Les enfants pris dans des conflits prolongés sont trois fois plus susceptibles de mourir d’une maladie transmise par l’eau que de la violence

NEW YORK, le 22 mars 2019 – Les enfants de moins de 15 ans vivant dans des pays touchés par des conflits prolongés sont, en moyenne, près de trois fois plus susceptibles de mourir d’une maladie diarrhéique provoquée par un manque d’eau salubre, d’assainissement et d’hygiène que des effets directs de la violence, affirme l’UNICEF dans un nouveau rapport paru aujourd’hui.

Ce rapport, intitulé L’eau sous le feu des bombes, explore les taux de la mortalité dans 16 pays exposés à des conflits prolongés et révèle que dans la plupart d’entre eux, les enfants de moins de 5 ans ont 20 fois plus de risques de mourir d’une maladie diarrhéique liée à un manque d’eau salubre et d’assainissement que des effets directs de la violence.

« Le combat est perdu d’avance pour les enfants qui vivent dans des pays touchés par des conflits prolongés sachant que beaucoup n’ont pas accès à des sources d’eau salubre », indique Henrietta H. Fore, Directrice générale de l’UNICEF. « Le fait est que le manque d’eau salubre tue plus d’enfants que les balles. »

En l’absence de services d’approvisionnement en eau, d’assainissement et d’hygiène sûrs et efficaces, les enfants risquent d’être victimes de malnutrition et de contracter des maladies évitables, dont la diarrhée, la typhoïde, le choléra et la polio. La situation est encore plus compliquée pour les filles. Elles s’exposent aux violences sexuelles lorsqu’elles vont chercher de l’eau ou sortent utiliser les latrines. Elles voient leur dignité bafouée au moment de se laver ou de gérer leur hygiène menstruelle. Et elles manquent les cours pendant leurs règles si leur école n’est pas équipée d’installations adaptées en matière d’eau et d’assainissement.

Ces menaces sont amplifiées en période de conflit, lorsque les attaques, qu’elles soient portées délibérément ou non, détruisent les infrastructures, blessent le personnel et coupent l’alimentation électrique qui permet aux systèmes d’approvisionnement en eau, d’assainissement et d’hygiène de fonctionner. Les conflits armés restreignent en outre l’accès à du matériel et à des produits de consommation essentiels, tels que le carburant ou le chlore, qui s’épuisent ou sont rationnés, ou dont la livraison peut être détournée ou bloquée. Bien trop souvent, les services indispensables à la population sont volontairement coupés.

« Prendre intentionnellement l’eau et l’assainissement pour cible revient à prendre les enfants pour cible », déplore Henrietta Fore. « L’eau est un droit fondamental. Sans eau, il est impossible de survivre. »

Dans les pays touchés par des conflits, l’UNICEF s’efforce de fournir des services d’approvisionnement en eau potable et d’assainissement sûrs et adaptés. Pour cela, l’organisation modernise et répare les systèmes de distribution d’eau, achemine de l’eau par camion, installe des latrines et sensibilise la population aux bonnes pratiques en matière d’hygiène.

L’UNICEF exhorte les gouvernements et ses partenaires :

À cesser de prendre les infrastructures d’approvisionnement en eau et d’assainissement ainsi que leur personnel pour cible ; À associer les interventions humanitaires d’importance vitale au développement de systèmes d’eau et d’assainissement durables pour tous ; À renforcer les capacités des gouvernements et des organismes d’aide humanitaire à fournir de manière systématique des services d’excellente qualité en matière d’eau et d’assainissement dans les situations d’urgence.

Note aux rédactions :

Le rapport a examiné les taux de mortalité dans 16 pays touchés par un conflit prolongé, à savoir l’Afghanistan, le Burkina Faso, le Cameroun, l’Éthiopie, l’Iraq, la Libye, le Mali, le Myanmar, la République arabe syrienne, la République centrafricaine, la République démocratique du Congo, la Somalie, le Soudan, le Soudan du Sud, le Tchad et le Yémen. Dans tous ces pays, à l’exception de l’Iraq, de la Libye et de la République arabe syrienne, les enfants de moins de 15 ans sont plus susceptibles de mourir d’une maladie transmise par l’eau que des effets de la violence collective. Quant aux enfants de moins de 5 ans, ils ont près de 20 fois plus de risques de mourir d’une maladie diarrhéique liée à un manque d’EAH que des effets directs de la violence, sauf s’ils vivent en République arabe syrienne ou en Libye.

Cette analyse s’appuie sur les estimations du nombre de décès imputables à la « violence collective » et aux « maladies diarrhéiques associées à un manque d’EAH » publiées par l’OMS pour la période 2014-2016.

Contacts presse

Joe English
UNICEF New York
Tél: +1 917 893 0692
Adresse électronique: jenglish@unicef.org

March 22, 2019 9:31 PM Dimo Silvo Aruelio

JUBA, SOUTH SUDAN — Tens of thousands of civilians who fled the South Sudanese city of Malakal during fighting that broke out in 2013 are slowly returning home.

The town still bears scars from South Sudan's five years of conflict. Bullet holes litter the walls of the buildings that remain standing. People are starting new businesses in the wrecked shells of shops.

Besides restoring the town, residents are trying to rebuild their families and locate people who disappeared during the war. The International Committee of the Red Cross is helping them out with its tracing program.

Relatives eager to find news about lost loved ones often stand in line at the ICRC snapshot centers to have their photos taken, or to identify relatives from the photos snapped at U.N. protection-of-civilian sites across the country.

Search for a brother

Last year, the ICRC, with help from the South Sudan Red Cross, reunited 68 people who had been separated from their families during the conflict.

Nyadel Udong Jak, 36, was separated from her brother in 2014 in Luakat village and returned to Malakal from Khartoum last month.

"Until now, I don't know his whereabouts, only to hear recently that he is in Akob and he is fishing at the riverbank. That is why I have come to look for him," Jak told VOA's South Sudan in Focus.

Nyachangjwok Unak, 30, returned to Malakal about two months ago to find her two children, Sarah and Bullish. Unak said she lost track of them when the fighting erupted in 2013, when the kids were just 4 and 7 years old.

Unak said she could not contain her joy when she learned her children had made it out of Malakal alive.

"When the war started in Malakal at around 7 a.m., there was bombing and shelling and everybody was frightened. While I was collecting some belongings to flee with, I found that my children had fled with other people to the unknown location. I was sad and thought I would never find them, but I was praying to God to reunite me with them. And when I got them back, I was very happy and excited," Unak told VOA.

Snapshots help reunite families

The snapshot centers in Malakal give family members the option of either calling or sending messages to lost family members in hopes of tracking them down at other camps across the country.

Lisa Pattioon, the ICRC field coordinator in Malakal, said the snapshot program focuses on searching for relatives of minors separated from parents during the conflict.

"We see the snapshot as one of the complementary tools to these beneficiaries' individual actions. Many beneficiaries will have challenges in the search, such as economic factors. If they don't have the money to take transport to their former community, perhaps go to Ethiopia, to Sudan, to where they last heard their family member was living, the snapshot is another way of facilitating that search," Pattioon told South Sudan in Focus.

