Health

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.

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.

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.

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.