloch, Melut County, are in close proximity to oil wells and facilities, and within a short distance of a large lake of toxic produced water, exposing them to highly toxic chemicals.
Livestock graze around the oilfields, passing on highly toxic pollutants to residents through the food chain.
Community drinking water, held in containers that are placed on dusty roadsides by Dar Petroleum Operating Company (DPOC), and chemical containers used by community members to hold water, are likely sources of human exposure to toxic pollutants.
Communities have repeatedly complained about a high prevalence of petroleum pollution that causes diseases and reproductive health issues, including birth defects, infertility, stillbirth, and miscarriages, among others. We discovered 13 cases of birth defects, including spinal bifida, facial and head deformities, sexual organ deformities, limb deformities, and growth retardations.
All of the participants expressed anger and frustration, a sign of a more serious potential crisis that could cripple petroleum industry operations in the area, if not prioritized and addressed.


We recommend the following to the Revitalized Transitional Government of National Unity (RTGONU) and DPOC:

Urgently identify areas sufficiently distanced from the oil fields, build basic services infrastructure in those areas, and relocate residents away from the oil fields and facilities;
Fence off the oilfields to prevent access by humans, livestock, and wildlife;
Conduct a comprehensive environmental and social assessment similar to the one that was conducted in Ogoniland in Nigeria by the United Nations Environment Programme (UNEP) to assess the extent of pollution damage, determine compensation and remediation costs, and make recommendations that are enforceable through an act of parliament or a presidential order; and
Expedite the tabling, review, and passage of the draft Environmental Protection and Management Bill to strengthen environmental protection rules and enforcement capacity to better protect the health and welfare of those South Sudanese suffering from oil industry operations.

While South Sudan awaits the arrival of the vaccines, whenever that will be, the focus should be on the prevention strategies, implemented in tandem with restrictions that should minimally affect daily lives. A mask mandate throughout the country will go a long way in preventing new cases of the virus

This paper reviews the existing literature to determine the adequacy of evidence and extent
of the environmental impacts in the oil producing areas in South Sudan. The following is
revealed:
o Evidence from previous studies shows that there is a serious environmental and
social disaster in the three oil producing areas, even though such evidence does not
generate enough consensus for the decision makers.
o Environmental impacts assessments (EIA) conducted before the oil operations
reveal that (1) the air in these locations was of good quality and (2) the water was
safe for both human and animal consumption, except for the pockets with high
concentration of salt in groundwater in the Um Ruwaba geological region.
o Still, many parameters of environmental quality usually recognized by World
Health Organization (WHO) have not been tested in both the EIAs and related
environmental studies.
o In summary, existing evidence links high concentrations of salt and heavy metals to
oil exploration, development and production, which are the cause of the widely
reported birth defects, miscarriages, infertility, and cancers in the affected areas.
We recommend a comprehensive, independent environmental and social assessment to
determine the extent of environmental and social impacts. Resulting insights could be used
to develop remediation measures to restore the environment and address related health
and social problems. The assessment should be carried out by a reputable firm or an
organization, which would need to be selected by the Ministry of Environment and
Forestry through a competitive bidding process. In the long term, results from this
assessment could help lay the foundation for sustainable development, provide oil
companies with new social license to operate, avert potential conflict and ecological
disasters, and aid in building a lasting peace in the country

The first 1000 days, the period from conception to 2 years of age, is a crucial time for early childhood growth and development. This period sets the basis for a child’s health and physical, social, cognitive, emotional and behavioural development and is when the child is most dependent on parental care and a healthy environment.

This helpdesk report reviews the lessons learned from the delivery of health programmes in a conflict-sensitive way including in South Sudan. Recommendations on conflict sensitivity and health programming identified in this review include: coordination between governments and implementing agencies, training for healthcare staff in conflict sensitivity, health and hygiene promotion for refugees and social cohesion activities for refugees and host communities involving children.

Meanwhile, lessons for achieving health outcomes in fragile and conflict-affected states include: political commitment and government ownership, participatory decision-making, evidence-based programming and refinement, reliable and sustained funding and strengthening of community structures that provide support in health. Programming experience in fragile and conflict-affected states also provides useful tips on: capacity building, contracting out, health pool funding, labour markets, different providers and gender

Background: A key part of treating and preventing malnutrition is the provision of effective nutrition education to the clients and caretakers so that they can self-manage their nutrition needs even after discharge from the hospital. For effective nutrition education,three factors are paramount; The successful transfer of knowledge and skills, client motivation to act on theacquired skills and knowledge and ensuring that the patient is able to understand and put to practice the educational messages given.

Methods: The study used cross sectional design with mixed method of data collection that involved 83 caretakers of admitted SAM children at Al-Sabah children hospital ITC, Sample size was determined using Cochran 1975, interviewer administered questionnaires and focus group discussion guide were the tools used in collecting data. Data set was generated using EPI info andanalyzed using SPSS version 21, the analyzed descriptive data was triangulated with the qualitative data collected using FGD.

Results: The majority of the caretakers were female 78 (94%) of which 68 (81.9%) were mothers to the children that were admitted. Only 8 (9.6%) of the respondents were found to have attained effective nutrition education and majority of the respondents were found not to be recalling the information they were given during the education session.Conclusion: As per the guidelinesadaptedby the ministry of health republic of South Sudan, the nutrition education sessions conducted was found not be effective as most of the clients could not even recall the information given.