There are rewards

Despite witnessing all the agony and pain that the South Sudanese people have endured during the war, Pattioon said it was enormously rewarding to see some finding lost loved ones.

"They may have lost their home, may have lost their livelihood ... but more often the primary concern is what happened to their family members. Are they well? Are they OK? And being able to have answers to those questions is an enormous relief to the beneficiaries, to know the fate of their loved ones," Pattioon told VOA.

ReDSS on behalf of the European Union Trust Fund (EUTF) consortium in Uganda comprising of DRC, CEFORD, Save the Children and ZOA implementing programmes under the support programme for refugees and host communities in Northern Uganda (SPRS-NU), is very pleased to share with you its study ‘Are integrated services a step towards integration?’

The study examines whether, and in what ways, integrated services contribute to better outcomes for refugees who are in situation of protracted displacement in Northern Uganda. Focusing in particular on host community-refugee relations as instrumental to refugee- hosting conditions, it examines how the policy of integrated services to refugees and their host has been applied and analyses the longer-term implications of this approach. Three main issues are considered:

• What is the current policy in terms of shared services to host and refugee communities in Uganda and how has this been applied in practice?

• From the perspective of refugees and host populations, what are the social and economic implications of shared services? Do they contribute to more positive relationships and greater economic engagement?

• What are the longer-term implications of an integrated service delivery model for refugee hosting in Uganda, including links to the integration of refugees into Uganda?

Qualitative research undertaken in Adjumani and Rhino Camp settlements, and surrounding host community villages and parishes, comprise the primary data upon which this report is based. Education and livelihood are explored as two examples of shared services.

Operational learning workshops with practitioners and policy- makers will take place in late March and April in Adjumani and Kampala to discuss how to adapt programming and policies based on findings and recommendations. Feedback sessions with displacement-affected communities in Adjumani will also take place at the end of March.

EXECUTIVE SUMMARY

UNHCR and ACROSS carried out the nutrition survey in Gorom refugee camp from 17 to 21 September 2018.
The overall aim of the survey was to assess the nutrition situation among the refugee population and to monitor ongoing programme interventions.
The survey was based on the UNHCR Standardized Expanded Nutrition Survey (SENS) guidelines for refugee populations (version 2, 2013). Following four modules of SENS were used (1. anthropometric and health, 2.
Anaemia, 3. IYCF, and 4. Food Security). Modules 5. Water Sanitation and Hygiene and 6. Mosquito net coverage were not carried out as access limitations required for module prioritization. The camp has a WASH monitoring system in place and no blanket mosquito net distribution was carried out within the year.
UNHCR population figures from ProGres were used to determine the total population and that of children 6-59 months for survey planning purposes. At the end of August 2018 the Gorom refugee population was 2203 individuals. 393 (17.8%) of these were children under five years.
An exhaustive survey was conducted in relation to children as the total population size of Gorom camp was below 2,500 people rendering sampling unnecessary. All children aged 6-59 months in the camp were surveyed.
A total of six survey teams composed of four members each (one team leader, one haemoglobin measurer, one anthropometric measurer/translator and one anthropometric/haemoglobin measurement assistant were included in each survey. A standardized training lasting five days, which included a standardization test was provided. Data collection lasted five days. The survey teams were supported by a team of 2 supervisors and 1 coordinator who roved between the teams duration the data collection.
Mobile phone questionnaires using Open Data Kit (ODK) android software was used for data collection for all the modules. Data validation was carried out on a daily basis by the survey coordinator, which allowed for daily feedback to the survey teams. Data analysis was carried out using ENA for SMART July 9, 2015 version for anthropometric indices and Epi info version 7 for all the other data.
Under the various forms of malnutrition, the survey results showed a prevalence of Global Acute Malnutrition (GAM) of 4.0%. This falls within the acceptable category GAM prevalence <5% according to WHO classification.
The prevalence of global stunting among children aged 6-59 months was 17.1% which is within the acceptable WHO range of <20%. Total anaemia prevalence among children aged 6 to 59 months reported 55.2% and among women of reproductive aged between 15-49 years (non-pregnant) was 56.9%. Both categories are classified as of high public health significance as are above 40%. Despite of reducing trends in the prevalence of anaemia compared to the results of SENS 2017 (anaemia was 71.0% and 66.2% among children and women), the high prevalence of anaemia among children aged 6-59 months and non pregnant women aged 15-49 years remains a key concern.
Under infant and young child feeding practices, the proportion of children aged 0-23 months that had timely initiation of breastfeeding within the first hour of delivery was 84.6%.The rate of exclusive breast feeding for the first six months of life was 93.3%. The proportion of children aged 6 to 8 months that were introduced to solid and semi-solid foods on time was 66.7%. 17% of the surveyed children aged 0-23 months were bottle fed and the same proportion also received infant formula. The results above indicate positive gains in terms of breastfeeding practices. Appropriated practices around complementary feeding remain sub optimal indicating the need to continue strengthening the IYCF program to improve feeding practices.
The household diet diversity score (HDDS) reported 4.8 out of 12 food groups. Majority of the refugees (78.5%) in Gorom refugee camp reported to have used negative coping strategies within the last month pre the survey to fill the food assistance gap.

19.7% of children had dieahroea during the last two weeks prior to the SENS survey, compared to 12.8% reported in SENS 2017.
Maintenance of a comprehensive nutrition program, strengthening of preventative activities including the provision of adequate household food intake, appropriate caring practices with support and promotion of optimal IYCF practices, health and sanitation at household level are recommended to facilitate optimal nutrition. This to be accomplished through adequate food assistance, support, promotion and protection of infant and young child feeding practices, improved health services, adequate water and sanitation and the expansion of livelihood activities in addition to the treatment of malnourished persons.

Interpretation of results:

• The overall nutrition situation is classified as acceptable as the GAM prevalence is 4%1 . In 2017 the GAM prevalence was 5% among children 6-59 months. The reduction from 5.0% to 4.0% in 2018 was not statistically significant (p>0.05) but indicates that the acute malnutrition situation is on a downward trend.
  This was also the case for severe acute malnutrition.

• The 17.1% prevalence of global stunting is acceptable according to WHO standard2 but should be interpreted with caution due to the age estimation limitation. 10% of the children 6-59 months had no reliable age documentation. Stunting prevalence remained the same in 2018 compared 2017 as the reduction was not statistically significant (p>0.05). In 2017 stunting among children 6-59 months was 17.6%.

• The TFP coverage using MUAC was 100%. The coverage for TSFP was below standard using both the MUAC and WHZ scores criterion. Most of the cases identified with acute malnutrition based on the WHZ scores did not meet the MUAC cut off of <125mm. This indicates the need to strengthen case finding, including innovative ways of identifying cases that are acutely malnourished based on WHZ scores.

• The coverage of measles vaccination and vitamin A supplementation was slightly below the target coverage of ≥95% and ≥90% respectively indicating the need to continue improving routine and campaign strategies.

