WHO responds to health crises facing war-wracked South Sudan

After 6 years in Juba, WHO’s Abdinasir Abubakar (pictured above) understands better than most the impact war can have on people’s health – from shrapnel wounds and malnutrition to battered and beleaguered hospitals and clinics.

But the impact of the crisis that has raged in the world’s youngest country since late 2013 surpasses anything he saw during the two-decade civil war that tore Sudan in half.

“The emergencies in the past were more localized. There wasn’t as much displacement and less impact on public health,” says Dr Abubakar, a medical officer and epidemiologist. “This conflict is very different. In the past eight months we have seen more fighting spread out over more than half of the country, and many more people displaced.”

Large-scale displacement
Violence has displaced more than 1.8 million people. Over 10 000 have died in 2014 through conflict and disease outbreaks. Almost 450 000 have fled to neighboring Ethiopia, Kenya, Sudan and Uganda. While the current state of nutrition and food supply is stable, the situation could worsen towards the end of the year and into 2015. The destruction of health facilities and displacement of health workers have stretched an already vulnerable health system to breaking point.

In February 2014, WHO categorized South Sudan’s health crisis as a “Grade 3” – the highest level of humanitarian emergency. This is one of five Grade 3 parallel crises, in which WHO is coordinating the health response. The others are the Ebola outbreak in West Africa, and the humanitarian emergencies in Central African Republic, Iraq, and Syria.

WHO leads the group of organizations providing humanitarian health care in South Sudan. From January through mid-August 2014, the group – known as the Health Cluster – delivered more than 2.3 million medical interventions. “It is a very big challenge for humanitarian agencies in general, but it is unique in terms of health, as WHO and several partners have had to provide the bulk of the leadership, and the services, due to the fragility of the government,” Dr Abubakar says.

Controlling cholera, kala-azar, measles
Although there have recently been fewer cases of cholera nationwide, the disease is a cause of concern in three states – Eastern Equatorial State, Central Equatorial State, and parts of Upper Nile State – due to limited access to safe drinking water and sanitation. As of 14 September, 2014, more than 6000 cases of cholera, and 139 deaths, had been reported.

Health partners are also tackling a widening outbreak of the deadly kala-azar disease, or visceral leishmaniasis, which is carried by sandflies. Already this year, there have been more than 4000 cases of this disease. On just one day in August, 34 people died.

Around two-thirds of South Sudan’s internally displaced people live in flood-prone areas. With the recent onset of the rainy season, health service providers have more than doubled their efforts to prevent and treat malaria in camps. Malaria is a major problem in places like Mingkaman, in Lakes State, where the disease accounts for almost 40% all outpatient consultations and over 80% of all health facility admissions.

Measles is another problem. Although agencies have run emergency vaccination campaigns, between January to mid-August, more than 3500 cases, and 170 deaths, had been reported. Almost all were recorded in displaced people’s camps. Mass measles and polio vaccination campaigns have been conducted in the conflict-affected states since July 2014, in addition to the 400 000 displaced children who were vaccinated in the first four months of this year.

WHO is also supporting the Government of South Sudan to prepare for any possible cases of Ebola virus disease. No cases have been reported in South Sudan linked to the 2014 West African outbreak, but South Sudan has experienced four previous outbreaks. A task force has been formed, isolation and treatment facilities set up, trainings conducted for health workers, and risk communication through radio spots, posters and leaflets and screening of new arrivals into the country is being conducted at the airport and key border crossings.

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