Humanitarian Health Action

South Sudan conflict-related crisis - Health situation report no. 2 - 8 September 2009

Latest information on South Sudan conflict-related crisis health situation.

HIGHLIGHTS

  • Conflict continues, with inter-tribal attacks in States of Jonglei and Upper Nile and continuing Lord's Resistance Army (LRA) attacks in Western Equatoria State (WES) leaving over 70 dead and many more injured. The security situation remains precarious.
  • Inter-agency assessment teams arrive in Ezo County (WES) and Twic East County (Jonglei State) on 3 September.
  • Medicines and medical supplies urgently needed for health facilities in Ezo County.

HEALTH IMPACT

  • The conflict in southern Sudan appears to be escalating. In addition to continued LRA attacks in and around Ezo County (WES), inter-tribal clashes in the states of Upper Nile and Jonglei have left over 70 people dead and wounded dozens of others, some severely. The security situation remains fragile and some areas are still inaccessible. Government forces are trying to restore peace. LRA attacks have intensified in the area stretching from Sakure to South Yubo on the borders with the Democratic Republic of the Congo (DRC) and Central African Republic (CAR).

    Thousands of IDPs from Ezo are making the perilous journey to Yambio, the capital of WES, on foot. The road between Yambio and Ezo is considered extremely dangerous.

  • An inter-agency team visited Ezo County on 3 September for a first assessment of the security and humanitarian situation. The team held a series of meetings with the commissioner of Ezo, military commanders, the South Sudan Relief and Rehabilitation Commission (SRRC), representative and community leaders. According to the county commissioner, security in the town of Ezo has improved following the deployment of additional security forces by the Sudan People’s Liberation Army and the Ugandan People’s Defense Forces (UPDF). Nonetheless, local communities from nearby villages are continuing to take refuge in the town for security reasons. The LRA remains active in the area.
  • Based on information gathered from authorities and UN agencies as of the last week of August, the estimated number per location of IDPs and refugees in WES is as follows:

Place IDPs Refugees (from DRC and CAR)
Ezo 25 566 5 762
Nzara 1 902 -
Yambio 4 824 1 813
Makpandu refugee camp 0 2 377
Ibba 2 661 -
South Yubo 929 489
Total 35 882 10 441
  • The WHO medical officer who participated in the inter-agency assessment met the county medical officer and other health workers to discuss the scale of health needs and the current status of health facilities serving IDPs and local communities in Ezo. Findings were as follows:
    • The exact number of deaths and injuries in Ezo cannot be quantified at present due to the ongoing insecurity and limited movements in the area.
    • Many patients who were badly injured during LRA attacks were not able to be transferred to Yambio for surgery due to insecurity and lack of transportation.
    • Eleven out of 20 primary health care (PHC) units in Ezo County remain closed due to the security situation. The remaining nine are short of health personnel and services. All health facilities are running out of basic medical supplies and surgical materials. Common paediatric antibiotic drugs, anti-malarial and anti-parasitic syrups and other medicines are not available in either county health department warehouses or in camp clinics. Immunization activities have been halted and IDPs and refugees are at risk of vaccine-preventable diseases such as measles.
    • There are many HIV-positive patients in the camps. Although they have enrolled at the antiretroviral (ARV) treatment centre in Nzara hospital (50km west of Ezo), the prevailing insecurity and lack of transport mean they have been unable to travel to Nzara to obtain ARV drugs. These HIV patients say they are afraid of developing drug resistance if they interrupt their treatment regimens. They have asked WHO for help.
    • Community health workers at the Ezo PHC centre and in camps report the most common illnesses are upper respiratory tract infections, malaria, diarrhoea and gastroenteritis. The leading causes of morbidity and death in children in camps are acute watery diarrhoea, malaria and lower respiratory tract infections.
    • This week, six cases of measles and 15 cases of chicken pox among children under 5 years were reported from IDP and refugee camps by the county surveillance officer.
    • Ezo town lacks clean water and appropriate sanitation.
  • Following a request by the acting governor of Jonglei State, another inter-agency assessment team visited Twic East County on 3 September 2009. Team members included representatives of the World Food Programme, the United Nations Missions in Sudan (UNMIS), UNICEF, Médecins sans Frontières (MSF), the Southern Sudan Relief and Rehabilitation Commission, UNMIS - Return Reintegration Recovery (RRR) and Ministry representatives. Main findings were as follows:
    • The government estimates there are over 24 000 IDPs in Jonglei State. The assessment team only managed to visit two areas (Kongor and Panyagor), but estimated there were between 3000 and 4000 IDPs, mainly women, children and the elderly, in Panyagor. Most of the affected population are returnees who have recently come back and have not yet fully reintegrated into the community. The assessment team was told that many IDPs were still hiding in the bush and that IDP numbers can therefore be expected to increase. Estimates of IDP numbers in Kongor vary greatly (from 2000 to 14 000).
    • The immediate needs of IDPs are food, shelter, non-food items and mosquito nets.
    • Health facilities in Panyagor are presently satisfactory, with 16 beds, two medical officers, one midwife, three clinical officers and two pharmacists and sufficient medical supplies to manage the current caseload.
    • The Kongor PHC unit has been very busy due to the large number of IDP consultations. But health staff are currently coping. Main health problems reported are diarrhoeal diseases, malaria, respiratory tract infections and skin diseases.