• 19.7% of children 6-59 months were reported to have had diarrhoea in the last two weeks prior to the survey indicating a morbidity caseload requiring continued health, water and sanitation services provision.
  In 2017 SENS around 12.8% of children were reported to have had diarrhoea in the last two weeks of survey.
  Total anaemia prevalence in children 6 to 59 months was 55.2% (with 1.3% being severe anaemia). The prevalence among women aged 15-49 years (non-pregnant) was 56.9% (with 3.2% being severe anaemia). The prevalence of anaemia among both categories is critical as it is above the 40% level of public health significance (WHO classification)3 . Analyis by age categories indicated that the prevalence of anaemia was higher among children aged 6-23 months (as high as 65.9%, with 2.2% being severe anaemia). The high prevance of anaemia among children aged 6-59 months and non-pregnant women aged 15-49 years remains a key concern in the camps. It requires to be addressed through multi-sectoral preventive and curative interventions.

• The rate of exclusive breastfeeding of 93.3%, introduction of solid, semi-solid or soft foods 66.7%, and consumption of iron-rich or iron-fortified foods 67.0% improved greatly compared to 2017. The introduction of solid, semi-solid or soft foods and consumption of iron-rich or iron-fortified foods of remain sub optimal indicating the need for continued IYCF program strengthening to improve feeding practices.

• Under food security: 100% of the HHs had a ration card; the household diet diversity score was 4.8 out of 12 food groups; most of the households reported using one or more of the negative coping strategies (borrowed cash or food 40.5%, sold assets 12.4%, reduced quantity or frequency of meals 42.9%, begged 9.0%, and engaged in potential risky or harmful activities 26.4%. Only a small proportion of the refugees in Gorom (21.4%) reported not using any of the negative coping strategies to fill the food assistance gap (a 70% of the recommended general food ration is provided per person per month). This group is likely to be benefiting from the complementary livelihood interventions in place. This however needs to be scaled up to increase the proportion to cover majority of the population.

Recommendations

Nutrition related

• Continue the implementation of the comprehensive Community based Management of Acute Malnutrition (CMAM) program providing both therapeutic and supplementary feeding programs to facilitate the rehabilitation of identified acute malnourished children, pregnant and lactating women, people living with HIV/AIDS and TB patients on treatment. This to include active case finding and community mobilization. (UNHCR, UNICEF, WFP and ACROSS).

• Ensure all the children aged U5 in the community screened and referred 6-59 months children identified with a MUAC less than 125mm get enrolled into the management of acute malnutrition programs through community outreach follow up at household level (ACROSS)

• Community outreach, triage areas and nutrition centres to systematically screen and refer all persons with anaemia signs and symptoms (palmar pallor).

• Ensure monthly blanket supplementary feeding programme for children 6-23 months, pregnant and lactating women using a fortified blended food or lipid based supplement to prevent malnutrition and to cover the nutrient gap these vulnerable groups have in light of a predominant grain based general food diet (UNHCR, WFP and ACROSS)

• Conduct two step MUAC and WHZ scores (for children with MUAC at risk) screening during BSFP and at the health facilities’ triage areas to ensure both high MUAC and WHZ score coverage (ACROSS)

• Continue strengthening the capacity of the nutrition facility in terms of provision of adequate staff and training to ensure quality provision of both curative and preventative components of nutrition (UNHCR, WFP, UNICEF and ACROSS)

• Expand and strengthen preventative nutrition components including Infant and Young Child Feeding (IYCF) and community outreach education aspects to stop the various forms of malnutrition from occurring in the first place. (UNHCR, UNICEF and ACROSS)

• Continue implementing the micronutrient reduction strategy to curb the high anaemia prevalence.

• Conduct follow up quarterly mass MUAC screening to monitor the evolution of the nutrition situation at the community level. (ACROSS)

• Ensure regular monitoring, quarterly joint monitoring and yearly program performance evaluations in all camps to assess performance progress and formulate recommendations for any identified gaps. (UNHCR, WFP, UNICEF and ACROSS).

• Undertake a follow up annual joint nutrition survey to analyze trends and facilitate program impact evaluation in 2018. (UNHCR, ACROSS, WFP and UNICEF).

Food security related

• Provision of a General Food Ration (GFR) providing the recommended minimum dietary requirements (2100kcal/person/day) and milling assistance (UNHCR, ACROSS and WFP).
• Continue the routine joint monthly food basket monitoring on site and ensure the inclusion of the refugee camp in the post distribution monitoring at the household level to ensure that refugees receive their entitlement (UNHCR, ACROSS and WFP).
• Expand the coverage of sustainable food security and livelihood solutions to allow diet diversity and to complement the general food distribution. This to include the promotion of all year-round production of micronutrient-rich foods or crops in home gardens, fruit trees and small animal husbandry. (UNHCR, WFP and ACROSS).

