Humanitarian Health Action

South Sudan Regional Refugee Response Plan

Despite the Resolution of the Conflict in the Republic of South Sudan, signed by the warring parties in August 2015, the volatile situation in the country with violations of the ceasefire and the vulnerability of its population, continues to prompt South Sudanese to keep seek refuge in neighbouring countries. While over 1.6 million people are displaced inside South Sudan, more than 700 000 sought asylum in the neighbouring countries of Ethiopia, Kenya, Sudan and Uganda since the current conflict broke out. Additionally, another 121,000 South Sudanese who were already refugees before December 2013 find themselves trapped in countries of asylum, without the possibility of returning home. The total number of South Sudanese refugees could exceed 938,000 by the end of 2016.

ETHIOPIA

Health and nutrition situation

Ethiopia hosts over 326 000 South Sudanese refugees. Despite the improvements in access to health services, the number of available health facilities is insufficient to cater for the needs of the increasing refugee population. Currently, one health facility serves an average of 15 000 refugees, as opposed to the standard of one facility per 10 000. Malaria is a major disease among the refugee population with crude incidence rates ranged between 9.4 in Jewi and 55.5 in Kule at the end of September 2015.

Hepatitis E outbreaks were reported from refugee sites in Gambella, particularly in Kule camp, affecting 1 082 individuals between March 2014 and September 2015. HIV/AIDS prevalence among pregnant women is higher in the Gambella refugee camps as compared to other camps in Ethiopia. Okugo refugee camp has seen an increased infection rate of new HIV cases. In combination with high rates of other sexually-transmitted infections, broader interventions are needed to prevent transmission. Given the severe drought, household food consumption is expected to decrease, and acute malnutrition is expected to increase across the camps in Gambella.

Health and Nutrition Sector partners planned activities

Health services: Implement primary health care service package focusing on curative, preventive and promotion of health care; upgrade primary health facilities at camp level to semi-permanent structures; provide medical equipment and supplies (including ambulances); establish additional health centres/health posts to reach the standard of one health centre/10,000 refugees; procure essential drugs; provide HIV/AIDS and tuberculosis prevention, care and treatment services; support referral to secondary and tertiary health care facilities; provide prosthetic, orthotic, and mobility aid services.

Immunization and preventative care: Maintain outbreak response preparedness and immunization services for new arrivals and provide vitamin A supplements and deworming to children 1-5 years; enhance communitybased preventive health services by involving health workers in the refugee population for effective communication and health services support.

Nutrition: Triage and management of acute malnutrition in the outpatient therapeutic programs (OTP), stabilization centre programmes (SC), targeted supplementary feeding programmes (TSFP) for about 6 900 severe acute malnutrition (SAM) and 15 700 moderate acute malnutrition (MAM) cases; promote, protect and support optimal infant and young child nutrition at entry points and in the camps for 13 500 pregnant and lactating women; procure and provide 187 000 kilograms of Ready to use therapeutic foods (RUTF); F100 milk, F75 milk and Plumpy-nut to all malnourished children; provide blanket supplementary feeding programmes at entry points and in camps and micronutrient supplements for children 6-59 months and pregnant and lactating women; conduct community outreach activities including malnutrition screening systematic Mid Upper Arm circumference (MUAC) to monitor acute malnutrition trends and provision of nutrition messages; conduct annual refugees Standardised Expanded Nutrition Survey (SENS).

Health and Nutrition Sector partners

ACF, ADRA, Concern Worldwide, DCA, DICAC, DRC, ERCS, GOAL, HelpAge, IMC, IOM, IRC, LWF, MCMDO, NCA/DCA/DASSC, NRC, NRDEP, Oxfam, Plan International, RaDO, SCI, UNHCR, UNICEF, WFP, WVI, ZOA International.

Health and Nutrition partners funding requirements for 2016

US$34 242 764

KENYA

Health and nutrition situation

Kenya hosts over 102 000 refugees from South Sudan, out of which 48 000 arrived as a result of the 2013 conflict. Most of them reside in Kakuma refugee camp, in north-western Kenya. The arrival of new South Sudanese refugees in Kakuma has overstretched the health system beyond its capacity, since they access the same services provided to the old refugee population. As a result, consultations per clinician remains high at 92 consultations per clinician per day compared with UNHCR standard of 50 consultations per clinician per day and the bed occupancy is above 100 per cent, implying that patients have to share beds. The situation is further worsened by increased incidence of communicable diseases such as watery diarrhoea and respiratory tract infections due to overcrowding and increased competition for water. In the nutrition sector, the operation normally records a high number of children who are malnourished or at risk of malnutrition. The high numbers of children in the feeding programmes overstretches the staffing and facilities compromising the quality of services, more so in monitoring the growth of children from birth to five years of age. High numbers have been recorded in the blanket supplementary feeding programme (BSFP) for children aged 6-23 months.

The health and nutritional status of the refugees is relatively stable as evidenced by indicators, which are within Sphere standards. The crude mortality is 0.2/1000/month and under five mortality rate is 0.6/1000/month against standards of 1.5/1000/month and 3/1000/month respectively. The operation is planning to construct two clinics at Kalobeyei before end of the year. The rate of global acute malnutrition for new arrivals was 9 per cent and severe acute malnutrition was 0.4 per cent.

Health and Nutrition Sector Partners planned activities

Health services: Construct one maternity ward at the Kalobeyei settlement site and equip it with modern medical equipment to ensure fast and accurate diagnosis as well as high quality curative services; recruit additional staff to ensure consultations per qualified clinician ratio is maintained within standards of 50/clinician per day; provide adequate facilities at the new site to include stores and nutrition distribution waiting bays for the outpatient therapeutic program as well as the supplementary feeding program for malnourished children and those at risk of malnutrition respectively; construct and equip a stabilization ward for the treatment of malnourished children with medical complication; hire additional technical nutrition staff as well as supportive staff to ensure effective implementation of planned activities.