HEALTH SECTOR RESPONSE

  • NGOs currently operating in Twic East (Jonglei State) include Care International US, Lutheran World Federation, Norwegian People Aid and Save the Children Sweden.
  • Teams from MSF-France and MSF-Belgium flew to Twic East on 30 August to assess the scale of medical needs. The teams provided medical assistance to those in need, while referring complicated cases to Juba Teaching Hospital. According to the MSF teams, the medical situation in Twic East is under control, and all wounded people are recovering well. MSF-Belgium has donated essential drugs and surgical materials to health facilities in the district. Diarrhoeal diseases, malaria, respiratory tract infections and skin diseases are among the common health problems reported.
  • UNICEF has donated two Primary Health Care Centre (PHCC) kits and 20 cartons of plumpy nuts to health facilities in Panyagor, the headquarters of Twic East.
  • WFP has distributed two to three months' supply of food to displaced people and refugees in Ezo through SRCCS.
  • The International Organization for Migration, World Vision International, International Committee of the Red Cross and MSF-Spain are teaming up to support and distribute food to IDPs and refugees in Ezo, Sakure and Nabutina.
  • MSF-Spain is the only health partner providing emergency health services and medical supplies to displaced people and refugees in and around Yambio.

WHO RESPONSE

WHO has donated items to health facilities in the following areas through the County health department:

Ezo, WES
  • one Inter-Agency Emergency Health kit (IEHK), containing enough medicines and supplies to treat 10 000 people for three months
  • one Inter-Agency Diarrhoeal Disease kit (containing medicines to treat 100 severe cases of diarrhoea, 400 moderate cases of diarrhoea and 200 Shigella dysentery cases)
  • 2000 adult doses and 3000 children’s doses of artemisinin-based combination therapy (ACT)
  • 5000 malaria rapid diagnostic tests
Twic East, Jonglei State
  • one IEHK
  • 4000 adult doses and 3000 children’s doses of ACT
  • 2000 malaria rapid diagnostic tests
  • surgical Kits
Malakal, Upper Nile State (through the State Ministry of Health)
  • 4000 adult doses and 3000 children’s doses of ACT
  • 2000 malaria rapid diagnostic tests.

WHO has assigned senior medical officers to Jonglei State, Upper Nile and Western Equatoria to support the humanitarian response.

WHO is supporting disease surveillance activities in all counties in Jonglei, Upper Nile and Western Equatoria States.

WHO is coordinating all health response activities in Jonglei, Upper Nile and Western Equatoria with the State Ministry of Health and local health partners.

NEEDS

  • The State Ministry of Health in Jonglei State has appealed for medical supplies for health facilities serving displaced people in areas including Akobo, Pibor and Twic East county. Needs include antibiotics, skin disease treatments, vitamins and anti-helmenthics, medical supplies and equipment.
  • Provide more medicines (antibiotics, skin disease treatments, vitamins and anti-helmenthics), medical supplies and equipment to health facilities in Twic East District, Jonglei State.
  • Provide mosquito nets, anti-malaria drugs and diagnostic instruments to health facilities servicing displaced people in Ezo, Twic East and Malakal.
  • Improve access to antiretroviral therapy among HIV-positive individuals living in the camps.
  • Support and organize measles immunization campaigns in all IDP and refugee camps if and when security improves in Jonglei and WES.
  • Train health service providers on the management and control of disease outbreaks.
  • Strengthen disease surveillance to control spread of common communicable diseases like malaria, acute watery diarrhoea and measles together with health authorities and partners.
  • Coordinate the WASH sector to improve the availability of safe drinking water and sanitation.

Contacts

WHO Southern Sudan Office
Dr Abdi Aden Mohamed
Head of Office
e-mail: mohameda@nbo.emro.who.int
Tel: + (249) 927 361440

WHO Regional Office for the Eastern Mediterranean
Mr Irshad Shaikh
Emergency and Humanitarian Action Regional Adviser
e-mail: shaikhi@emro.who.int
tel.+202 276 5525
mobile: +2010 173 3924

WHO headquarters
Mr Jukka Sailas
External Relations
Health Action in Crises
e-mail: sailasj@who.int

Mr Paul Garwood
Communications Officer
Health Action in Crises
e-mail: garwoodp@who.int
tel. +41 22 791 3462
mobile: +41 79 475 5546

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