EXECUTIVE SUMMARY

South Sudan continues to host refugees who are mostly fleeing from neighbouring Sudan (93%), the Democratic Republic of Congo (5%), Ethiopia (1%) and the Central African Republic (1%). By May 2018, close to 296,000 refugees and asylum seekers were registered in South Sudan. 52% of the refugee population is female and 62% of refugees are below the age of 18. Since the last JAM in 2015 the refugee population has grown by 8.8% or 60,000 people. Refugee numbers are likely to increase due to continued conflict and insecurity in neighbouring countries, specifically in Sudan, and natural growth. By the end of 2019, the population projection was estimated to be 334,400 refugees. The conflict in Sudan erupted in June 2011 between the Sudan Armed Forces (SAF) and the Sudan People’s Liberation Movement–North (SPLM-N) in South Kordofan State, which spread and reached Blue Nile State by September 2011, causing a mass exodus from these two states into Upper Nile and Unity States in South Sudan. Initially, refugees coming from Sudan settled in Maban (Doro, Yusuf Batil, Gendrassa and Kaya camps) and Yida. In February 2016, however, the Government of South Sudan announced the closure of Yida refugee settlement (effective June 2016) due to its proximity to the contested border, exposing refugee communities to protection risks such as forced recruitment, thereby compromising the civilian character of the settlement. Following this, transitional phase down of assistance delivery in Yida was initiated. This continues to be implemented through the Yida exit strategy. Joint Assessment Missions (JAM) are carried out roughly every two years to assess the food security situation among camp-based refugees and to make recommendations for programme review and/or adjustment. This JAM fieldwork was conducted by WFP, UNHCR, South Sudan Commission for Refugee Affairs (CRA) and partners working in the refugee camps from 28th May to 6th June 2018. The 2018 JAM assessed the food security, nutrition and related needs and services in the refugee settlements in South Sudan; it included an extensive secondary data review and analysis and primary data collection in seven refugee camps across the country (Ajoung Thok, Pamir, Doro, Yusuf Batil, Kaya, Gorom and Makpandu). Primary data was collected through focus group discussions, key informant interviews, household interviews and general observations. Since August 2015, all registered refugees in South Sudan receive a General Food Ration (GFR) at a 70% ration scale, representing 1491 kilocalories per person per day. The food assistance modality in late 2017 was expanded to the use of a hybrid basket (a combination of in-kind food and cash). This started by the provision of cash for milling in Maban and Jamjang in the fourth quarter of 2017 and in Makpandu from May 2018. In 2018 a hybrid basket is being provided in Makpandu from May and in Maban from July. Distribution follows a 30 days cycle with one distribution per month. Reliance on food assistance remains widespread. The food pipeline has improved due to prepositioning early in the year compared to last JAM, however, pipeline breaks due to access and security challenges remain a challenge. The 30% food ration gap, combined with lack of adequate livelihood options negatively impact on refugee household food security. Overall since the last JAM, the Food Consumption Score (FCS) has only improved slightly among refugees (from 43% with acceptable FCS in 2015 to 48.2% in 2018), with data suggesting that access to nutrition messaging and kitchen garden ownership had a positive impact on FCS. Despite an overall positive trend in FCS among refugees, 57.5% of female-headed households have poor or borderline food consumption compared to 49.5% in male-headed households indicating greater vulnerability to food shortages. According to the results of 2017 Standardised Expanded Nutrition Surveys (SENS) among the refugee population, the overall nutrition situation remains poor. Global Acute Malnutrition (GAM) prevalence ranged from 2.8% in Ajoung Thok to 8.2% in Pamir in 2017 with an average of 6.2% among the surveyed refugee population. Although below the 15% WHO emergency threshold, the 6.2% prevalence indicates a poor nutrition situation. This, however, has improved in 2017 as compared to the situation in 2015 where the average GAM prevalence was 11%. The improvement of the average GAM prevalence reduction can be possibly attributed in part to the maintenance and strengthening of the Community based Management of Acute Malnutrition (CMAM) and the prevention of malnutrition initiatives in place. Total anaemia prevalence among children aged 6-59 months at the end of 2017 was 48%, while anaemia among young children aged 6-23 months reported ranged between 58.1% - 78.1% which is categorised as high public health significance according to WHO classification. Although this improved slightly compared to 2015, the high levels remains of concern. The prevalence of global stunting was 44%, which is categorised as critical according to WHO classification. The later remained the same as that in 2015. Timely initiation of breastfeeding was practiced by majority of lactating women in 2017, which also improved compared to 2015. The timely introduction of complementary feeding from 6 months however, remained low, with only 52.8% of children introduced to complementary feeding in a timely manner. The high prevalence of anaemia and stunting can be attributed to a number of factors that characterise the refugee population including a diet poor in micronutrients and inadequate macronutrients, frequent infections and sub optimal child care and feeding practices among others. A strategy to address anaemia and other micronutrient deficiencies was developed in 2017. Several of the planned interventions are already in place but the entire strategy is yet to be fully funded to ensure a complete roll out. Continued promotion of appropriate IYCF practices and optimal feeding of children is essential for the reduction of chronic malnutrition. Maintaining the current treatment-based service provision for the management of acute malnutrition is likely to ensure that the nutrition situation does not deteriorate. The JAM recommends strengthening and expanding malnutrition prevention in an integrated manner, to tackle the root causes of malnutrition through a more holistic approach that includes all the complementary sectors (livelihoods, WASH, shelter and health). Refugees have access to primary health care services, which are provided at the refugee camps or at government health facilities. Improvement of health seeking behaviour is supported by a comprehensive community health programme that focuses on health, nutrition, HIV/AIDS, water, sanitation and hygiene promotion. Mortality trend monitoring using the UNHCR Health Information System (HIS) at the end of 2017 indicated that mortality rates were below the emergency threshold of 2/10000/day for under five Death Rate (U5DR) and 1/10000/day for Crude Death Rate (CDR). Diarrhoea, malaria, respiratory tract infections, skin diseases, eye diseases, and intestinal worms remain the top morbidities seen in the refugee camps/settlements. These are all linked to the environment, the shelter situation and WASH practices in the camps and are likely to affect the nutrition situation negatively. This highlights the importance of multi-sectoral interventions to address health, WASH, shelter and nutrition issues. Camp populations remain vulnerable to disease outbreaks as a result of congestion, cross-border movements, and frequent outbreaks affecting the rest of the country. The end of 2017 WASH reports noted that the average individual water consumption among the refugee population met the SPHERE minimum standards of ≥15l/p/d, but only 50% met the UNHCR standards of ≥20l/p/d. All refugees reported spending less than 30 minutes to collect their water. Since 2016, potable water accessibility has generally improved through the introduction of innovations such as solarisation of boreholes and upgrading (solar/generator) hybrid systems. Water needs for uses other than domestic water use has increased in the camps. This is linked to livelihood and environmental activities such as kitchen gardens and brick-making. Sanitation and hygiene promotion in the refugee camps remains a work in progress. Approximately 77% of refugees had access to a drop-hole latrine by the end of 2017. The crude latrine coverage ranged from 6 to 20 people/latrine drop hole. Soap provision by UNHCR has been below standard since the last JAM. Refugees receive 250g of multi-purpose soap per month instead of 500g. Refugees reported selling part of their GFD in order to purchase it from the local markets. Sustainable livelihood and self-sustainability opportunities remain a challenge for refugees in South Sudan. This is exacerbated by the current context of insecurity and civil war. Farming remains the most viable option for promoting self-reliance. Refugees have access to some land for farming and are provided with the seeds and tools necessary to utilise the land. The demand for agricultural land, far outstrips allocation. Agricultural output is further limited by harsh climatic conditions, limited access to irrigation water, poor post-harvest techniques and diminishing soil fertility. Insecurity surrounding the camps hampers secure access to land for cultivation, making women and girls especially vulnerable to harassment and rape. Kitchen gardening among refugees is rain fed and limited to the planting season when agencies provide farm inputs for cultivation. Agriculture production should be intensified and integrated into wider nutrition, health and other livelihoods programmes. Some refugees have received skills trainings through the various NGO vocational training centres but opportunities to fully exploit the skills acquired is limited by insecurity, market saturation, lack of start-up capital and high inflation. There is poor or non-existent formal access to loans/start-up capital to begin or expand a small business and widespread poverty in the areas where camps are located. This negatively impacts sustainability of business enterprises. Furthermore, poor employment opportunities in the camp and surrounding areas fuel tensions between host and refugee communities, with negative perception amongst host communities that refugees receive preferential treatment when it comes to jobs in the camps. The major source of cash income for the refugees living in the camps remains firewood collection (risky business done largely by women and girls). Based on data analysis during the JAM, it appears that refugees in South Sudan are unable to adequately meet the food gap based on agriculture alone and the other limited non-agricultural livelihood support such as entrepreneurship and microfinance. Deforestation in and around the camps was noted as a major concern during the JAM. This is largely a result of burgeoning population (in and out of the camps) and its over-reliance on natural resources for fuel, construction and as a source of income (in the form of wood and charcoal). Refugees in all camps/settlements are increasingly having to buy firewood and/or charcoal due to the limited availability of firewood in the forests and the limited access to it due to insecurity. It was noticed that low utilisation of fuel-efficient cooking methods are being used by refugees. Majority of refugees use fuel in-efficient open three-stone fire for cooking. The adoption of energy-saving stoves interventions over the years has been relatively low. Better understanding on context-specific causes of the low adoption and utilisation of alreadydistributed stoves needs to be established. This is to guide the introduction of locallyappropriate fuel efficient stoves. Refugees in South Sudan are at risk of protection violations by virtue of their refugee status, especially girls and women. As with all other aspects of refugee life in South Sudan, this is heightened by the prevailing context of insecurity in and around the areas where refugees live. SGBV results from deeply rooted, pervasive and harmful gender inequalities both at country of origin and in South Sudan. This is further accentuated by poverty and limited livelihood opportunities, insufficient nearby access to firewood and cultivatable land near the refugee camps/settlements, poor camp-level lighting, militarisation of the camps and surrounding areas. Early marriage of adolescent girls is common across the camps with high rates of adolescent pregnancies which invariably causes girls to drop out of school. Support from social networks that used to exist in countries of origin have been weakened as a result of displacement. Refugees reported limited capacity and willingness to assist each other in a context where everyone struggles to sustain his/her own family. Persons with Specific Needs (PSNs) including the elderly are among the most vulnerable people in the refugee camps/settlement. Their ability to fill the 30% food assistance gap was noted to be quite often impossible. Girl’s enrolment and retention in school remains suboptimal. Lack of school feeding was raised as one of the primary reasons for absenteeism, along with the shortage of school supplies, distance to school and infrequent distribution of sanitary ware. Discussions with refugees indicated that children were more likely to start missing school in the third week of the ration cycle, when food stocks started to dwindle at the household level. An independent parentteacher-driven school feeding initiative in Makpandu appears to allow better school retention. The possibility of implementing this in other schools was proposed. For new arrivals to South Sudan, a one-time standard NFI kit comprised of emergency shelter and basic core relief items is provided by UNHCR. There is infrequent NFI replenishment, with some refugees in Gorom refugee camp citing distributions of certain NFIs as far back as a decade ago. Due to resource constraints, UNHCR has adopted a targeted approach, responding to the needs of the most vulnerable first. Longer-term/protracted refugees that are not categorised as PSNs are, therefore, rarely able to qualify for NFI replenishment despite their status not necessarily equating to improved self-sufficiency and the ability to procure NFIs. Gaps in the provision of NFIs continue to oblige refugees to compromise their food purchases and consumption at the expense of non-food items. The potential monetisation of certain NFI commodities through cash based interventions may ease the pressure on food at the household level by preventing the sale of the GFD to fill the gap. Since the last JAM in 2015, widespread conflict, insecurity, and militarisation of the areas where the camps are located has posed great challenges to refugees, humanitarian agencies and partners providing services in the various refugee locations. High staff turn-over, as a result of insecurity and the remoteness of the camps, has resulted in institutional memory loss and low morale among staff delivering services in the challenging operational context. At the country level, some key staff positions are not filled in a timely fashion which negatively affects the implementation timelines. Insecurity and limited access have sporadically hampered food distributions and have at times led to pipeline breaks.