Nutrition: Implement and strengthen the Infant & Young Child Feeding (IYCF) friendly framework; conduct an annual camp nutrition survey; carry out systematic MUAC screening to monitoring acute malnutrition trends; provide micronutrients supplementation and deworming for children 1-5 years.

Health and Nutrition Sector Partners

Danish Refugee Council, Film Aid International, Lutheran World Federation, Norwegian Refugee Council, Peace Winds Japan, UNHCR, UNICEF, WFP.

Health and Nutrition Partners funding requirements for 2016

US$ 4 056 969

SUDAN

Sudan continued to face a steady influx of South Sudanese refugees throughout 2015. By the end of October, over 197 000 South Sudanese had sought safety in Sudan. Including the previous caseload, Sudan hosts a total of 270 375 refugees. The majority of the arrivals, around 84 per cent, are women and children. Children alone represent over 63 per cent of the refugee population. Reception arrangements upon arrival include medical screenings and provision of hygiene kits for females.

Gaps in health-care delivery and nutrition services still exist, a direct result of the heightened burden of the refugees on the already-weak health system in the affected states, and a nutrition assessment across all sites in White Nile State will be carried out in 2016 to accurately assess the malnutrition rates. There is a pressing need to establish more long-term health-care and nutrition facilities, with support to facilities like blood banks, reference laboratories, delivery rooms equipped with comprehensive emergency obstetric care, and theatres for surgeries. The referral system needs to be strengthened with proper ambulances assigned to clinics and major hospitals ensuring 24-hour referral capacity. Referral hospitals need to be supported to be able to respond to the needs of South Sudanese refugees, as well as vulnerable Sudanese host community members.

Health and Nutrition Sector partners planned activities

Health facilities: Maintain and reinforce existing health facilities to ensure free access to primary health care including reproductive health, maternal, neonatal and child care for refugees and host communities; establish new health outposts/ centres at new locations.

Health services: Support integrated management of childhood illnesses; support health facilities with basic and comprehensive emergency obstetric care; support health promotion and health awareness activities; strengthening of medical referral systems; facilitate better availability and access to secondary-level health care; support mental health counselling and care at community level and health facilities. Medicines and medical supplies: Procure and distribute drugs, reagents, kits (diarrhoeal disease kits, rapid response kits, primary health care kits, and reproductive health kits, integrated management of childhood illnesses, clean delivery and hygiene kits), emergency obstetric care equipment and medical supplies to all health facilities; strengthening the capacity of blood donation units by provision of basic and comprehensive supplies, and equipment in support of comprehensive emergency obstetric and newborn care services.

Disease prevention: Weekly collection of epidemiological data and enhanced detection of communicable diseases outbreaks; support malaria prevention with long-lasting insecticide treated nets distribution; immunization coverage against measles, polio and other antigens above 90 per cent for targeted children.

Health and Nutrition Partners

Almanar, Assist, FAO, IOM, Pancare, SCI, SRCS, UNFPA, UNHCR, UNICEF, UPO, WFP, WHO.

Health and Nutrition Sector partners funding requirements for 2016

US$24 000 653

WHO funding requirements for 2016

US$10 200 000

UGANDA

Health and nutrition situation

Uganda now hosts some 495,000 refugees. The largest groups originate from the Democratic Republic of the Congo, South Sudan, Somalia and Burundi. There are a total of 238 855 refugees from South Sudan. The Government has made refugee-hosting areas a priority through the inclusion of the Settlement Transformative Agenda (STA) in the National Development Plan (NDP II), which will also be supported through the Refugee and Host Population Empowerment (ReHoPE) approach endorsed by the UN Country Team. ReHoPE focuses on progressively enhancing social service delivery in refugee-hosting areas, with a view to integrating services with local government systems, and on economic empowerment of refugee hosting areas.

With an increasing number of refugees arriving, new settlement areas will need to be opened, requiring a high initial investment in basic services infrastructure and/or strengthening existing public services. The existing settlements will need to be stabilized with a focus on capacity building for local government authorities and community self-management structures, including host communities. Primary health care services risk being overwhelmed by the increasing population. The existing health centres are operating beyond capacity thereby stretching their limited resources.

Health and Nutrition partners planned activities

Health services: Health services fully integrated with the national health system with a minimum health service package (including vaccinations) provided to new refugees; build health staff capacity through training, including refresher courses and support supervision; support access to both preventative and curative health services to persons of concern; access to reproductive health and nutrition services; strengthened health outreach services through the village health teams (VHT) system; access to special medicine facilitated for chronically sick patients; facilitate access to specialized care through medical referral system; additional medicine and health supplies purchased with a focus on vital and essential medicine and supplies; provision of vaccinations for new arrivals and old caseloads; strengthen infant, young child and mother feeding practices.

Nutrition: Support the management of severe and moderate acute malnutrition and prevention of micronutrient deficiencies, including anaemia; deworming for children aged 1-5 years old and provision of vitamin A supplementation for children aged 6-59 months; expand existing supplementary feeding programmes for malnourished children.

Health and Nutrition Sector partners

ACF, ACORD, AIRD, DRC, FAO, International Aid Services, IOM, IRC, LWF, Malteser International, NRC, Oxfam, Plan international, TPO, UNFPA, UNHCR, UNICEF, WCC, Welthungerhilfe, WFP, WHO, WVI.

Health and Nutrition Sector partners funding requirements for 2016

US$ 20 995 599

WHO funding requirements for 2016

US$3 924 600

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