Health

The trends reported in the Integrated Food Security Phase Classification (IPC) show a growing food security crisis in South Sudan, with a high proportion of people sliding into crisis and emergency food insecurity level. The underlying fears concern an emerging acute lack of food in almost all parts of the country, with millions of people, many of them rural women and children, affected. At the peak of the lean season in August to September 2016, Northern Bahr el Ghazal had 72% of its population facing crisis and emergency[1] level. It should also be noted that Northern Bahr el Ghazal’s food security indicators continue to be alarming with 62% of the population being severely food insecure (phase 3,4,5) by the peak of the lean season (July)[2]. In January 2017, the Sudd Institute, with generous support from Food and Agriculture Organization (FAO) of the United Nations, explored the proximal risk factors undermining food security resilience and triggering or perpetuating emergency level vulnerabilities in the former states of Warrap and Northern Bahr el Ghazal. Examining 6 major assumptions using Participatory Rural Appraisal (PRA) tools to draw important information from rural households, the results are instructive and in direction of our expectation. They provide insights into appropriate response options for combating food security vulnerability in the region that is nearly sliding into famine. We outline the key results as follows.

South Sudan has, up to the time of writing, avoided the worst effects of the global coronavirus pandemic. However, as the disease spreads further through the African continent, South Sudan—and other countries in the Greater Horn of Africa region—need to carefully calibrate their response to prevent a dangerous escalation. Of critical importance to this is the need to take into account local knowledge and expertise. Drawing on the RVI's network of South Sudanese researchers, this note reflects shared findings and recommended actions collated by a team of nine male and female researchers working in urban, rural and cattle camp locations across the country. It focuses on 6 key areas: public messaging; epidemic management; economic considerations; the politics of the response; risks of conflict; and international agency and donor tactics.

This document provides evidence of practical and affirmative options of people-centered, participatory forms of community organizing and engagement in diverse areas of prevention, care and wider social protection in responding to COVID-19. The 42 case studies from different regions intend to inspire, inform and support.

Due to increasing cases and requests from many developing countries, the World Health Organization (WHO) designated snakebite as a neglected tropical disease of high priority in 2017. According to WHO, “bites by venomous snakes can cause acute medical emergencies involving severe paralysis that may prevent breathing, cause bleeding disorders that can lead to fatal haemorrhage, cause irreversible kidney failure and severe local tissue destruction that can cause permanent disability and limb amputation.”
The data coming out of the Médecins Sans Frontières (MSF)snakebite programme in Agok are a cause for concern for this medical emergency (See article on page 146).[2] With no centralized data on snakebites from across the country, this bellwether programme should be celebrated and replicated. Different states have varied rates and incidences of snakebites and one size fits interventions may not be relevant. However, a clear programme would put snakebite high on the agenda and help prevent needless deaths. When there are no specific integrated programmes, individuals resort to traditional and ineffective remedies for snakebites which could do more harm than good. This issue is compounded by the lack of anti-venoms, awareness by health workers, poor training and appropriate treatment guidelines and protocols. The Ministry of Health and all relevant NGOs should ramp up efforts to expand the snakebite programmes by integrating them into the primary healthcare system, developing awareness and training materials, as well as ensuring the availability of anti-venom as part of the essential drugs list. The MSF programme in Agok has shown that it can be done.

South Sudan has some of the worst health outcome indicators globally, in spite of modest
improvements over the last five years. Maternal mortality ratio has stagnated at 2054 per
100 000. Mortality rate for infants and children under five years declined from 102 and 135
in 2006 to 75 and 104 in 2012 per 1000 live births respectively. The significant disparity in
health status across socio-demographic factors and geographical location is well
documented.

This British Academy/Leverhulme-funded research investigated the health and justice service responses to the needs of South Sudanese refugees living in refugee settlements in Northern Uganda who had been subjected to sexual and gender-based violence (SGBV) and torture. It involved the collection and thematic analysis of the narratives of 20 men and 41 women who were refugee survivors of SGBV and torture, including their experiences in South Sudan, their journeys to Uganda and experiences in refugee settlements, in particular their access to health and justice services.

Thirty-seven key stakeholders including international, government, non-government organisations and civil society organisations were also interviewed regarding their experiences of providing health and justice services to refugees. All refugees had survived human rights abuses mainly carried out in South Sudan but some had also occurred on route to Uganda and within Uganda. Despite the significant impact of their experiences, the analysis indicated that there was limited service response in refugee settlements in Northern Uganda once the immediate humanitarian crisis ended. The thematic analysis indicated five main themes coming from the interviews. These included: the nature of refugee experiences of SGBV and torture, including domestic violence and child abduction and forced marriage; issues associated with service provision such as lack of adequate screening and under resourcing of health and justice services; a lack of gender sensitivity and specialist services, particularly for men; the sustained involvement of civil society organisations and local non-governmental organisations in providing counselling and offering emotional support and hope to survivors; and enhancing health and justice responses and services to improve refugee recovery, dignity and resilience. The authors recommend that integrated gendered and culturally sensitive service provision should be adopted, which brings together formal and informal health, justice services and survivor support programmes.

his policy brief studies the economic impacts of the COVID-19 pandemic in South Sudan. The findings are educative. First, the health effects of the pandemic in the country have been surprisingly less pronounced than expected, marked by very low morbidity and fatality rates. Second, despite this positive health news, the pandemic has had negative effects on the economy, starting with dramatic declines in domestic production and revenue collection, followed by a very volatile rising cost of living. These economic consequences are far-reaching, severely weakening, for example, human capital formation, especially in education, as the lockdown has deprived some 2 million school-age children of learning opportunities. Finally, economic recovery from COVID-19 will require a coordinated strategy that fosters broadened synergies in response to sector-specific COVID-19 ramifications. Interventions that prioritize smaller firms and women enterprises should be in order.

The implementation of the R-ARCSS is stalled, as the parties have had difficulty gathering sufficient momentum to push the Agreement forward.
The outbreak of the COVID-19 pandemic has had serious negative impacts on the ability of the parties to implement the Agreement.
The crush of oil prices in the global market, South Sudan’s lack of credit worthiness internationally, US Treasury’s warnings, corruption, and South Sudan’s weak fiscal and monetary policies, all make it difficult for the country to access external resources to cushion budget shortfalls.
While the economic downturn as a result of the pandemic has dried up the public coffers, a combination of distrust among the parties and lack of political will is the most important factor hampering the implementation of the R-ARCSS.
To turn things around, leadership of the parties to the Agreement must renew their commitment to the Agreement and show by actions their willingness to move the country forward, possibly attracting external budgetary supports.
The international community needs to push the parties to live by their commitments and also contribute necessary financial and material resources to enable the parties to overcome the economic consequences of COVID-19. Significant donor reengagement will require evidence of significantly higher political will for peace in South Sudan.
The formation of state government is extremely critical to combating the pandemic and to restoring peace at the grassroots, which will help protect people from the virus and reduce cattle raiding and communal violence. Recent developments toward this issue are commendable.
Provisions aimed at returning to democracy and good governance such as election and constitutional making processes should be expedited and started early so as to build confidence in this transition. The parties to the Agreement blame current deficits in democracy and governance on COVID-19.
Should the parties fail to implement governance protocols fully, the potential for national elections to be conducted will have been thwarted, risking a return to an all-out war.