Living conditions in some of Uganda´s largest refugee settlements are deteriorating while refugees are taking drastic measures to survive due to a lack of funding. The Norwegian Refugee Council calls on donor countries to take more responsibility for the 1.2 million refugees living in the poverty-stricken nation.

"Rich countries have broken their promises of international responsibility-sharing for handling the global refugee crisis. Nowhere is this more evident than in Uganda," said Adam Bouloukos, Uganda´s Country Director for the NRC.

"Unlike the US and many European countries, Uganda shouldered the so-called ´burden´ of the global refugee crisis, and opened its borders without complaint and showed humanity to their neighbours when others wouldn´t. Still, there have been damaging cuts in life-saving aid by the international community, who are shamefully neglecting this growing crisis," he explained.

Last year's response plan estimated that about $220 million was needed to respond to the large influx of refugees from DR Congo. Of this, less than 40 per cent was funded. The response to the large number of refugees from South Sudan, the highest number of refugees in Uganda, was also gravely under-funded.

"In some ways, Uganda is a victim of the international community´s perception that it could cope with the influx of refugees. But nothing could be further from the truth. Uganda is already struggling with a huge range of social and economic challenges. The refugee population adds to those challenges and as such, the country needs support to address the massive needs," he said.

Some South Sudanese refugees have returned home despite fresh violence in several provinces across the border, due to poor living standards and a lack of opportunities in the settlements in Uganda.

Anna, a 37-year-old refugee from South Sudan said: "We only have one meal a day. To meet some of the other basic needs like fuel, we have to sell or exchange our rations, so we always run out of food before the next distribution."

Recent incidents of mismanaged donor funding have not helped the situation. The NRC stresses the need for donor countries to ensure that in light of such cases, mechanisms should be put in place to reallocate funds rather than freeze them.

"Any temporary or permanent disruption to humanitarian funding in Uganda will invariably have ramifications for some of the world's most vulnerable people. Donor countries must ensure that refugees and host communities are not punished for the failings of others," Bouloukos noted.

Note to editors:

• NRC is working across Uganda to ensure that people fleeing violence, as well as Ugandan host communities, can access safe shelter, water, food, education and legal assistance. As a result of lack of funding the organization has had to cut back on WASH and Shelter programmes.

• Uganda is hosting over 1.2 million refugees from South Sudan, DR Congo, Burundi, Somalia, Rwanda, Eritrea, Sudan and Ethiopia, making up 3.5% of the country's total population.

• $577 million was needed for support to South Sudanese refugees in Uganda and the host community last year, according to the updated response plan. Only $394 million was put forward (68%)

• $220 million was needed to respond to the influx of refugees from DR Congo. The appeal was less than 40% funded ($86 million).

Sources: UN, NRC.

For more information or interviews, please contact:

In Oslo
Catriona Loughran
catriona.loughran@nrc.no
+254 702 910 077

In Nairobi
Geno Teofilo
geno.teofilo@nrc.no
+47 909 25 528

INTRODUCTION

The 2018-2022’ Christian Mission for Development (CMD) Strategic Plan is the second strategic plan developed after an analysis of the organisation’s position to key contexts including an understanding of the political environment and the situation in South Sudan. The strategic plan is developed to respond to the emergencies, recovery and development needs of the country based on the prevailing situation.

This Strategic Plan therefore, represents the organisation’s efforts to respond to the dynamic environment within which it operates. It is an effort to align itself strategically in light of its changing external and internal environments as well as challenges arising from its rapid expansion. The Plan presents the organisation’s current position in anticipation to the desired future using available resources as well as harnessing emerging opportunities in the programme sectors.

As a tool, it is expected to guide the organisation in attaining effectiveness, efficiency and focus towards achieving designated results towards transformation of communities. Successful implementation of this “Strategic Plan” will contribute to effective service delivery in the areas of “Education, WASH, Healthcare, Nutrition, Food Security & Livelihoods, Protection and Peace building”.

Overview and Methodology

The dynamic and multi-faceted nature of the South Sudanese displacement crisis has created significant challenges for the delivery of humanitarian aid.

