Southern Sudan in crisis

It is a cruel irony for the people of Southern Sudan that the world is focusing on the potential fallout of this weekend’s referendum on secession from the north, while the ongoing emergencies facing the region since the signing of the Comprehensive Peace Agreement (CPA) six years ago have been all but ignored.

In 2005, when the north and the south signed the agreement, ending Africa’s longest-running civil war that claimed two million lives and displaced four million more, the “international community” shifted focus.

It concentrated on ensuring that the government’s delivery of services contributed to making the peace agreement “stick” and that there were “peace dividends” for the people of Southern Sudan.

The aim was to bring stability to the southern region ahead of the much-anticipated vote that takes place on Sunday. But this focus had an important consequence—the ongoing crises facing Southern Sudan, all needing emergency responses, were often overlooked and downplayed.

Throughout the region, mortality rates remain high - one out of seven mothers die due to pregnancy-related complications—malnutrition is chronic and regular outbreaks of preventable diseases remain a persistent threat to the lives of the population.

It is estimated that 75% of the population still lack access to basic healthcare. The bombs may have stopped falling in 2005, but the medical emergencies did not subside.

Southern Sudan currently faces its biggest kala-azar (visceral leishmaniasis) outbreak in eight years. It is a neglected tropical disease contracted from the bite of a parasite-carrying sandfly that is endemic in the region.

Symptoms include an enlarged spleen, fever, weakness and wasting. If untreated, kala-azar is fatal within one to four months in almost all cases, but timely treatment can bring a cure in up to 95% of cases.

By the end of November last year, Médecins sans Frontières (MSF) had treated 2 355 people for the disease in the Upper Nile, Unity and Jonglei states—eight times more than for the same period of the previous year.

The outbreak was exacerbated by increased levels of malnutrition this year, which weakened people’s immune systems. In the first 10 months of 2010, MSF admitted 13 800 patients to its clinics with severe malnutrition, a 20% increase compared to the same period of 2009 and a 50% increase compared to the whole of 2008.

At the same time, MSF conducted a mass measles vaccination campaign between December 30 and January 1 to contain an outbreak among a group of returnees in Warrap state.

The outbreak once again highlighted the vulnerability of the population and the weakness of the health system. These are just some of the many emergencies that have afflicted Southern Sudan in recent years.

Also insecurity has persisted in many parts of the south, peaking in 2009 when MSF saw an increase in violent clashes caused by Lord’s Resistance Army activity in the Equatorias and so-called “tribal clashes” in the Upper Nile and Jonglei states.

Women and children were targeted and 250 000 people were displaced.
In 2010, another 215 000 people were displaced and 900 killed as a result of so-called ethnic clashes and the emergence of new militias.

Instability in the border areas to the north was a further destabilising factor resulting in more displacements and medical emergencies.

Meanwhile, international donors, many of whom had a stake in ensuring the success of the CPA, channelled most funding into longer-term development initiatives and underfunded the emergency needs of the populace.

As the world focuses on the politics of the approaching referendum, it must not lose sight of the people who are plunging from one emergency to the next.

Southern Sudan is mired in a humanitarian crisis and, as a viable health system will take years to build, peoples’ immediate needs for food, shelter and healthcare must be met more effectively. This will require a sustained and robust emergency response, regardless of the outcome of the referendum.

Jonathan Whittall is a humanitarian adviser for Médecins sans Frontières, based in Johannesburg. He was head of mission for MSF in Southern Sudan in 2009 and is the author of the report, “Facing up to reality: Health crisis deepens as violence escalates in Southern Sudan”, available online at www.msf.org.za

Jonathan Whittall

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