Accessibility and security issues within South Sudan have impeded a systematic understanding of WASH needs in many areas of the country, and have created difficulties in establishing a clear and unambiguous system for prioritizing the delivery of aid, thereby limiting the effectiveness of humanitarian planning and limiting the potential impact of donor funding. As this crisis continues to expand, evolve and spill into neighbouring countries, it has become increasingly important to fill information gaps to inform a more effective humanitarian response and planning for immediate life-saving WASH activities and contingency planning for durable solutions.

In 2018, REACH, in close coordination with the WASH Cluster, identified five core WASH indicators: 1. % of Households (HHs) by displacement status; 2. % of HHs reported having safe access to and use an improved water source (borehole, tapstand, water yard) as their main source of drinking water; 3. % of HHs reported having access to a latrine (private, shared, or communal/ institutional); 4. % of HHs reported having access to key WASH NFIs (soap, mosquito nets, water containers); and 5. % of HH reported that one or more HH member was affected by self-reported water or vector borne disease in the two weeks prior to data collection.

These five indicators were used to establish the first countrywide WASH baseline in July and August of 2018 during Round 22 of the Food Security and Nutrition Monitoring System (FSNMS). FSNMS partners agreed to once again incorporate WASH cluster indicators for FSNMS Round 23 (November and December of 2018). FSNMS is a seasonal countrywide assessment conducted, funded and run by the World Food Programme, UNICEF, and the Food and Agriculture Organization, and supported by REACH in Round 22. FSNMS, established in 2010, is a representative survey that employs two-stage cluster sampling, using a state based sample size and cluster determination. In each county, access permitting, 9 clusters were selected and 12 households interviewed per cluster.

FSNMS is a critical source of information that allows for the identification of affected areas, the prioritization of resources and for monitoring trends. The data collected during FSNMS is used for the Integrated Food Security Phase Classification (IPC) analysis, the Humanitarian Needs Overview (HNO) and the Humanitarian Response Plan (HRP), as well as additional decision making platforms.

Overview and Methodology

The dynamic and multi-faceted nature of the South Sudanese displacement crisis has created significant challenges for the delivery of humanitarian aid.

Accessibility and security issues within South Sudan have impeded a systematic understanding of WASH needs in many areas of the country, and have created difficulties in establishing a clear and unambiguous system for prioritizing the delivery of aid, thereby limiting the effectiveness of humanitarian planning and limiting the potential impact of donor funding. As this crisis continues to expand, evolve and spill into neighbouring countries, it has become increasingly important to fill information gaps to inform a more effective humanitarian response and planning for immediate life-saving WASH activities and contingency planning for durable solutions.

In 2018, REACH, in close coordination with the WASH Cluster, identified five core WASH indicators: 1. % of Households (HHs) by displacement status; 2. % of HHs reported having safe access to and use an improved water source (borehole, tapstand, water yard) as their main source of drinking water; 3. % of HHs reported having access to a latrine (private, shared, or communal/ institutional); 4. % of HHs reported having access to key WASH NFIs (soap, mosquito nets, water containers); and 5. % of HH reported that one or more HH member was affected by self-reported water or vector borne disease in the two weeks prior to data collection.

These five indicators were used to establish the first countrywide WASH baseline in July and August of 2018 during Round 22 of the Food Security and Nutrition Monitoring System (FSNMS). FSNMS partners agreed to once again incorporate WASH cluster indicators for FSNMS Round 23 (November and December of 2018). FSNMS is a seasonal countrywide assessment conducted, funded and run by the World Food Programme, UNICEF, and the Food and Agriculture Organization, and supported by REACH in Round 22. FSNMS, established in 2010, is a representative survey that employs two-stage cluster sampling, using a state based sample size and cluster determination. In each county, access permitting, 9 clusters were selected and 12 households interviewed per cluster.

FSNMS is a critical source of information that allows for the identification of affected areas, the prioritization of resources and for monitoring trends. The data collected during FSNMS is used for the Integrated Food Security Phase Classification (IPC) analysis, the Humanitarian Needs Overview (HNO) and the Humanitarian Response Plan (HRP), as well as additional decision making platforms.

Overview and Methodology

The dynamic and multi-faceted nature of the South Sudanese displacement crisis has created significant challenges for the delivery of humanitarian aid.
Accessibility and security issues within South Sudan have impeded a systematic understanding of WASH needs in many areas of the country, and have created difficulties in establishing a clear and unambiguous system for prioritizing the delivery of aid, thereby limiting the effectiveness of humanitarian planning and limiting the potential impact of donor funding. As this crisis continues to expand, evolve and spill into neighbouring countries, it has become increasingly important to fill information gaps to inform a more effective humanitarian response and planning for immediate life-saving WASH activities and contingency planning for durable solutions.

In 2018, REACH, in close coordination with the WASH Cluster, identified five core WASH indicators: 1. % of Households (HHs) by displacement status; 2. % of HHs reported having safe access to and use an improved water source (borehole, tapstand, water yard) as their main source of drinking water; 3. % of HHs reported having access to a latrine (private, shared, or communal/ institutional); 4. % of HHs reported having access to key WASH NFIs (soap, mosquito nets, water containers); and 5. % of HH reported that one or more HH member was affected by self-reported water or vector borne disease in the two weeks prior to data collection.

These five indicators were used to establish the first countrywide WASH baseline in July and August of 2018 during Round 22 of the Food Security and Nutrition Monitoring System (FSNMS). FSNMS partners agreed to once again incorporate WASH cluster indicators for FSNMS Round 23 (November and December of 2018). FSNMS is a seasonal countrywide assessment conducted, funded and run by the World Food Programme, UNICEF, and the Food and Agriculture Organization, and supported by REACH in Round 22. FSNMS, established in 2010, is a representative survey that employs two-stage cluster sampling, using a state based sample size and cluster determination. In each county, access permitting, 9 clusters were selected and 12 households interviewed per cluster.

FSNMS is a critical source of information that allows for the identification of affected areas, the prioritization of resources and for monitoring trends. The data collected during FSNMS is used for the Integrated Food Security Phase Classification (IPC) analysis, the Humanitarian Needs Overview (HNO) and the Humanitarian Response Plan (HRP), as well as additional decision making platforms.

Overview and Methodology

The dynamic and multi-faceted nature of the South Sudanese displacement crisis has created significant challenges for the delivery of humanitarian aid.
Accessibility and security issues within South Sudan have impeded a systematic understanding of WASH needs in many areas of the country, and have created difficulties in establishing a clear and unambiguous system for prioritizing the delivery of aid, thereby limiting the effectiveness of humanitarian planning and limiting the potential impact of donor funding. As this crisis continues to expand, evolve and spill into neighbouring countries, it has become increasingly important to fill information gaps to inform a more effective humanitarian response and planning for immediate life-saving WASH activities and contingency planning for durable solutions.

In 2018, REACH, in close coordination with the WASH Cluster, identified five core WASH indicators: 1. % of Households (HHs) by displacement status; 2. % of HHs reported having safe access to and use an improved water source (borehole, tapstand, water yard) as their main source of drinking water; 3. % of HHs reported having access to a latrine (private, shared, or communal/ institutional); 4. % of HHs reported having access to key WASH NFIs (soap, mosquito nets, water containers); and 5. % of HH reported that one or more HH member was affected by self-reported water or vector borne disease in the two weeks prior to data collection.

These five indicators were used to establish the first countrywide WASH baseline in July and August of 2018 during Round 22 of the Food Security and Nutrition Monitoring System (FSNMS). FSNMS partners agreed to once again incorporate WASH cluster indicators for FSNMS Round 23 (November and December of 2018). FSNMS is a seasonal countrywide assessment conducted, funded and run by the World Food Programme, UNICEF, and the Food and Agriculture Organization, and supported by REACH in Round 22. FSNMS, established in 2010, is a representative survey that employs two-stage cluster sampling, using a state based sample size and cluster determination. In each county, access permitting, 9 clusters were selected and 12 households interviewed per cluster.

FSNMS is a critical source of information that allows for the identification of affected areas, the prioritization of resources and for monitoring trends. The data collected during FSNMS is used for the Integrated Food Security Phase Classification (IPC) analysis, the Humanitarian Needs Overview (HNO) and the Humanitarian Response Plan (HRP), as well as additional decision making platforms.

Overview and Methodology

The dynamic and multi-faceted nature of the South Sudanese displacement crisis has created significant challenges for the delivery of humanitarian aid.
Accessibility and security issues within South Sudan have impeded a systematic understanding of WASH needs in many areas of the country, and have created difficulties in establishing a clear and unambiguous system for prioritizing the delivery of aid, thereby limiting the effectiveness of humanitarian planning and limiting the potential impact of donor funding. As this crisis continues to expand, evolve and spill into neighbouring countries, it has become increasingly important to fill information gaps to inform a more effective humanitarian response and planning for immediate life-saving WASH activities and contingency planning for durable solutions.

In 2018, REACH, in close coordination with the WASH Cluster, identified five core WASH indicators: 1. % of Households (HHs) by displacement status; 2. % of HHs reported having safe access to and use an improved water source (borehole, tapstand, water yard) as their main source of drinking water; 3. % of HHs reported having access to a latrine (private, shared, or communal/ institutional); 4. % of HHs reported having access to key WASH NFIs (soap, mosquito nets, water containers); and 5. % of HH reported that one or more HH member was affected by self-reported water or vector borne disease in the two weeks prior to data collection.

These five indicators were used to establish the first countrywide WASH baseline in July and August of 2018 during Round 22 of the Food Security and Nutrition Monitoring System (FSNMS). FSNMS partners agreed to once again incorporate WASH cluster indicators for FSNMS Round 23 (November and December of 2018). FSNMS is a seasonal countrywide assessment conducted, funded and run by the World Food Programme, UNICEF, and the Food and Agriculture Organization, and supported by REACH in Round 22. FSNMS, established in 2010, is a representative survey that employs two-stage cluster sampling, using a state based sample size and cluster determination. In each county, access permitting, 9 clusters were selected and 12 households interviewed per cluster.

FSNMS is a critical source of information that allows for the identification of affected areas, the prioritization of resources and for monitoring trends. The data collected during FSNMS is used for the Integrated Food Security Phase Classification (IPC) analysis, the Humanitarian Needs Overview (HNO) and the Humanitarian Response Plan (HRP), as well as additional decision making platforms.

HIGHLIGHTS

• About 3,500 people in five return villages in Jebel Moon locality (West Darfur) were affected by tribal conflict.

• Over 22,000 people voluntarily returned to their home areas in Katayla and Ed El Fursan localities in South Darfur.

• In efforts to encourage, monitor and verify returns, authorities in North Darfur established the Committee for the Coordination of Voluntary Returns.

• Current macroeconomic conditions may drive high levels of food insecurity in 2019 – FEWS NET.

• Humanitarian organizations continue to assist some 21,500 IDPs in Sortony gathering site, North Darfur.

Aid agencies visit five return villages in Jebel Moon locality, West Darfur

On 17 January inter-communal conflict in the Jebel Moon locality of West Darfur State affected an estimated 3,500 people in the five return villages of Chilchil, Girji Girji, Bir Bateha, Dileibaya and Khomi. In some of the villages homes and recent harvests were burned and livestock was looted. Government forces brought the situation under control by 19 January and some of the perpetrators were reportedly arrested. People had spontaneously returned to these villages from refugee camps in Chad and from villages located along the Sudan-Chad border in 2017 and 2018 following encouragement from authorities to return and the improvement of the security situation with the establishment of police posts.

A joint inter-agency needs assessment team visited the affected villages from 12 to 14 February to assess needs. The villagers had initially fled their homes to Selea, Kuru and Rakkeina villages—close to the Jebel Moon mountains—and some moved into neighbouring Chad. At the time of the assessment most had returned to their homes.

The main gaps identified by the mission team were the lack of basic services and availability of only one functioning water pump in each village, which is shared with the nomadic communities living nearby. The mission team recommended establishing additional water sources to avoid possible conflict over resources. In addition, there are no health, nutrition, education, sanitation or community conflict resolution/reconciliation centres/mechanisms available in any of the villages. Other recommendations include the provision of emergency shelter and household supplies; and distribution of food aid as most food supplies were destroyed.

In addition to humanitarian assistance, more durable solutions are required, the mission reported. These include the reinforcement of the security situation and carrying out reconciliation activities to maintain peace in the area and to encourage more returns. Basic services such as water, health, nutrition, education and sanitation services also need to be established. Livelihood assistance is necessary to help the returnees rebuild their lives and should include the distribution of agricultural supplies such as seeds and tools.

Africa

Burkina Faso

02 February 2019: In Kongoussi region, militants presumed to be from Ansaroul Islam (JNIM) attacked and stole a Burkina Faso Red Cross vehicle, abducting its four passengers and driver in the process. Source: ACLED1

13 February 2019: In Ougarou area, Est region, an ambulance transporting a pregnant woman from Diapaga to Fada-N’gourma was shot at by presumed JNIM or ISGS militants, leaving the pregnant woman’s partner with a gunshot wound but the driver and woman unharmed. Source: ACLED1 14 February 2019: In Djibo town, Sahel region, a bomb of unknown origin hidden in a corpse dressed in military uniform killed an army doctor and wounded two police officers. Sources: News 24 and The Defense Post

Cameroon

11 February 2019: In Kumba city, Meme department, Southwest region, suspected separatists raided and torched the Kumba District Hospital, killing at least four patients and reducing most of the building to ashes. Sources: AFP, Africa Freedom Network, Africa News (a), Africa News (b), BBC, Eyewitness News, US Embassy in Cameroon and VOA News

17 February 2019: In Kumba city, Meme department, Southwest district, soldiers looking for wounded separatists entered the Shisong Hospital, fired several shots in the air and threatened to kill a man in front of employees. Source: Human Rights Watch

Democratic Republic of the Congo

General: In eastern Democratic Republic of the Congo, armed groups continued to subject health and frontline workers to sporadic attacks, making it hard for them to prevent and mitigate

JAMES SOKIRI

“It was a hard day to describe, as men in uniform surrounded our village in pick-up cars and armoured personnel carriers, shooting everywhere at random. I escaped alone, leaving all my four children behind, two of them arriving in Yei town a week later,” said a 39-year-old mother of four and resident of Pisak village, Rose Tumalu, breaking down into tears as she narrated her ordeal.

Ms. Tumalu is one of the recently-displaced residents of Yei. Two of her children, some relatives told her, were surviving in the hands of good Samaritans in the woods.

“I do not know the kind of future we are going to lead. This is the third time in a row that I am escaping death in less than a year,” she said.

“It was a mission to beat people and loot goats, chicken, bicycles and food like cassava and beans, and whatever they could find. They burnt what they could not carry along,” said Jackson Batali Solomon, resident of Logo village of Otogo County now displaced to Yei town.

“We ran in disarray. It is terribly sad, so we are here, sheltering under trees, verandas and sometimes in the open, with literally nothing to eat. This war that kills civilians and destroys their property is something hard to imagine now.”

Most of the displaced people are women, children and the elderly.

“They were trekking through the jungles for the whole day to reach Yei, arriving totally dehydrated, very hungry and dried up. I nearly shed tears,” said Hillary Luate Adeba, Bishop of the Episcopal Church of South Sudan’s Diocese of Yei, describing the plight of the arrivals.

But Jackson Batali Solomon blamed the government security agencies for mistreating them by claiming they were spies and opposition sympathizers, and he has a strong message to all warrying parties: “We are not supporting opposition forces, nor are we politicians. We are farmers who use our traditional implements like hoes to feed ourselves and send our children to school. We even fed the South Sudan army during the war of liberation from Sudan to achieve our independence.”

The Bishop, now the only source of respite in their destitution, has become a witness to this new spate of suffering.

“It is unfortunate that people can be uprooted from their livelihoods at a time that everyone has high hopes for peace, and when people are considering returning home. The signed peace has failed to stop the displacement and suffering of our people,” said Bishop Hillary Luate Adeba.

The displacement is taking a huge toll on children, too.

“You can see that our children are no longer going to school…and you know that any child who has not seen even a nursery class at the age of 12 has been killed in the mind,” said Jackson Batali Solomon, adding that the conflict was taking a terrible toll on the children’s mental health, with nightmares becoming a constant in their sleep.

“Whenever they wake up in their dreams, they cry out loud as they tell us tales of bad dreams of being beaten, tortured or being chased by gunmen,” he said.

Even elderly people are traumatized by the sound of moving vehicles, as that has become synonymous with death. “We don’t want to hear any sound of a vehicle…even dogs, goats and chickens now hide from it, and this is the peace we are talking about?” Mr. Solomon questioned.

“An old person like me is dead physically and mentally, but will presidents, governors, and doctors not come out of these children? Why do we want to kill their minds – and their bodies as well? The suffering has already reduced us to mere living corpses!”

Whilst efforts by humanitarian actors are afoot to support the displaced communities in Yei, there is considerable goodwill from the host communities, as they contributed food items, clothes and many other items through Bishop Adeba’s church. But such support is limited and unsustainable.

“The number of arrivals overwhelmed the church as we didn’t have facilities to accommodate them. We didn’t have ready food, water and medical support for the children, mothers and expectant women, some of whom were in severe pain due to the daylong walk. You can imagine this kind of life!” exclaimed Bishop Adeba.

He added that most of the aid is of non-food items, emphasizing the importance of food: “What do you do with a jerrycan if you have no water to draw? And what do you do with a saucepan if you have no food to cook? Just think of the cost of giving this population of 1,361 individuals two meals a day!”

On the other hand, Arthur Beingana, United Nations Mission in South Sudan’s Human Rights Officer at Yei Base, said that the peacekeepers have continued to intensify their patrols within Yei town and to areas worst affected by the displacement.

“We have, so far, visited Logo, Pisak, Goli and Mile 16 to assess the security and relief needs, as we have had from our warning indicators that displacement was likely in those areas due to government operations against armed elements,” Mr. Beingana said.

The patrols seem to be paying off.

“We were able to make early warning reports to alert the state authorities to ensure that their cardinal role would be to protect the lives of civilians in those affected areas,” said Beingana, urging all armed elements to embark on a broad-based dialogue to seek a long-term political solution that would pave the way for the implementation of the peace agreement to prevent further atrocities.

“People talk of peace, but the displacement I see happening today tells me that peace has not been achieved yet. We need just peace from our leaders, so that we can go back home to live in peace and harmony and rebuild our livelihoods without the fear of the gun,” Ms. Rose Tumalu concluded.

Yambio, 25 March 2019 – The Ministry of Health with support from the World Health Organization (WHO) and partners launched a reactive yellow fever (YF) vaccination campaign in Sakure, Nzara County Gbudue State to vaccinate 19 578 individuals aged 9 months to 65 years against YF.

The vaccination campaign follows the declaration of a yellow fever outbreak on 29 November 2019, where a total of three laboratory confirmed cases with no deaths have been reported after investigations were carried out in Sakure payam.

In December 2018, a team comprising of epidemiologists, a public health officers, entomologists; laboratory specialists as well as risk communication experts carried out detailed epidemiological, laboratory, and entomological investigations to determine the magnitude of the outbreak, identify the vectors, assess the risk of an epidemic, and to initiate control measures to interrupt transmission and prevent further spread of the disease.

The reactive YF vaccination is part of the global strategy to Eliminate Yellow Fever Epidemics (EYE) by 2026, said Dr Olushayo Olu, WHO Representative for South Sudan. It serves to protect high-risk populations against the YF virus in the immediate term and will serve as a bridge towards the introduction of yellow fever vaccine into the routine immunization system in the long term.

YF is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The "yellow" in the name refers to the jaundice that affects some patients. Symptoms of yellow fever include fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue. A small proportion of patients who contract the virus develop severe symptoms and approximately half of those die within 7 to 10 days.

YF has an incubation period of 3-6 days following infection. Many people do not experience symptoms, but when these do occur, the most common are fever, muscle pain with prominent backache, headache, loss of appetite, and nausea or vomiting. In most cases, symptoms disappear after 3 to 4 days.

South Sudan last experienced a yellow fever outbreak in May 2003, in Imatong region of Torit County, with a total of 178 cases with 27 deaths (CFR 15%) in Imatong and Ikotos districts, Torit County.

With funding from Gavi, the Vaccine Alliance, European Union Humanitarian Aid (ECHO) and the United States Agency for International Development (USAID), South Sudan secured a total of 21 800 doses from the Global emergency yellow fever vaccine stockpile of the International Coordination Group (ICG) on vaccine provision.

For Additional Information or to Request Interviews, Please contact:

Dr Wamala Joseph Francis
Tel : +211923362401
Email: wamalaj@who.int

Dr Victor Guma Paul
Tel: +211 922 555 222
Email: vpaul@who.int

Dr Sylvester Maleghemi
Tel: +211 956 779 467
Email: maleghemis@who.int
Ms Jemila M. Ebrahim

Communications Officer
Mobile: +211 921 647 859
Email: ebrahimj@who.int